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PSYCHIATRY > Clinical Aspects of Dementia > Flashcards

Clinical Aspects of Dementia Flashcards

1
Q

What is dementia?

A

Progressive global cognitive decline
Irreversible
Associated decline in functioning

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2
Q

Dementia diagnosis rates have increased in Scotland in recent years. TRUE/FALSE?

A

TRUE

  • national push for more patients to get their diagnosis (targets)
  • Diagnosis of Dementia will continue to increase due to ageing population
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3
Q

Prevalence of dementia increases after what age?

A

65 years (this then counts as “older adults”

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4
Q

Why is it important to know how may patients suffer from dementia in Scotland?

A

Helps budget for their care

Larger push towards developing new treatment if more patients suffering

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5
Q

Why is post diagnostic support important after a diagnosis of dementia?

A
  • often a time of uncertainty
  • Advance planning should be encouraged while patients have the capacity
  • counselling may be required
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6
Q

What advance planning mechanisms should be considered when patients are given a dementia diagnosis?

A
  • practical and legal advice (i.e Powers of Attorney, guardianship (if lacking capacity)
  • driving - inform DVLA
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7
Q

Explain why dementia causes strain on the NHS in terms of finances and hospital beds.

A
  • using up to ¼ of hospital beds
  • stay longer in hospital than other
  • 1/3 go into hospital from own homes but are discharged to a care home
  • Supporting people with dementia to leave hospital one week sooner would save least £80 million a year
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8
Q

How is dementia clinically diagnosed?

A
  • Hx consistent with global cognitive decline over months/years
  • Cognitive testing consistent with Hx
  • Decline in level of function
  • No evidence of reversible cause
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9
Q

What cognitive testing is usually offered for patients who present with memory loss?

A

Addenbrookes Cognitive Assessment (ACE-III)
Montreal Cognitive Assessment
Frontal Assessment Battery (FAB)
Detailed neuropsychological testing

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10
Q

How do patients with memory loss usually present to the GP?

A
  • rarely present themself

- usually brought by a spouse OR an older child

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11
Q

What symptoms are first noticed by patients themselves in relation to memory loss?

A

Short term memory loss

Word finding difficulties

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12
Q

What do patients often blame their memory loss symptoms on?

A

Sensory impairments - e.g. poor eyesight, poor hearing

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13
Q

What can potentially affect a patient’s performance in an Addenbrooke’s assessment?

A

Low IQ
Sensory impairment
depression
Anxiety when in clinic

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14
Q

When is the Montreal Cognitive Assessment used?

A

Smaller than addenbrooke’s
=> often used if patient may not be able to tolerate full addenbrooke’s test

  • available in other languages => useful if patient does not use English as first language and requires an interpreter
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15
Q

When would a Frontal Assessment Battery be used?

A

If suspicious of FTD or to test for decline in executive function (as Addenbrooke’s and MoCA dont test these well)

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16
Q

What questionnaire is used to provide a collateral history and compare the patients function NOW to their function 10 years ago?

A

Short IQCODE

16 Qs

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17
Q

What is involved in an OT assessment for Dementia and where is it carried out?

A

Observation of activities- washing, dressing, using a phone, shopping, making toast, travelling.

Carried out in assessment “kitchen” i.e. an unfamiliar environment

Estimates cognitive level and level of supervision required for daily living

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18
Q

Give examples of the reversible causes of cognitive impairment?

A 
Delirium
Alcohol
Thyroid/metabolic disorders
Depression
Brain lesion
Neuro infections/inflammation
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19
Q

What is mild cognitive impairment?

A
  • Noticeable cognitive impairment

- Little deterioration of function

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20
Q

How much do patients with a Mild Cognitive Impairment usually score on the ACE-III or MoCA?

A

ACE-III usually 75-90

MoCA usually 24-26

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21
Q

If a patient is found to have mild cognitive impairment, how often should cognitive testing be repeated?

A

Yearly

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22
Q

What is meant by subjective cognitive impairment?

A
  • Patient thinks they are cognitively impaired
  • cognitive testing and function = NORMAL
  • associated with anxiety/depression/stress
  • often have a relative or friend with dementia
  • Vicious cycle of increasing anxiety about memory =>
    causing more memory lapses
23
Q

Who usually refers patients with dementia to old age psychiatry?

A

GP
Medicine for the elderly
Neurology
Other general hospital clinic

24
Q

What should be involved in giving a dementia diagnosis?

A
  • Ask patient if they want to bring relative/friend to appointment
  • Allow adequate time
  • What do they already know? Do they remember cognitive testing?
  • What do they want to know?
  • Clear explanation of condition
  • How do they feel?
  • Address specific concerns - e.g. admission/ nursing home etc
25
Q

What are the main clinical features of Alzheimer’s Dementia?

A

Memory loss particularly short term
Dysphasia
Dyspraxia
Agnosia

26
Q

Scans are not diagnostic, but what may appear on a CT/MRI of a patient with Alzheimer’s?

