Clinical Aspects of Dementia Flashcards
(53 cards)
What is dementia?
Progressive global cognitive decline
Irreversible
Associated decline in functioning
Dementia diagnosis rates have increased in Scotland in recent years. TRUE/FALSE?
TRUE
- national push for more patients to get their diagnosis (targets)
- Diagnosis of Dementia will continue to increase due to ageing population
Prevalence of dementia increases after what age?
65 years (this then counts as “older adults”
Why is it important to know how may patients suffer from dementia in Scotland?
Helps budget for their care
Larger push towards developing new treatment if more patients suffering
Why is post diagnostic support important after a diagnosis of dementia?
- often a time of uncertainty
- Advance planning should be encouraged while patients have the capacity
- counselling may be required
What advance planning mechanisms should be considered when patients are given a dementia diagnosis?
- practical and legal advice (i.e Powers of Attorney, guardianship (if lacking capacity)
- driving - inform DVLA
Explain why dementia causes strain on the NHS in terms of finances and hospital beds.
- 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
How is dementia clinically diagnosed?
- Hx consistent with global cognitive decline over months/years
- Cognitive testing consistent with Hx
- Decline in level of function
- No evidence of reversible cause
What cognitive testing is usually offered for patients who present with memory loss?
Addenbrookes Cognitive Assessment (ACE-III)
Montreal Cognitive Assessment
Frontal Assessment Battery (FAB)
Detailed neuropsychological testing
How do patients with memory loss usually present to the GP?
- rarely present themself
- usually brought by a spouse OR an older child
What symptoms are first noticed by patients themselves in relation to memory loss?
Short term memory loss
Word finding difficulties
What do patients often blame their memory loss symptoms on?
Sensory impairments - e.g. poor eyesight, poor hearing
What can potentially affect a patient’s performance in an Addenbrooke’s assessment?
Low IQ
Sensory impairment
depression
Anxiety when in clinic
When is the Montreal Cognitive Assessment used?
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
When would a Frontal Assessment Battery be used?
If suspicious of FTD or to test for decline in executive function (as Addenbrooke’s and MoCA dont test these well)
What questionnaire is used to provide a collateral history and compare the patients function NOW to their function 10 years ago?
Short IQCODE
16 Qs
What is involved in an OT assessment for Dementia and where is it carried out?
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
Give examples of the reversible causes of cognitive impairment?
Delirium Alcohol Thyroid/metabolic disorders Depression Brain lesion Neuro infections/inflammation
What is mild cognitive impairment?
- Noticeable cognitive impairment
- Little deterioration of function
How much do patients with a Mild Cognitive Impairment usually score on the ACE-III or MoCA?
ACE-III usually 75-90
MoCA usually 24-26
If a patient is found to have mild cognitive impairment, how often should cognitive testing be repeated?
Yearly
What is meant by subjective cognitive impairment?
- 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
Who usually refers patients with dementia to old age psychiatry?
GP
Medicine for the elderly
Neurology
Other general hospital clinic
What should be involved in giving a dementia diagnosis?
- 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
