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Psychiatry > Memory Problems > Flashcards

Memory Problems Flashcards

1
Q

is clouding of consciousness a symptom of dementia

A

no

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2
Q

what are the types of memory

A

sensory (<1 second)
working (repeating things in your head before storing them in short term)
short term (< 1 min)
long term (life time):
-implicit (unconscious, procedural- skills and tasks)
-explicit (conscious); declarative (facts and events)= episodic (events and experiences) or semantic (facts and ceoncepts about the world)

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3
Q

what are the stages of memory processing

A

attention
encoding
storage
retrieval

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4
Q

what is anterograde amnesia

A

difficulty in acquiring new material and remembering events since the onset of the illness/ injury

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5
Q

what is retrograde amnesia

A

difficulty in remembering information prior to the onset of the illness/injury

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6
Q

give examples of long term retrograde amnesia causes

A

korsakoffs

late stages of Alzheimers

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7
Q

what is globus pharyngeus/ hystericus

A

feeling of a lump in throat

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8
Q

define dementia

A

a syndrome due to disease of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not clouded. The impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.

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9
Q

what conditions can you get dementia in

A 
alzheimers 
FTD
huntingtons
creutzfeldt-jacobs
hydrocephalus
lewy body dementia
parkinsons
vascular 
wernickes-korsakoss
depression 
diabetes
acohol misuse
head injury
medications
thyroid
tumour 
vit deficiency 
....
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10
Q

what symptoms do you need 2 or more of to have dementia

A 
forgetfullness
memory loss
confusion
poor reasoning and logic 
personality changes
poor judgement 
ability to focus 
visual perception
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11
Q

what is onset and course like in dementia

A

insidious
lasts months to years
stable, progressive or step wise

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12
Q

which out of dementia, delirium and depression will have altered alertness

A

delirium

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13
Q

which out of dementia, delirium and depression will have normal orientation

A

depression

can be normal in early dementia

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14
Q

is memory affect in depression

A

no but concentration is poor

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15
Q

how does thinking differ in dementia delirium and depression

A

dementia- slowed, reduced interest

delirium- can be paranoid, bizarre

depression- slow and preoccupied

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16
Q

how does perception differ in dementia delirium and depression

A

dementia- hallucinations

delirium- visual and auditory hallucinations common

depression- mood congruent auditory hallucinations

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17
Q

how do emotions differ in dementia delirium and depression

A

dementia- shallow, labile, irritable

delirium- irritable, aggressive and fearful

depression- flat, unresponsive and sad

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18
Q

how does sleep differ in dementia delirium and depression

A

dementia- nocturnal wandering and confusion

delirium- nocturnal confusion

depression- early morning wakening

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19
Q

what is it useful to ask in a corroborative history

A

Functional abilities at home
Help required to support them whilst at home
Any significant cognitive, physical or emotional changes in recent weeks
Rate and pattern of cognitive decline

also get corroborative history from staff

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20
Q

what does 4AT screen for

A

rapid assessment test for delirium

aimed at detecting moderate- severe cognitive impairment

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21
Q

what is included in the 4AT

A

months backwards test
abbreviated mental test- 4
Alertness- normal/ mild sleepiness/ clearly abnormal
AMT-4 (age, DOB, place, place, current year)
Attention (months backwards)
Acute or fluctuating course

