Cognitive Impairment CSI Flashcards
(37 cards)
What are the symptoms of dementia
Memory disorders, personality change, personal care deterioration, impaired reasoning, disorientation, deterioration in emotional control, social behaviour and motivation
What can reduce the risk of developing dementia
Physical activity (as reduces risk of stroke and heart disease)
Mediterranean diet (antioxidants red. Damage to cerebral neurones and reduce b-amyloid plaques)
Not smoking
Not drinking to excess
Remaining socially active
Cognitive stimulation
Prompt treatment of infections and depression
What is the 6CIT
Six item Cognitive Impairment Test is a screening test for cognitive impairment and dementia.
Simple and quick
0-7= normal
8-9= mild cognitive impairment
10-28= severe cognitive impairment (refer)
What do each of the 6CIT questions test for
Orientation: Q1,2,4
Attention: Q5,6
Short term memory: Q3,7
What members of the multidisciplinary team (MDT) can aid someone with dementia
Dementia social worker (ensure safety and support at home) Dietician Carers Volunteers Specialist nurse Consultant Occupational therapist Physiotherapist
How is dementia diagnosed
Referral to Memory clinic MRI and CT scans Identify causation of memory loss Blood tests (pathology) Neurological examinations Physical examinations (test motor functions)
What must a person be able to do if they have capacity
Understand the info relevant to decision
Retain that info (recall and communicate back)
Use or weigh up info to make a decision
Outline the mental capacity act
Independent decisions unless proven otherwise Actions in their best interest; inc patient opinion (autonomy)
appoint a trusted person to make decision on their behalf
independent advocate to support when rights and freedoms are restricted
What is the 2 stage test of capacity set out my the MCA
How must capacity be withdrawn
- Mind or brain impairment due to illness or ext factor eg drug use?
- Unable to make specific decision when needed?
Two doctors must assess and agree, decision lasts 24 hours before needing review
How will fluctuating mental capacity affect the decision making process
May be delayed to a point where mental capacity has been regained or improved
How do the medical team decide what is in the patients best interest
Input from family and friends
Attempt to discover pre existing values, belief systems and ideals
What is an advance statement
Written statement with persons preferences, wishes, beliefs and values for future care
Not legally binding
What is an advance decision
A legally binding decision that allows an over 18 to refuse specified medical treatment for a time in the future where they may lack capacity to consent to or refuse
What is Legal Power of Attorney
Enables another person to make decisions for a person should they lose capacity
Health, welfare, property, financial affairs
Describe the pathophysiology of Alzheimer’s in regards to extracellular plaques
Amyloid precursor protein (transmemb assist in neur growth +repair), cleaved abnorm by beta and gamma secretases (rather than alpha). Surplus of amyloid beta
Amyloid beta proteins aggreg = oligomers +fibrils, diffuse out of cell and deposit as insoluble plaques, form amyloid plaques, interfere w neuronal comm, causes inflammation
Mutation in amyloid precursor protein coding genes incr risk
What are the 5 As of Alzheimer’s
What are other symptoms of AD
Amnesia (memory loss)
Aphasia (impaired communication)
Apraxia (loss in voluntary motor skills)
Agnosia (inability to name and recognise nouns)
Anomia (difficulty finding right world)
Misplacing items
Forgetting recent events, faces and names
uncertain about time and date and misdirection
Becoming repetitive
Increased anxiety and irritability
What are the symptoms of vascular dementia
Stepwise progression (vs gradual of AD) Slower thinking Personality changes Movement problems Bladder problems Similar to stroke and dementia
Describe the pathophysiology of Alzheimer’s in regards to intracellular tangles
Tau proteins (microtubuke assemb., neur growth+devel) are hyper-phosphorylated, undergo oligomerisation, aggreg into filamentois neuroanatom-fibrillary tangles (NFTs)
S
Disrupt microtubular system= x neuronal growth, transp and comm
Deposit in hippocampus, medial temporal lobe, frontal cornices, lateral pariotemporal regions
What is the correlation between disease severity alpha location- density of NFTs
Amyloid beta plaques trigger phosphor of tau, dissociating from microtubles and accumulating into NFTs
Reduction in neuronal function and apoptosis (atrophy)
Degen of chol inertia nuclei, reduc in acetylcholine
What is neuronal atrophy
Loss of synapses and neurones, macroscopically= cerebro-cortical atrophy particular loss of neurones in nucleus basalis of Meynert- rich in acetylcholine, supply hippocampus, amygdala and neocortex
Neuronal atrophy subsequently causes Ach deficiency
What causes the mood and sleep effects of Alzheimer’s
Loss of neurones in the brain stems median rapid and locus ceruleus neurones cause serotonin and noradrenaline reduction
What drug treatments are available for Alzheimer’s and why do they help symptoms of the disease
Cholinesterase inhibitors, replace acetylcholine deficit. Acetylcholine is involved in memory function
What causes cardiovascular dementia
Reduced blood supply to brain due to diseased vessels, multiple infants within minor blood vessels of brain, linked with cardiovascular disorders
What causes dramatic changes to deterioration in vascular dementia
Strokes
Atherosclerosis contributes to vascular occlusion and transient ischaemic attacks (TIA strokes); deterioration of cognition
