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Psychiatry > Dementia > Flashcards

Dementia Flashcards

1
Q

define dementia

A

syndrome of progressive and global intellectula deteriorartion without impairment of consciousness

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2
Q

what is often the first symptom of dementia

A

memory loss

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3
Q

what are the symptoms of dementia for the following domains:
-behaviour 5

A

restless

repititive

purposeless activity

rigid

fixed routines

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4
Q

what are the symptoms of dementia for the following domains:
personality changes 4

A

sexual disinhibition

social gaffes

shoplifitng

blunting

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5
Q

what are the symptoms of dementia for the following domains:
speech 3

A

syntax erros

dysphagia

mutism

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6
Q

what are the symptoms of dementia for the following domains:
thinking 4

A

slow

muddled

poor memory-with confabulation

no insight

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7
Q

what are the symptoms of dementia for the following domains:
perception 2

A

illusions

hallucinations (often visual)

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8
Q

what are the symptoms of dementia for the following domains:
mood 3

A

irritable

depressed

emotional incontinence (labile mood and crying)

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9
Q

state the 4 As of alzheimers

A

amnesia

aphasia

agnosia

apraxia

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10
Q

state irreversible causes of dementia 5

A

alzeihmers

vascular

mixed

lewy body

fronto-temporal

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11
Q

reversible causes of dementia 3

A

subdural haematoma

hydrocephalus

hypothyroidism

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12
Q

risk factors for alzheimers 6

A

increasing age

FHx

inheritied autosomal dominnat trait
-mutation in amyloid precuros protein

apoprotein E allele E4
-encodes cholesterol transport protein

caucasian ehtnicitiy

Downs syndrome

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13
Q

macroscopic patholigcal cahnges in alzheimers 1

A

widespread cerebral atorphy
-particularuly involving cortex and hippocampus

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14
Q

microscopic patholgical changes in alzeihmers 2

A

cortical plaques
-deposition of type A-beta-amyloid protein and intraneuronal neurofibrillary tagles
-caused by aggregation of tau protein

hyperphosphorlyation of tau protein has been linked to AD

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15
Q

biochemical changes in alzheimers 1

A

deficity of acetylcholine form damgaeg to an asceindg forebrain projection

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16
Q

what makes neurofibrillary tangles in alzheimers

A

paired heliclal filaments
-partially made from tau protein

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17
Q

what is the function of tau and how does it change in alzheimers

A

interacts with tublin to stablise microtubules and promote tubulin assembly into microtubles

in AD- tau proteins are excessively phosphorylated impairing its function

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18
Q

non-pharmalogical managemnt of alzheimers 3

A

range of activities to promote wellbeing that are tailored to persons preference

offer group cognitive stimulation for mild/moderate

group reminiscne therapy and cognitive rehabilitation

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19
Q

managemnt for mild to moderate alzheimers (medical) 3

A

acetylcholinesterases inhibiotrs
-donepizil
-galantamine
-rivastigimine

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20
Q

‘second line’ for alzheimers

A

memantine
-NMDA receptor antagonist

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21
Q

when is memantine used 3

A

moderate alzheimers who are intolerant or CI to acetyle choinesterase inhbiotrs

add on drug to `cetylcholinesterase inhibitors for patients with moderate or severe alzheimers

monotherapy in severe alzheimers

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22
Q

use of antidepressants in alzheimers

A

not recommended

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23
Q

use of antipsychotics for alzheimers 2

A

only for patients at risk of harming themselves or others

or
when agitations, hallucinations or delusions are causing them severe distress

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24
Q

when is donepizil CI
-what is a significant adverse affect

A

relatively CI in patients with brady cardia

-adverse affect- insomnia

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25
Q

define vascular dementia

A

not a single disease but group of syndrome sof cogniti e impairment
-caused by ischaemia or haemorrhage secondary to cerebrovascular disease

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26
Q

incidence of vascular dementia

A

17% of UK dementias

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27
Q

how does a stroke affect the risk of developing dementia

A

doubles risk

28
Q

subtypes of vascular dementia 3

A

stroke related
-multi-infarct or single infarct dementia

subcortical
-small vessel disease

mixed dementia
-presecnd of both vascular dementia and alzheimers siease

29
Q

risk factors for vascular dementia 9

A

Hx of stroke or TIA

atrial fibrillation

hypertension

DM

hyperlipidaemia

smoking

obesity

coronary artery disease

FHx of stroke or cardiovascular disease

30
Q

what is the most important, characterisitc presentaiotn of vascular dementia

A

several months or several years of a history of sudden or STEPWISE DETERIORATION of cognitive function

31
Q

other sympotms of vascular dementia 7

A

focal neurological abnormlaites
-visual disturbajce, sensory or motor sympomts

difficulty w attention and concentration

sezirues

memory, gait, speech and emotional distrubances

32
Q

how is diagnosis of vascular dementia made 4

A

comprehensive history and physical examination

formal screen for cognitive impairment (MMSE, Addenbrookes)

medical review to exclude medication cause of cognitive decline

MRI scan- may show infarcts and extensive white matter changes

33
Q

how does NICE recommend diagnosis of vascular dementia is made

A

NINDS-AIREN criteria

34
Q

what does the NINDS-AIREN criteria for vascular dementia include

A

presence of cognitive decline
-interferes w daily living and not due to secondary effects of cerebrovascular event

cerebrovascular disease
-neurological signs and/or brain imaging

relationship between the above 2:
-onset of dementia within 3 months following stroke
-abrupt deterioration in cognitive functions
-fluctuating, stepwise progression of cognitive deficits

