Dementia Flashcards by Zach Geddes

What is Dementia?

Syndrome- condition with multiple features
-> progressive and chronic

Involves deterioration in cognitive function beyond what is expected from normal ageing

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What are some of the general functions affected by dementia?

Memory- difficulty with recent events

Thinking/Concentrating- difficulty making decisions/completing tasks

Orientation- losing track of day/date, being confused about where they are

Comprehension

Calculation

Learning capacity- impact on learning new skills

Language- use and understanding

Judgement

Visuospatial skills- judging distance and seeing in 3D (falls)

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What is the deterioration of cognitive function in dementia often preceded by?

Deterioration in:

Emotional control

Social Behaviour- anxiety, withdrawal, inappropriateness.

Motivation- Lethargy

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What is the most common type of dementia?

Alzheimers

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What causes damaging effects in Alzheimers?

Reduction in size of cortex- severe in hippocampus
Plaques of beta amyloid
Tangles

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How does build up of beta amyloid plaques cause damage in Alzheimers?

APP undergoes mutation affecting cleaving, so toxic beta form is made, this causes degradation of neurons (impairs pathways)
-> Plaques may cause inflammatory response and granulation formation

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What are tangles and their effect in Alzheimers?

Made of TAU protein (normally found in microtubules giving structure)
-> abnormal fold in this protein causes a tangle to form affecting structure of microtubule structure (can stick to other TAU proteins)
-> DAMAGE and DEGENERATION to neurones and synapse

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What are the distinctive features in Alzheimers?

STML

Aphasia

Communication difficulty

Mood swings

Withdrawal

Loss of confidence

Difficulty with everyday activities

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What causes vascular dementia?

Reduced blood flow to the brain- damage and death of brain cells

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Which conditions can vascular dementia occur as a result of?

Small vessel disease- narrowing and blocking of these within the brain

Stroke

TIAs- tiny widespread damage to brain

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What underlying issues can be linked to small vessel disease involved in vascular dementia?

Hypertension

Smoking

Obesity

-> modifiable risk factors

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What are the distinctive features of vascular dementia?

Memory issues of sudden onset

Visuospatial difficulties

Stroke symptoms

Anxiety

Delusions

Seizures

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What causes dementia with lewy bodies?

Build up of abnormal Lewy body protein in brain cells (same protein that causes damage in Parkinson’s) in areas responsible for memory or muscle movement

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What are the distinctive features of Dementia w Lewy bodies?

Fluctuating cognitive ability

Visuospatial difficulties

Attentional difficulties

Overlapping motor disorders

Speech and swallowing issues- affects dentistry

Sleep disorders

Delusions

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What is the function of the frontal lobe?

Behaviour/emotional control

Problem solving

Planning

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What proteins are associated with Frontotemporal dementia?

TDP-43

Ubiquitin associated clumps

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What is different about onset of FT dementia?

Occurs in younger patients

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What are the distinctive features of FT dementia?

STML- variable

Uncontrollable repetition of (other’s) words

Mutism

Personality change

Decline in social/personal conduct

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What are some examples of rarer forms of dementia?

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

What are the common effects of dementia on behaviour?

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Depression
Apathy / Emotional Blunting
Anxiety
Irritability/ Disinhibition

What percentage of patients with dementia suffer from depression?

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40%- may precede diagnosis

What are the features of emotional blunting?

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Not smiling

Laughing inappropriately

Not showing or reciprocating affection

What medications can help patients with emotional blunting and apathy in dementia?

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Drugs that can increase availability of Noradrenaline and Dopamine in brain

Why are stimulants used less often in patient with dementia?

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Side effects

What are the features of anxiety in dementia?

Can be situational or generalised Awareness of deficits can be heightened when patient fails to complete previously simple task or has to complete complex task Patients do not wish to leave their home Feeling of unease Rumination on anxiety laden topics- physical/money issues

What can be used to treat anxiety in dementia?

Non-stimulating anti-depressants

Why are sedatives not generally used to treat dementia patients with anxiety?

Due to increased risk of: Confusion solemnness Falls * May make dental treatment safer

How does irritability present in dementia?

Snappiness Patient is on edge Short fuse

What can happen as a result of disinhibition in dementia?

Hateful speech- race, gender etc -> may be out of character

Which non-pharmalogical intervention can help against behavioural effects of dementia?

Increasing social and physical activity

Which features of psychosis may affect patients with dementia?

Hallucinations Delusions Paranoia

What are hallucinations?

Abnormal perception of stimulus which isn't really there

What are the common types of hallucinations in dementia?

Visual Auditory Tactile

For which form of dementia are hallucinations a diagnostic criterion?

Dementia w Lewy bodies

What are delusions?

Fixed false belief that is resistance to reason or confrontation -> may involve paranoia- patient mistakenly believes that others are trying to in inflict harm in some way

What are the strategies for managing patients with dementia who are experiencing psychosis?

- Avoid explanations- be general but assertive - Avoid lengthy conversations - Avoid confrontation- consider not correcting or contradicting - Try and distract patient - Change topic, activity or venue - Use humour

What are the issues with using anti-psychotic medications in patients with dementia?

No drugs are approved Increased risk of death Metabolic risks -> Increased blood sugar and cholesterol -> lowering BP when standing Sedation

What should be considered/completed in terms of oral health in patients with early stage dementia?

- Oral assessment is good at this time to plan for future- remember dementia is progressive - High quality restorations- more insult as caries is increased (poor diet, poor OH, dry mouth) - Pragmatic treatment rather than complex restorative work may be wise - Preventive regime- F supplements

What are key teeth and their significance?

- Occluding teeth- functional, help mastication - Anteriors- incisional function and aesthetics -> Better nutrition goes with this- more likely to engage with healthy harder to eat foods -> Social aspects- more likely to engage and easier speech

What must be considered when treatment planning for patients with mid stage dementia?

Consider location where the consultation/treatment would be best for patient as access may be more challenging Are lower risk treatments available? -> prevention and maintenance Consider medical status

What is the focus of treatment for late stage dementia?

Comfort- hygiene, moisture -> Non-invasive- ART, prevention If emergency management- what is least likely to fail?

What aspects of behaviour management are useful in a dental setting for patients with dementia?

Touch and reassurance- ask for consent for every part of examination -> Can be valuable to help people with dementia feel comfortable and safe Treat at best time of day for them Find out about patient likes- can go back to this if patient becomes distressed

What is the issue with IS and dementia patients?

May be unlikely to understand or be able to remember to follow nose breathing instructions -> limited effectiveness

What are the differences with IV sedation in dementia patients?

- Slower drug metabolism- smaller quantity of drug will have to be titrated really slowly - Bigger risk of respiratory depression - Access issues for canulation- frailty - Patients may not have escort- lack of 1-1 care in care homes

What is the mean IV dose of patients over 70 to achieve sedation compared to those under 70?

Over- 2.8mg Under- 5.7mg

Which complications of GA are patients with dementia at an increased risk of?

Death Thromboembolic events Dehydration Insufficient nutrition intake Insufficient pain treatment Post operative delirium Post operative cognitive function loss – affects 1 in 3 of those >80 *Avoid at all costs unless only option

How does music therapy work in patients with dementia?

Can help reorientate patients with dementia as music is relevant to patient (Playlist for life- important songs that can trigger memory) -> Reduces stress and provides distraction

Dementia Flashcards

(47 cards)