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4th Year - Module 7 > Special Care > Flashcards

Special Care Flashcards

1
Q

What are three criteria for valid consent?

A

1) informed
2) given freely
3) capable patient

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2
Q

What is the acronym for what qualifies as incapacity?

A

AMCUR

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3
Q

What does the A in AMCUR mean?

A

ACTING

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4
Q

What does the M in AMCUR mean?

A

MAKING a decision

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5
Q

What does the C in AMCUR mean?

A

COMMUNICATING a decision

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6
Q

What does the U in AMCUR mean?

A

Understanding a decision

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7
Q

What does the R in AMCUR mean?

A

RETAINING memory of the decision or consistency

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8
Q

In the adults with incapacity act 2000, who are the 5 criteria of incapacity relevant to?

A

in relation to any particular matter due to mental disorder or an inability to communicate

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9
Q

Can a patient be rendered “incapable” without medical diagnosis of a condition?

A

no

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10
Q

How do you assess incapacity?

A
  • know the definition (AMCUR)
  • apply it to the patient
  • use the definition as a framework
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11
Q

How do you check a patient has understood and has the capacity to consent?

A
  • open questions
  • chunk and check
  • teach back
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12
Q

What act applies if a person lacks capacity to consent to dental treatment?

A

Adults with incapacity (Scotland) Act 2000

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13
Q

At what age is capacity no longer a responsibility of a parent?

A

16 in scotland

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14
Q

Is capacity “all or nothing”?

A

No, it is action or decision specific

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15
Q

What are the 5 key principles of capacity?

A

1) BENEFIT
2) LEAST restrictive of freedom
3) the person’s past and present WISHES should be taken into account
4) CONSULT relevant others
5) encourage RESIDUAL capacity

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16
Q

What is the definition of dementia?

A

general term for loss of memory , language, problem solving and other thinking abilities that are severe enough to interfere with daily life

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17
Q

Is dementia a natural part of ageing?

A

no

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18
Q

What is the likelihood of developing dementia in people >65?

A

1 in 3 people >65 will develop dementia

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19
Q

What is the prevalence of dementia in people >80?

A

1 in 6 people have dementia

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20
Q

What are 8 risk factors for dementia?

A

1) age
2) gender
3) ethnicity
4) genetics
5) down syndrome
6) medical factors
7) lifestyle factors
8) head injuries

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21
Q

What 5 medical factors can increase the risk of dementia?

A

1) type II diabetes
2) hypertension
3) high cholesterol
4) obesity
5) depression

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22
Q

What are 3 examples of lifestyle factors that can increase dementia risk?

A

1) smoking
2) alcohol
3) diet

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23
Q

What specific form of dementia can be associated with head injuries in sports?

A

chronic traumatic encephalopathy

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24
Q

How can people reduce the risk factors for dementia?

A

1) be physically active
2) stop smoking
3) eat healthily
4) healthy weight
5) reduce alcohol consumption
6) keep mentally active
7) be social

25
Q

What are 5 different types of dementia?

A

1) Alzheimer’s disease
2) Vascular
3) Mixed
4) Lewy-Body
5) Fronto-temporal

26
Q

What percentage of dementia does Alzheimer’s disease account for?

A

62%

27
Q

How does Alzheimer’s disease present?

A

presents as short term memory loss and word finding difficulties

28
Q

What are the biological changes seen in Alzheimer’s disease?

A
  • amyloid plaques
  • tangles - tau protein
  • loss of connections between neurons
  • decrease in acetylcholine
  • brain becomes smaller and shrivelled
29
Q

What infections can be connected to Alzheimer’s?

A

1) oral herpes
2) pneumonia
3) spirochete bacteria

30
Q

Is there an association between periodontal disease and Alzheimer’s?

A

yes. gingivitis more common among patients with Alzheimer’s

31
Q

What proportion of dementia does vascular dementia account for?

A

17%

32
Q

What is vascular dementia caused by?

A

reduced blood flow to the brain.
Often diagnosed after a stroke or series of TIAs

33
Q

What proportion of dementia does mixed dementia account for?

A

10%

34
Q

What proportion of dementia does Lewi-Body dementia account for?

A

4% cases

35
Q

What are Lewy bodies?

A

small deposits of protein in nerve cells

36
Q

What kind of problems can be caused with Lewy body dementia?

