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BDS3 Special Care Dentistry > Dementia > Flashcards

Dementia Flashcards

1
Q

What tasks do people struggle with as they get older?

A

Mobility:

  • Stairs
  • Getting to the shops
  • Some people will only use the lower level of their home

Dexterity:

  • making a cup of tea - holding the kettle can become dangerous
  • brushing teeth can become difficult

Communication:

  • sight and hearing deterioration
  • can lead to social isolation
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2
Q

What are some examples of medical diseases that increase in the older population?

A
  • Musculoskeletal – Arthritis, Osteoporosis, gout, fractures
  • Diabetes, Hormonal dysfunction
  • Cognitive Impairment and Visual conditions
  • Hearing conditions
  • Cardiovascular conditions
  • GI condition
  • Malignancy
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3
Q

What are some things that older people value?

A

Company and relationships

Time

A desire to contribute to society

Someone listening

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4
Q

What is dementia?

A
  • A chronic syndrome that is of progressive nature (keeps getting worse)
  • an acquired progressive loss of cognitive functions (i.e. the ability to process thought), intellectual and social abilities
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5
Q

What cognitive functions does dementia affect?

A 
Memory
Thinking
Orientation
Comprehension
Calculation 
Learning capacity
Language
Judgement
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6
Q

What is dementia characterised by?

A
  • Amnesia (especially for recent events) [memory loss]
  • Inability to concentrate,
  • Disorientation in time, place or person,
  • Intellectual impairment
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7
Q

What are some examples of things that a patient with dementia will have problems with?

A
  • Day-to-daymemory- difficulty recalling events that happened recently

Concentrating, planning or organising - difficulties making decisions, solving problems or carrying out a sequence of tasks (eg cooking a meal)

Language - difficulties following a conversation or finding the right word for something

Visuospatial skills - problems judging distances (eg on stairs) and seeing objects in three dimensions

  • Orientation - losing track of the day or date, or becoming confused about where they are.
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8
Q

Is the consciousness of a patient with dementia affected?

A

no (they always have some awareness)

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9
Q

What are the 4 more common forms of dementia?

A
  • Alzheimer’s
  • Vascular dementia
  • Dementia with Lewy Bodies
  • Frontotemporal dementia
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10
Q

What are some rarer forms of dementia?

A
  • HIV – related genitive impairment
  • Parkinson’s disease
  • Corticobasal degeneration
  • Multiple Sclerosis
  • Niemann-Pick disease
  • Creutzfeldt-Jakob disease
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11
Q

Give a brief aetiology of Alzheimer’s.

A
  • Reduction size of the Cortex, severe in hippocampus
  • Plaquesare deposits of a protein fragment called beta-amyloid that build up in the spaces between nerve cells. (results in loss of brain function)
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12
Q

What are the distinctive features of Alzheimer’s?

A
  • short-term memory loss
  • aphasia
  • communication difficulties
  • muddles over everyday activities
  • mood swings
  • withdrawn
  • loss of confidence
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13
Q

What are some risk factors/associated factors related to Alzheimer’s?

A

-increased age
-gender (woman>men)
-Head injury
-lifestyle: Increased risk = Smoking, hypertension, low folate and high blood cholesterol
Reducing risk = physical, mental and social activities
-genetic factor (abnormalities on chromosome 1, 14 or 21

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14
Q

What is vascular dementia caused by?

A

caused by reduced blood flow to the brain, which damages and eventually kills the brain cells

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15
Q

What can cause the reduced blood flow in the brain that leads to vascular dementia?

A
  • narrowing and blockage of small blood vessels deep inside the brain
  • a single large stroke
  • lots of mini strokes that cause tiny, but widespread, damage to the brain
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16
Q

What are distinctive features of vascular dementia?

A

Memory problem of sudden onset

  • visuospatial difficulties
  • anxiety
  • delusions
  • seizures
17
Q

Describe the aetiology of Dementia with Lewy Bodies.

A

-there are deposits of anabnormal protein called Lewy bodies inside brain cells.

18
Q

What are some distinct features of dementia with Lewy bodies?

A
  • STML
  • Cognitive ability fluctuates
  • visuospatial difficulties
  • attentional difficulties
  • overlapping motor disorders
  • speech and swallowing problems
  • sleep disorders
  • delusions
19
Q

What do the frontal lobes of the brain deal with?

