Lecture 6 (dementia and delirium)

Question 1

Dementia definition and mild vs major NCD

Answer 1

-> Cognitive impairment represents gradual continuing declining from previous higher levels of cognition
Cognitive / behavioural deficit involve min of 2 domains
-> memory, language, exec function, visuospatial abilities, changes in personality

Mild = do NOT interfere with independence
Major = DO interfere with dependence

Question 2

Epidemiology dementia

Answer 2

65-69 = 1%
75-79 = 6%
>90 = 40% exhibit symptoms of moderate to severe

450,000 people live with dementia and 1.6 mil care for dementia

Alzheimers most common

then vascular dementia
then FTD (more common in <65)
Huntington less common

Question 3

Alzheimers aetiology

Answer 3

More spaces in sulci, and gyrus become thinner, generalised across the brain
Gaps in CSF spaces, hippocampal damage

Build up of beta-amyloid plaque build up between neurons

Neurofibrillary tangles -> tau protein becomes tangles and cannot bind to microtubules of neuron -> neuron loses structure

PET imaging finds that PiB compound which cause beta amyloid plaque is high in those with AD

Question 4

AD progression and stages

Answer 4

1. preclinical -> increase in all of the bio markers e.g. beta amyloid and tau stuff
2. mild -> difference in volume of brain structures, and beginning
   -> difficulties in IADLS (instrumental activities of daily livings e.g. shopping)
   -> increasing cognitive problems
   -> denial of disease
   -> physically healthy
3. moderate-severe -> difficulty in ADLS (activities of daily living e.g. toilet)
   -> more intense supervision needed
   -> motor difficulties
4. severe -> plaques and tangles widespread
   -> complete dependance
   -> loss of ability to speak/control movement

Question 5

Memory and Learning and their assessments

Answer 5

Semantic memory (e.g. facts of the world)
-> may show degraded content and loss of representations ( e.g. for glasses, cant remember what it does and how to use it)
-> deficit in retrieval of semantic memories

Language
Aphasia -> language disorders
Expressive -> impaired ability to produce speech -> words with high frequency (e.g. say them a lot), easier to say e.g. banana -> naming tests
Receptive -> impaired ability to comprehend speech (pointing tests)

Visual and space perception
Agnosia -> not recognise an object
-> visual = recognise the ‘what’ of an object
-> spatial = locate object in environment
Clock drawing test

Speed and attention
for attention / concentration -> test digit span (repeat back and forwards) -> testing auditory working memory and ability to hold words in WM and repeat
Speed of processing
-> digit substitution tests

Executive function
Testing higher order abilities
“captain stayed with the sinking …” -> usually say ship but asked to say another word not associated with it -> test disinhibition and ability for self control
Colour/word test

Social cognition and emotion
-> testing emotion recognition and ToM

Question 6

Types of dementia

Answer 6

Amnestic AD (typical) -> memory loss is primary, have to have another cog deficit
Non-amnestic AD
-> language presentation primary
-> visuospatial presentation
-> executive dysfunction presentation

Posterior cortical atrophy
-> marked visuospatial impairment
-> visual agnosia
-> simultagnosia (cant see whole visual space)
-> topographical disorientation (lost in own house)
-> atrophy in parietal occipital cortex

FTD
-> atrophy in frontal and temporal lobes

expressed through language forms -> progressive nonfluent aphasia (disorder of speech production and fluency), disorder of semantic memory (semantic memory impairment)

Expressed through language forms -> disorder of personality, behaviour and social conduct

Question 7

Dementia protection, treatment and management

Answer 7

Protection -> bilingualism can protect, high education show ‘cognitive reserve capacity’ -> can prevent and strengthen certain networks -> holds you against dementia longer -> but once you get it decline is quicker

Accurate diagnosis important
Meds for Ach
Trying to get people to follow predictable schedule and make sure stay active and remain interested in events

Give support for caregivers who may face loneliness, guilt, and depression,

Question 8

Delirium criteria, causes, and treatment

Answer 8

Disturbance in attention and awareness
Develops over short periods of time and fluctuates in severity during the day
Disorientation
Evidence direct result of medical condition, substance, exposure to toxin

15% in hospitalised patients occurence

Symptoms usually worse at night, sleep wake disturbed, perceptual disturbances common

Treatment

stop prn meds, and reduce continuous meds to as low as possible
psychoeducation to patient and family
Environment -> room with window to cue night /day and reduce noise