A
  • problems with thinking, movement, behaviour and mood
  • unpredictable changes in attention/alertness
  • visual hallucinations
  • disturbed sleep
37
Q

What can Lewy body dementia sometimes be associated with?

A

Parkinson’s disease

38
Q

What kind of population does fronto-temporal dementia tend to affect?

A

generally effects people slightly younger
symptoms in 6th decade

39
Q

In what decade of life do symptoms of fronts-temporal dementia generally present?

A

6th decade

40
Q

What are the early features of fronts-temporal dementia?

A

personality change
challenging behaviour as distribution

41
Q

How can fronto-temporal dementia present?

A

short temperedness, aggression, mood swings and sexually inappropriate behaviour

42
Q

How is dementia diagnosed?

A
  • attendance at GP
    -taking personal and MH
  • physical exam and other appropriate investigations (bloods, urine, ECG)
  • review of medication that may be adversely affecting cognitive function
  • check mental abilities
43
Q

What does the MMSE assess and what does it stand for?

A

-Mini mental state exam
- short and long term memory
- attention span
- concentration
- language and communication skills
- ability to plan
- ability to understand instructions

44
Q

What kind of referral can be done for a suspected dementia patient?

A
  • refer to a specialist dementia diagnostic service - memory clinic, old age psychiatry, geriatrician
45
Q

What are the treatment options for dementia?

A
  • no cure
  • talking therapies/counselling
  • reducing cardiac risks may halt deterioration of vascular type dementias
  • NSAIDs may slow progression
  • drug treatment for Alzheimer’s
  • alternative therapies
46
Q

What are the four licensed drugs for Alzheimer’s disease?

A

1) donepezil (mild to mod)
2) galantamine (mild to mod)
3) rivastigmine (mild to mod)
4) memantine (blocks effects of glutamate)

47
Q

What do the symptoms of dementia depend on?

A
  • every person experiences dementia differently
  • depends on how and what parts of the brain are affected
48
Q

What are the three stages of progression of dementia?

A

1) early
2) middle
3) late

49
Q

What are the characteristics of early stage dementia?

A
  • changes in ability/behaviour may be minor
  • often misattributed to stress/bereavement/normal ageing
  • loss of short term memory
  • confusion, poor judgement, unwilling to make decisions
  • anxiety, agitation
  • inability to manage everyday tasks
  • communication problems
50
Q

How can the dental team recognise early dementia?

A
  • forgotten appointments
  • difficulty making decisions
  • deterioration in OH
  • forgotten conversations
  • repetition
  • confusion in grasping new ideas
51
Q

What are the characteristics of middle stage dementia?

A
  • more support needed in day to day life - reminders to eat/wash/dress/go to the toilet
  • increasingly forgetful and may fail to recognise people
  • distress, anger, mood changes
  • risk of wandering/getting lost
  • may behave inappropriately e.g. go out in pyjamas
  • may experience hallucinations, throw-back memories
52
Q

What dental aspects may we notice in patients with middle stage dementia?

A

confusion/agitation
may not recognise dental team
repeatedly ask same question

53
Q

What may be required in relation to appointments for dementia patients?

A
  • helpful to bring someone with them
  • what time of day is best?
  • longer appointments
  • assess capacity/consent
54
Q

What aspects of treatment planning are important in dementia patients?

A
  • OH
  • reliance on others
  • polypharmacy
  • dentures
  • plan for future
  • simple treatment plans
  • prevention !
    consent
55
Q

How does dementia impact cooperation for treatment?

A
  • declines as dementia progresses
  • early stages - behavioural management
  • sedation, GA
  • take into account age, frailty and co-morbidities
  • evidence to suggest dementia can worsen following GA
56
Q

What are the characteristics of late stage dementia?

A
  • increasingly dependent on others for their care
  • inability to recognise familiar objects, surroundings or people (may be some flashes of recognition)
  • increased physical frailty - eventually confined to wheelchair or bed
  • difficulty eating or swallowing
57
Q

In what dental scenario could you be treating a late stage dementia patient in?

A
  • emergency treatment
58
Q

How can you tell if a dementia patient has dental problems?

A
  • refusal to eat (particularly hard or cold foods)
  • frequent pulling at face or mouth
  • leaving previously worn denture out
  • increased restlessness

4th Year - Module 7 (16 decks)

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