Case 4 - Dementia Flashcards
(32 cards)
What is dementia?
Dementia is a syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.
What can cause dementia?
Dementia results from a variety of diseases and injuries that primarily or secondarily affect the brain, such as Alzheimer’s disease or stroke.
What symptoms characterise early stage dementia?
Early stage: the early stage of dementia is often overlooked, because the onset is gradual. Common symptoms include:
1) Forgetfulness
2) Losing track of the time
3) Becoming lost in familiar places
What symptoms characterise middle stage dementia?
Middle stage: as dementia progresses to the middle stage, the signs and symptoms become clearer and more restricting. These include:
1) Becoming forgetful of recent events and people’s names
2) Becoming lost at home
3) Having increasing difficulty with communication
4) Needing help with personal care
5) Experiencing behaviour changes, including wandering and repeated questioning
What symptoms characterise late stage dementia?
Late stage: the late stage of dementia is one of near total dependence and inactivity. Memory disturbances are serious and the physical signs and symptoms become more obvious. Symptoms include:
1) Becoming unaware of the time and place
2) Having difficulty recognizing relatives and friends
3) Having an increasing need for assisted self-care
4) Having difficulty walking
5) Experiencing behaviour changes that may escalate and include aggression (NICE suggests using ‘anti-psychotic’ drugs sparingly and only fit a short time)
What are the different forms of dementia?
There are many different forms of dementia and the boundaries between them are indistinct, so mixed forms often co-exist.
1) Alzheimer’s disease is the most common form (contributes to 60–70% of cases)
2) Vascular dementia
3) Dementia with Lewy bodies (abnormal aggregates of protein that develop inside nerve cells)
4) A group of diseases that contribute to frontotemporal dementia (degeneration of the frontal lobe of the brain)
How many people worldwide suffer from dementia?
Worldwide, around 50 million people have dementia, with nearly 60% living in low- and middle-income countries. Every year, there are nearly 10 million new cases.
What is the proportion of the population over 60 with dementia?
The estimated proportion of the general population aged 60 and over with dementia at a given time is between 5-8%.
How are dementia numbers projected to change in the future?
The total number of people with dementia is projected to reach 82 million in 2030 and 152 in 2050. Much of this increase is attributable to the rising numbers of people with dementia living in low- and middle-income countries.
Can dementia be treated?
There is no treatment currently available to cure dementia or to alter its progressive course. Numerous new treatments are being investigated in various stages of clinical trials.
What dementia support exists?
A lot can be offered to support and improve the lives of people with dementia and their carers and families. The principal goals for dementia care are:
1) Early diagnosis in order to promote early and optimal management
2) Optimising physical health, cognition, activity and well-being
3) Identifying and treating accompanying physical illness
4) Detecting and treating challenging behavioural and psychological symptoms
5) Providing information and long-term support to carers.
What are the risk factors of dementia?
1) Age is the strongest known risk factor for dementia, but young onset dementia (the onset of symptoms before the age of 65 years) accounts for up to 9% of cases.
2) Lack of regular exercise (0.5-1 hour, 3-5 times a week)
4) Smoking and harmful use of alcohol
5) Obesity and an unhealthy diet
6) Poorly maintained blood pressure (blood pressure medication has been shown to decrease cognitive decline), cholesterol and blood sugar levels
7) Mental health issues such as depression and social isolation (anti-depressants and social support could be useful)
8) Low educational attainment and cognitive inactivity
What is mild cognitive impairment (MCI)?
Mild cognitive impairment (MCI) is a condition causing minor problems with cognition - mental abilities such as memory or thinking. In MCI these difficulties are worse than would normally be expected for a healthy person of their age. However, the symptoms are not severe enough to interfere significantly with daily life, and so are not defined as dementia.
What proportion of the population over 65 suffer from mild cognitive impairment?
It is estimated that between 5 and 20% of people aged over 65 have MCI. It is not a type of dementia, but a person with MCI is more likely to go on to develop dementia. There is a lot that someone can do to help reduce their chances of MCI progressing to dementia.