A

CT/MRI may be normal,

OR medial temporal lobe atrophy or temporoparietal atrophy

27
Q

What variants of Alzheimer’s dementia are known to exist?

A

Frontal

Posterior cortical atrophy

28
Q

What are the main clinical features of vascular dementia?

A

Dysphasia
dyscalculia
frontal lobe symptoms
affective symptoms more common than in Alzheimers

May ALSO have:

  • focal neurological signs
  • vascular risk factors
  • step wise decline
29
Q

What do CT/MRI and SPECT scans usually show in vascular dementia?

A

CT/MRI = moderate-severe small vessel disease or multiple lacunar infarcts

SPECT- patchy reduction in tracer uptake throughout brain

30
Q

What are the 3 main syndromes of Frontotemporal dementia?

A

Behavioural variant- behavioural changes, executive dysfunction, disinhibition, impulsivity, loss of social skills,

Primary progressive aphasia- effortful non-fluent speech, speech sound/articulatory errors,

Semantic dementia- impaired understanding of words, fluent but empty speech, difficulty retrieving names

31
Q

How does Frontotemporal dementia appear on CT/MRI or SPECT scans?

A

CT/MRI- frontotemporal atrophy

SPECT- frontotemporal reduction in tracer uptake

32
Q

What is the criteria for a diagnosis of Dementia with Lewy Bodies?

A

Early reduced attention, executive function and visuospatial skills

AND Two of:

  • Visual hallucinations
  • Fluctuating cognition (delirium-like)
  • REM sleep behaviour disorder
  • Parkinsonism
  • Positive DAT scan
33
Q

What is the difference between Dementia with Lewy Bodies and a diagnosis of Parkinson’s Disease Dementia?

A

Must have parkinsonism for at least 1 year prior to onset of dementia
=> Parkinsons dementia NOT Dementia with Lewy Bodies

34
Q

What imaging may be used in a patient with a suspected dementia?

A

CT
MRI
Single Photon Emission CT
DaT (Dopamine Active Transporter) Scan

35
Q

CT is used to exclude what organic causes of cognitive decline?

A

tumour
bleed
stroke

36
Q

When is MRI typically used to investigate a dementia?

A

if <70
Fast progression
Atypical features

37
Q

What is SPECT useful for?

A

Differentiating types of dementia

especially Frontotemporal Dementia

38
Q

A DaT scan is used to indicate what types of dementia?

A

Dementia with Lewy Bodies

Parkinson’s Dementia

39
Q

What cholinesterase inhibitor is licensed for the treatment of dementia with Lewy Bodies and Parkinson’s dementia?

A

Rivastigmine

40
Q

What are the usual side effects of cholinesterase inhbitors?

A

Nausea and diarrhoea

these usually subside after 2 weeks

41
Q

When is memantine used?

A

Moderate alzheimer’s dementia

can be used earlier to prevent further decline

42
Q

Why is it important to monitor BP in memantine use?

A

Can increase blood pressure

43
Q

Who makes up the informal carers who help dementia patients?

A

60% spouses

30% older children

44
Q

What can be used to test if patients with dementia are competent to drive?

A
  • Score >70 on Addenbrookes
  • Rockwood driving battery (tests divided attention/ visuospatial function)
  • On road driving test
45
Q

What cholinesterase inhibitors are licensed for use in ALzheimers dementia?

A

donepezil
Rivastigmine
Galantamine

46
Q

When are cholinesterase inhibitors contraindicated?

A

active peptic ulcer

severe asthma/COPD

47
Q

What other function does memantine have other than slowing dementia decline?

A

prevents behavioural and psychological symptoms

48
Q

What household items can be made more dementia-friendly for patients?

A

Clock - digital, morning/afternoon etc, reminders to take tablets
Phone - large numbers or even photos on phone handset
Signposting - made obvious
Clear kitchen cupboards
GPS

49
Q

What are the most common behavioural and psychological symptoms associated with dementia?

A 
Hallucinations/Delusions
Insomnia
Anxiety
Disinhibition
Agitation
Aggression
Depression
50
Q

What non-pharmacological management should be used for patients initially in dementia?

A 
Review physical symptoms
Consider medication side effects 
sensory aids
Environment
Activities
Exercise
Sleep hygiene
51
Q

What short term treatments can be used to restore circadian rhythm in dementia patients suffering from insomnia?

A

melatonin
Z drugs
benzodiazepines
sedating antidepressants

52
Q

What drugs can be used for agitation and aggression in patients with dementia?

A 
benzodiazepines
antipsychotics
sedating antidepressants
cholinesterase inhibitors
memantine
pregabalin
53
Q

What drugs can be used for visual hallucinations in dementia?

A

cholinesterase inhibitors

antipsychotics (BE AWARE OF USING THESE IN LEWY BODY)

PSYCHIATRY (35 decks)

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