Give 5 tools that can be used for dementia screening / cognitive assessment?
MMSE AMT GP-COG mini-COG assessment instrument 6-CIT Addenbrooke's
What can be used to treat mild-moderate alzheimers?
Acetylcholinesterase inhibitors (e.g. rivastigmine or donepazil)
What is used for the assessment of mental capacity? (EXAM)
COP3 form
What are the 5 principles of the MCA?
Individual assumed to have capacity
Individual supported to make their own decisions
Right to unwise/eccentric decision
Any decision made on behalf of the patient is done in their best interest
Least restrictive option (the decision should restrict the freedoms/rights of the patient no more than needed)
How do you assess mental capacity
decision + time specific
stage 1: is there an impairment in the brain or mind of the person
stage 2:
- understand –> retain –> weigh up –> communicate the decision
Give some examples of services for dementia sufferers/family
Age UK Alzheimers society (telephone support) Support groups Respite care memory cafe Carers direct helpline
Give some examples of community care for dementia sufferers
Admiral nures
Home carers
Meals on wheels
Home adaptations
What is required for a DOLS?
Lacks capacity
Must be in a care home / hospital
Must be under complete supervision + not free to leave
What does a DOLS ensure?
- Arrangements made are in the persons best interest
- a person is appointed to represent them
- Right to appeal their situation
- Situation reviewed regularly
How long does a DOLS last?
up to 12mths
What is best interest?
Whether a decision made is the best one for the patient all things considered (e.g. their prior/current wishes; risk + benefit)
What is a LPA (lasting power of attorney)?
An adult with capacity can appoint someone to make decisions on their behalf - should they lack capacity
What are the two types of LPA?
for health
for finance
What is an IMCA?
An independent mental capacity advocate
This is when a pt doesn’t have a friend/relative to act as a consultee for their best interest. They act as an independent safeguard for those lacking capacity (represent them in decisions)
What is advanced care plan?
for pts to make decisions about the care they receive before they lack capacity (in the event of)
What 4 things to consider in an advanced care plan (EXAM)?
- Advanced statement
- Advanced decision to refuse treatment
- Lasting power of attorney (for health/welfare)
- preferred place of care plan
In alzheimer’s where is there most atrophy?
Temporal lobes –> hippocampus (memory)
Someone is diagnosed with dementia, what might you want to do?
Advanced care plan:
(1) Lasting power of attorney
(2) Advanced directive/statement
(3) Advanced decision to refuse Tx
(4) preferred place of care plan
What is the ABCD2 score?
age 60+ BP: >140 or >90 Clinical features --> 2points (unilateral weakness), 1 point (speech) Duration (10-60 (1) and 60-24 (2)) DM
What ABCD2 score warrants neuroassessment within 24hrs?
4+
What abcd2 score warrants neuroassessment within 1 week?
0-3
What also warrants a neuroassessment within 24hrs?
Crescendo (even if abcd2 score <4)