What are the symptoms of mild cognitive impairment?
A person with MCI has mild problems with one or more of the following:
1) Memory: forgetting recent events or repeating the same question
2) reasoning, planning or problem-solving: struggling with thinking things through
3) Attention: being very easily distracted
4) Language: taking much longer than usual to find the right word for something
5) Visual depth perception: struggling to interpret an object in three dimensions, judge distances or navigate stairs
How can MCI be tested?
Tests of mental abilities can be taken, and problems would be shown by a low test score or by falling test scores over time. This decline in mental abilities is often caused by an underlying illness.
What are the 3 forms of cognitive intervention?
1) Cognitive stimulation: comprises involvement in group activities that are designed to cognitive and social function in a nonspecific manner.
2) Cognitive training: this is the most widely used intervention as it is a more specific approach, which teaches theoretically supported strategies and skills to optimise specific cognitive functions.
3) Cognitive rehabilitation: involves and individualised approach using tailored programs centred on specific activities in daily life. Personally relevant goals are identified, and the therapist, patient and family work together to achieve these goals (e.g. joining a social group).
What other therapies have been found useful in combatting cognitive decline?
1) Reminiscence therapy: encouraging patients to think or talk about significant events that occurred in the past.
2) Art and dance therapies: cognitively stimulating activities that improve well being.
3) Music therapy: used to improve apathy, depression, irritability, agitation and anxiety, euphoria, hallucinations and inhibition.
Define multidisciplinary team (MDT)
This refers to a combination of professionals from a variety of clinical backgrounds and with specific expertise, that work together to optimise a patient’s care. Multidisciplinary team meetings (MDM) refers to a meeting between the different specialities to plan the best care for a patient.
Outline the MDT composition for a patient suffering from dementia
Core: consultant in old-age psychiatry, several specialist nurses (CPNs and/or Community Matrons), advanced Practice Nurse, dementia social worker, carer
Additional team: GPS, social workers, OTs, physiotherapist, voluntary services
How does Alzheimer’s develop?
Alzheimer’s often develops slowly over several years, so symptoms are not always obvious at first. A loss of interest and enjoyment in day-to-day activities can often be one of the first changes, but this can be subtle and may be mistaken for other conditions such as depression. In the early stages of the disease, it can also be difficult to distinguish memory problems associated with Alzheimer’s from mild forgetfulness that can be seen in normal ageing.
What are the typical early symptoms of Alzheimer’s?
1) Memory problems (e.g. forgetting recent events, names and faces).
2) Becoming increasingly repetitive (e.g. repeating questions after a very short interval or repeating behaviours and routines).
3) Regularly misplacing items or putting them in odd places.
4) Confusion about the date or time of day.
5) Uncertainty of whereabouts or getting lost, particularly in unfamiliar places.
6) Problems communicating or finding the right words.
7) Becoming low in mood, anxious or irritable. Also, losing self-confidence or showing less interest in what’s happening around them.
What are the symptoms associated with Alzheimer’s progression?
1) Memory and thinking skills, remembering thinking and making decisions worsens.
2) Communication and language become more difficult.
3) Difficulty recognising household objects or familiar faces.
4) Carrying out day-to-day tasks becomes harder (e.g. using a TV remote control, phone or kitchen appliance). May also have difficulty locating objects in front of them.
5) Changes in sleep patterns often occur.
6) Becoming sad, depressed or frustrated about the challenges they face. Experience anxieties seeking extra reassurance or become fearful or suspicious.
7) Problems walking, being unsteady on their feet, finding swallowing food more difficult or having seizures.
8) Experiencing hallucinations or delusions.
9) Requiring more help with daily activities like dressing, eating and using the toilet.
How does vascular dementia develop?
The symptoms of vascular dementia get worse over time. This can take several years, but the speed of change can vary over time and from person to person. There may be a sudden change after an event such as a stroke.