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22
Q

what test for the diagnosis of dementia

A

MMSE

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23
Q

what test for initial cognitive testing

A

addenbrookes

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24
Q

what test for delirium

A

4AT

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25
what is included in the MMSE
``` orientation memory visuospatial language scored out of 30 <24 support dementia ```
26
what are the pros and cons of MMSE
pros- quick, different languages, only need blank paper and pen, memorisable cons- not adjusted for age, poor in severe impairment, poor assessment of executive function, poor in high premorbid functioning, hard if poor verbal skills, poor in detecting early stages
27
what are the bed side non specialist tests for dementia
GPCOG - Community setting -Orientation to time, short-term recall, clock-drawing - Informant history if score low 6CIT - Attention, orientation to time, short-term recall, corroborative Hx clock drawing test
28
what does clock drawing test
executive function (planning- enough room for numbers) visuospatial ability abstraction (ability to use symbols) correlates will with overall cognitive functioning (frontal-parietal
29
what is the MoCA
rapid screening instrument for mild cognitive dysfunction | assesses multiple cognitive domains
30
what does addenbrookes test
``` orientation and attention memory fluency language visuospatial functioning ```
31
what are the functions of a neuropsychological assessment
To identify areas of deficits and preserved functioning in the cognitive profile Aid with diagnosis process Provide information regarding prognosis To obtain a baseline assessment of functioning To inform and facilitate interventions and strategies To monitor change in cognitive functioning To evaluate effectiveness of interventions To provide indicators regarding the rate of recovery
32
does a good cognitive assessment rule out dementia
no
33
what are the features of lewey body dementia
fluctuates visual hallucinations parkinsonism frequent falls
34
what does SPECT show in FTD
reduced blood flow to FT lobes due to atrophy
35
what is dementia
progressive global cognitive decline, irreversible, associated decline in functioning
36
what are the cognitive tests for dementia
ACE-II (most common for dementia- used for monitoring mild cognitive impairment and diagnosing dementia, no dementia if score over 82) MoCA (shorter, in lots of languages) frontal assessment battery (tests executive function) detailed neuropsychological testing (standardised to pre morbid ability)
37
what questionnaire can be used to obtain a collateral history
short information cognitive decline in the elderly
38
what are the reversible causes of cognitive impairment
``` depression brain lesion infection/ inflammation medication (steroids, anticholinergics) delirium alcohol medication thyroid/ metabolic disorders ```
39
what defines mild cognitive impairement
noticeable cognitive impairment with little deterioration of function ACE-II 75-90, MoCA 24-26 repeat testing yearly
40
what is subjective cognitive impairment
patient feel that they are cognitively impaired but cognitive testing and day to day function are normal often associates with anxiety, stress, depression often have relative/ friend with dementia vicious cycle of increasing anxiety about memory causing memory lapses
41
what are the features of Alzheimers
``` memory loss, esp short term dysphasia dyspraxia agnosia insidious onset ```
42
what is seen on imaging in alzheimers
CT/MRI normal | medial temporal lobe atrophy or temporoparietal atrophy
43
what are the variants of alzheimers
frontal | posterior cortical atrophy
44
what are the features of vascular dementia
dysphasia dyscalculia frontal lobe symptoms and affective symptoms more common than in alzheimers may have: focal neuro signs, vascular risk factors, step wise decline
45
what is seen on imaging in vascular dementia
CT/MRI shows moderate- severe small vessel disease or multiple lacunar infarcts SPECT- patchy reduction in tracer uptake throughout brain
46
what are the features of FTD
3 syndromes: behavioural variant- behavioural changes, executive dysfunction, disinhibition, impulsivity, loss of social skills, apathy, obsessions, change in diet primary progressive aphasia- effortful non fluent speech, speech sound/ articulatory errors, lack of grammar, lack of words semantic dementia- impaired understanding of meaning of words, fluent but empty speech, difficulty retrieving names
47
what is seen in imaging of frontotemporal dementia
CT/MRI- frontotemporal atrophy | SPECT- FT reduction in tracer uptake
48
what are the features of lewey body dementia
early involvement of reduced attention, executive function and visuospatial skills two of: -visual hallucinations -fluctuating condition (delirium like) -REM sleep behaviour disorder -parkinsonism (not more than 1 year prior to onset of dementia) -positive DAT scan
49
what is the difference with dementia in parkinsons to lewey body dementia
in parkinsons with dementia must have parkinsons 1 year prior to onset of dementia
50
when should you suspect that something uncommon is causing the dementia
``` fast progression young patient neurological signs family history of rare/ young dementia medical Hx- e.g. HIV ```
51
what should you ask when diagnosing someone with dementia
``` What do they already know? What do they want to know?- some people dont want to know if they have it, ask if its okay to discuss with their family Clear explanation of dementia +/- type What do they think? How do they feel? Address specific concerns Management plan including support Give information over time ```
52
what imaging is used in dementia diagnosis and when
CT- standard (good for excluding tumout/ bleed/ large stroke, for quanitfying vasuclar changes/ identifying structural features) MRI- if young, fast progression or atypical features single photo emission CT (SPECT)- FTD (or clarifying alzheimers) DaT (dopamine active transporter) scan - for suspected DLB/ DPD when patient doesnt have enough supporting clinical features for a diagnosis
53
what drugs are uses in the treatment of dementia
cholinesterase inhibitor: - alzheimers disease - donepezil, rivastigmine, galatamine - DLB and DPD- rivastigmine, donepezil memantine- licensed for alzheimers
54
what do cholinesterase inhibitors do
block the enzyme cholinesterase which is responsible for breaking down acetylcholine slow cognitive decline have more effect in DLB/DPD than alzheimers
55
what are the side effects of cholinesterase inhibitors
nausea and diarrhoea most common | headache, muscle cramps, bradycardias, can worsen COPD/ asthma
56
what are the precaution when prescribing cholinesterase inhibitors
check pulse before prescribing/ increasing dose (bradycardia) nor with active peptic ulcer or severe asthma/ COPD
57
what does memantine do
NMDA glutamate antagnoist slows cognitive decline, prevents behavioural and psychological symptoms of dementia start in moderate dementia when cholinesterase inhibitors CI
58
what are the SEs of memantine
``` well tolerated (but less effective) hypertension (check BP before starting) sedation dizziness headache constipation ```
59
what can reduce informal carer distress and delay nursing home admission
psychosocial interventions
60
can people with dementia drive
yes but must be reported to DVLA on diagnosis fill out CG1 form, get report from doctor who decides if patient can drive will Ix ongoing have to do on road driving test and rookwood driving battery
61
what happens as dementia progresses
behavioural and psychiatric aspects of dementia become more prominent physical co morbidity increases reduced ability to carry out activities of daily living independently and hence greater need for support services - institutional care
62
what are the behavioural and psychological symptoms of dementia
``` hallucinations depression aggression agitation disinhibition anxiety insomnia delusions ```
63
what pharmacological management for agitation in dementia
in alzheimers- antipsychotics, citralopram, mematine, analgesia, sextromethorphan trazodone for FTD
64
what type of dementia should you be very careful when prescribing antipsychotics
lewy body dementia
65
what is used for anxiety in dementia
antidepressants, benzodiazepines, pregabalin
66
what is used for visual hallucinations in dementia
cholinesterase inhibitors, antipsychotics
67
what is used for insomnia in dementia
melatonin, Z drugs, benzodiazepines, sedating antidepressants
68
what is used for agitation and aggression in dementia
benzodiazepines, antipsychotics, sedating antidepressants, cholinesterase inhibitors, memantine, pregabalin

Psychiatry (27 decks)

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