dementia Flashcards
Give some examples of screening tools for dementia?
Time, date, remember address, counting backwards, months reverse - six item cognitive scoring
Draw clock and time; recall three words that gave before clock drawing - mini cognitive tool
MMSE - orientation (date, time, where you are, season, year); registration (repeat 3 objects); calculation; recall 3 objects; language (name two objects, repeat phrase, three stage verbal command, written command, write sentence); copying (copy set of intersecting pentagons)
What are the different types of dementia?
Alzheimers Vascular Lewy body FTD Other causes: alcohol/ drugs; repeated trauma; whipple's disease, HIV, HD, AD inherited
Describe Alzheimer’s dementia?
most common, accumulation of beta amyloid plaques, loss of Ach, hippocampus. Amygdala and subcortical nuclei most vulnerable
steady progression, gradual, short term memory loss, cortical function eventually all affection, apraxia, agnoia aphasia
Describe vascular dementia?
may be secondary to stroke or TIA. Have htn, pmhx CVD, neuro signs
slowness of thought; difficulty with planning, understanding and concentration
changes to mood or behaviour
memory and language LESS common
Describe LBD?
associated parkinson’s - shuffling gait, tremor, increased tone and falls
visual hallucinations!!!
FLUCTUATING cognition, prominent memory loss later, depression and sleep disorders, low inhibition
Describe fronto temporal dementia?
aka as pick's disease insidious onset behavioural and personality change, disinhibition poor judgment apathy
How is dementia diagnosed?
MMSE
Blds (FBC
How is dementia managed?
Memory clinic Support - keep socially active Med BP control in vascular dementia Vitamin supplements Treat depression - CBT and meds Anti-psychotics if extreme agitated or psychotic - but increases risk stroke - bad in lewy body due to risk of neuroleptic sensitivity Advance directives and LPOA
What community services are available for dementia?
Applying for social services
Alzheimers’ society
National dementia helpline
Age UK
Memory service - geriatrician - make the diagnosis + direct to social services
Refer to social prescribing - offer befriending services
What meds are used for dementia?
Ach inhibitors eg rivastigmine, donepezil, galantamine SE: can exacerbate heart block so do ecg before. Only use when disease more severe
Avoid sedatives, neuroleptics, tricyclics if possible.
Anti–glutamatergic second line
What are the five core principles of the Mental Capacity Act?
- Assume a person has capacity unless proven otherwise - should not be assumed, not of how they appear or past lack of capacity
- Do not treat people as incapable of making a decision unless all reasonable precautions have been done to otherwise do that - eg is there a time of day they are more alert or a means of communication that is better for them
- Just because a decision is unwise does not mean they lack capacity - decision itself is irrelevant
- Keep best interests at the forefront (if are deemed not to have capacity then this is what shall be done) - no legal definition of best interests → MCA has principles to help
- Minimise restriction - least restrictive version possible
What is pseudodementia vs dementia?
pseudo = retain insight
What do the scores on the MMSE mean?
The maximum MMSE score is 30 points. A score of 20 to 24 suggests mild dementia, 13 to 20 suggests moderate dementia, and less than 12 indicates severe dementia.