35
Q

general managemnt of vascular dementia 2

A

treatment mainly sympotmatic
-aim to addres indiviual problems

detect and address cardiovascular risk factors
-help slow progression

36
Q

non-pharmacological managemnt of vascular dementia 3

A

tailored to individual
-cognitive stimulation programmes
-multisensory stimulation
-music and art
-animal assisted therapy

managing challenging behaviours
-address pain
-avoid overcrowding
-clear communication

37
Q

pharmacolgical managemnt of vascular dementia

A

no specific pharmacoligical treatment approved

no evidece of aspirn or statin effectiveness

38
Q

when would AChE inhibitors or memantine be considered for patients with vascular dementia 3

A

suspected comorbid Alzheimers disease

parkinsons disease dementia

dementia with lewy bodies

39
Q

incidence of lewy body dementia

A

20% of dementia cases

40
Q

characteritisc pathophys of lewy body dementia

A

alpha-synnuclein cytoplasmic inclusions (lewy bodies) in the substantial nigra, paralimbic and neocortical areas

41
Q

what is lewy body dementia related to

A

parkinsons disease (although ocmplicated)

*_also 40% of alzheimers ptx have lewy bodies

42
Q

featutes of lewy body dementia 4

A

progressive cognivtive impairement
-typically before parkinsonism
-but usually both occur within a year of each other

cognition can FLUCTUATE in contrast to other dementias

parkinsonism

visual hallucinations (other delusions/hallucinations may be seen)

43
Q

how do sympotms of lewy body dementia differ to parkinsons

A

in lewy bodies parkinsonism and cognitive impariment typically occur WITHIN A YEAR of each other

in parkinsons -motor symptoms typically present AT LEAST one year before cognitive symptoms

44
Q

how does lewy body dementia contrast to alzheimers

A

lewy body dementia- early attention and executive function loss

alzheimers- early memory loss

45
Q

diagnosis of lewy body dementia 2

A

usually clinical

SPECT-single-photon emission computed tomography
-increasingly used
-radioisotope is used to detect lewy bodies
-V effective

46
Q

managemtn of lewy body dementia

A

AChE inbhiotrs and memantine as used in alzheimers

47
Q

what should be avoided in lewy body dementia

A

neuroleptics should be avoided as patients are extremely sensitive and may develop irreversible parkinsonism

48
Q

subtypes of frontotemporal lobar degeneration 3

A

frontotemporal dementia (picks disease)

progressive non fluent aphasia (chornic progressive aphasia CPA)

semantic dementia

49
Q

common features of frontotemporal dementias 4

A

onset before 65

insidious onset

relatively preserved memory and visuospatial skills

personality change and social conduct problems

50
Q

most common type of frontotemporal dementia

A

Picks disease (frontotemporal dementia)

51
Q

what is picks disease characterised by 2

A

personality changes and impaired sociaal conduct

52
Q

other common featutes of picks disease 4

A

hyperorality (compulsive need ot place both edilbe and inedible objects in ones mouth)

disinhibition

increased appetite

perseveration behaviours

53
Q

what is characterisitc of picks disease on imaging

A

focal gyral atrophy with kinfe-blade. appearance

54
Q

macrosocpic changes of picks disease 1

A

atophy of frontal and temporal lobes

55
Q

microscopic changes of picks diseae

A

pick bodies
-spherical aggregatiosn of tau proteins (silver-staining)

gliosis

neurofibrillary tangles

senile plaques

56
Q

managemnt of picks disease

A

AChE inhibotrs or memantine not recommneded with frontotemporal dementia

57
Q

chief factor of chronic progressive aphasia

A

non fluent speech
-short utterances that are agrammatic

comprehension relatively preserved

58
Q

characteriscs of semantic dementia

A

fluent progressive aphasia

speech is fluent but empty and conveys little meaning

memory is better for recent rather than remote events (unlike Alzheimers)

59
Q

cognitive function tests 4

A

TYM test (test your memory)

MMSE

Montreal cognitive assessment (MOCA)

Addenbrookes

60
Q

frontal lobe funciton test

A

frontal assessment battery
-beside test help discriminate frontotemporal type dementia from others

61
Q

key princiopels of teh mental capcity act 5

A

A person must be assumed to have capacity unless it is established that he lacks capacity

A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success

A person is not to be treated as unable to make a
decision merely because he makes an unwise decision

An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests

Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action

62
Q

assessment of capacity

A

He or she has an ‘impairment of, or disturbance in, the functioning of the mind or
brain’ whether permanent or temporary AND

  1. He or she is unable to undertake any of the following
    a. understand the information relevant to the decision
    b. retain that information
    c. use or weigh that information as part of the process of making the decision
    d. communicate the decision made by talking, sign language or other means
63
Q

what should be considered when assessing someones best interests 4

A
  1. Whether the person is likely to regain capacity and can the decision wait.
  2. How to encourage and optimise the participation of the person in the decision.
  3. The past and present wishes, feelings, beliefs, values of the person and any other relevant factors
  4. Views of other relevant people
64
Q

what does a lasting power of attorney do

A

allows a person to act on the patients behalf
and
-proprery andfinancial affairs
-health and welfare decisions

only has otherity to make decision about life-sustaing treatment

65
Q

define advance decisoins

A

Advance decisions can be drawn up by anybody with capacity to specify treatments they would not want if they lost capacity. They may be made verbally unless they specify refusing life-sustaining treatment (e.g. Ventilation) in which case they need to be written, signed and witnessed to be valid. Advance decisions cannot demand treatment

Psychiatry (21 decks)

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