A
  • behaviour
  • problem solving
  • planning
  • control of emotions
20
Q

What are some distinctive features of frontotemporal dementia?

A
  • STML not always present
  • uncontrollable repetition of words
  • mutism
  • repetition of words of other people
  • personality change
  • decline in personal and social conduct
21
Q

Compare the cost of dementia in society and the research investment.

A

Costs the UK economy a huge sum of money but has very little funding

22
Q

What are the general risk factors for dementia?

A
  • Age
  • Gender
  • Genetic background
  • Medical history
  • Lifestyle
23
Q

Why should we be aiming to diagnose early?

A

insert flow chart

Is more about increasing the quality of the patients life than the longevity. If diagnosed early have time to have difficult conversations and plan what they want for themselves when they no longer have the capacity.

24
Q

What are the early stage symptoms of dementia?

A

Loss of short-term memory

Confusion, poor judgement, unwilling to make decisions

Anxiety, agitation or distress over perceived changes

Inability to manage everyday tasks.

Communication problems – a decline in ability or interest in talking, reading
and writing.

25
Q

Early stage dementia symptoms are often misattributed to what?

A

stress, bereavement or normal aging

26
Q

What are some middle stage symptoms of dementia?

A

More support required, including reminders to eat, wash, dress and use the lavatory;

Increasingly forgetful and may fail to recognise people;

Distress, aggression, anger, mood changes – frustration;

Risk of wandering and getting lost, leaving taps running, gas unlit, cooking unattended or forgetting to light the gas;

May behave inappropriately e.g. Going out in nightclothes;

May experience hallucinations, throw-back memories.

27
Q

What are some late stage symptoms of dementia?

A

Inability to recognise familiar objects, surroundings or people – but there may be some flashes of recognition.

Increasing physical frailty, may start to shuffle or walk unsteadily, eventually becoming bed/wheelchair confined.

Difficulty eating and sometimes swallowing, weight loss.

Incontinence and gradual loss of speech.

Symptoms are progressive and irreversible.

28
Q

How is dementia diagnosed?

A
  • rule out all treatable causes first

- then neurological examination and detailed cognitive testing (mini mental state exam)

29
Q

What are examples of cognitive testing that can be done?

A

Mini-mental State Examination ( Folstein)

Blessed Dementia Scale

The Montreal Cognitive Assessment (MoCA)

Single Neuropsychological Tests:

Clock draw, Delayed word recall, Category Fluency

Combined single tests

7 minute screen, IQCODE, AD8 Dementia Screening

30
Q

What is the mini mental state exam?

A

Asked to remember 3 words and recall them later on

31
Q

What are the pros of the mini mental state exam (MMSE)?

A
  • well known
  • easy to administer
  • samples range of cognitive functions
  • test-re-test and inter rater availability
32
Q

What are the cons of the MMSE?

A
  • only 3 words to remember (not sensitive to mild impairment)
  • non standardised time between registration and recall
  • not sensitive in testing frontal lobe
33
Q

What is the delayed word recall test?

A

10 words and asked to recall later

easiest to make up a sentence with them

34
Q

What are the treatments available?

A
  • no cure
  • counselling (may delay residential care by up to 1 year)
  • aspirin and reducing cardiac risks (for vascular dementia)
  • NSAIDs (may slow progression)
  • Vit E and Ginko Biolba (may slow progression)
  • anticholinesterases for mild/moderate Alzheimer’s
35
Q

What makes a care home dementia friendly? (6 points)

A

Walls, floor coverings, skirting boards and doors are all different colours – provides good visual contrast to aid wayfinding

Fix labels and images to drawers to help let people find what they need without assistance

A bedroom WC should be visible from the bed on sitting and when lying down

Position personal pictures and items with personal relevance

Radiators should be low temperature heating

Furniture traditional and domestic

36
Q

What things can be done to make a healthcare environment more dementia friendly? (8 points)

A

Reception desk visible from the entrance door

Ceilings, floors and floor coverings should be acoustically absorbent to support audible communication

Colour and tone of walls should be distinctive from the flooring

Colour and tone of furniture should be distinctive from the flooring

Avoid non-essential signs

Any signage should be at eye level with simple clear use of text and colour. Use pictorial elements

Ensure good levels of natural light to minimise artificial light

Any staff only or locked rooms should be coloured the same as the walls to avoid attention

BDS3 Special Care Dentistry (9 decks)

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