Memory Problems: Assessment Flashcards

(33 cards)

1
Q

What is memory?

A

Essential to normal human functioning; allows us to recognise people/things, talk, read, write, learn from experience

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2
Q

Types of memory?

A
  1. Sensory memory (<1 second)
  2. Short-term memory, AKA working memory (<1 minute):
    • Explicit memory, AKA declarative memory (conscious) - allows for knowledge of facts, e.g: Paris is the capital of France
    • Implicit memory,
    AKA procedural memory (unconscious) - allows for knowledge of HOW TO complete tasks and to have skills, e.g: riding a bike
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3
Q

Sub-types of declarative memory?

A
  1. Episodic memory - memory of autobiographical events (times, places, assoc. emotions and other contextual who, what, when, where, why knowledge), i.e: for events and experiences
  2. Semantic memory - consists of general facts and knowledge we have gathered about the world and language, i.e: for facts and concepts
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4
Q

Stages of memory processing?

A
  1. Attention
  2. Encoding
  3. Storage
  4. Retrieval
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5
Q

2 types of memory loss?

A

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

Retrograde amnesia - difficulty remembering info prior to the onset of the illness or injury:
• Short-term, e.g: potentially following a head injury
• Long-term and extensive, e.g: Korsakoff’s syndrome and later stages of Alzheimer’s disease

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6
Q

Comparison of examples of normal memory loss VS mild cognitive impairment VS dementia?

A

ADD IMAGE

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7
Q

What is dementia?

A
Syndrome of the brain, usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, inc:
• Memory
• Thinking
• Orientation
• Comprehension
• Calculation
• Learning capacity
• Language
• Judgement 

Impairment of cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour or motivation

NOTE - there is no clouding of consciousness

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8
Q

Criteria for diagnosis of dementia?

A
2 or more of the following:
• Forgetfulness
• Memory loss
• Confusion
• Poor reasoning and logic
• Personality changes
• Poor judgement
• Ability to focus
• Visual perception
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9
Q

Various causes of dementia?

A

Alzheimer’s disease is the most common cause

Vascular dementia is the 2nd most common cause

Other causes:
• Creutzfeldt-Jacob's 
• FTD
• Huntington's disease
• Hydrocephalus
• Lew Body Disease
• Mixed 
• Parkinson's
• Wernicke-Korsakoff's
• Depression
• Diabetes
• Excess use of alcohol
• Head injury
• Medications
• Mild cognitive impairment
• Thyroid 
• Vitamin deficiency
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10
Q

Typical type of memory loss in Alzheimer’s disease?

A

Initial anterograde amnesia is followed by retrograde amnesia

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11
Q

Comparison of characteristics of dementia, delirium and depression?

A

ADD IMAGE

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12
Q

Compare thinking, perception, emotions and sleep in dementia, delirium and depression?

A

ADD IMAGE

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13
Q

Important Qs in the HPC of a patient with memory problems?

A

What are the difficulties and when & where do they happen?

Has their memory problem affected their day-to-day functioning?

Issues in the kitchen (burning food, forgetting recipes)?

Able to use the remote control, washing machine, microwave, etc?

Do they follow the news? Ask about something they have seen recently

Have they ever gotten lost or been disorientated?

Do they drive? Any accidents?

Can they still enjoy hobbies?

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14
Q

Important PMH factors to consider in a patient with memory problems?

A

Any medical problems, inc. stroke, diabetes, heart disease, Parkinson’s, vascular disease

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15
Q

Purpose of a corroborating Hx from the family?

A

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

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16
Q

Qs to ask an inpatient with memory problems?

A

What is your name?
Where do you live?
Where are you at the moment?
Why are you in here?
How long have you been in here?
Why are you in hospital?
Do you know the date, day of the week, year and month?
How has your memory been lately?
Do you find yourself forgetting things more than you did before?
How is your concentration been the last couple of weeks?
How has your mood been the last couple of weeks?
Is there anything you have been anxious or worried about over the past couple of weeks?
How were you managing at home?

17
Q

Qs to ask the staff (corroborating Hx) looking after an inpatient with memory problems?

A

Does the patient recognise staff?
Can the patient follow basic instructions?
Can they orientate themselves round the ward, e.g: know where the bed and toilet are?
How is their personal care?
What is their routine like? (sleep, activity and appetite)
How has their mood been in the ward?
What are their language skills like?
Is their presentation changeable or consistent across the day?
Do they demonstrate an understanding of their illness?
What is their physical functioning like?
Is there any evidence of anxiety or low mood?

18
Q

What must be assessed in a cognitive screening?

A
  1. Memory
  2. Attention and conc.
  3. Executive functioning
  4. Visuospatial functioning
  5. Language

NOTE - consider using a screen to rule out co-morbid psychological problems, e.g: depression, delirium

19
Q

Rapid assessment test for delirium?

A

4AT (aimed at detecting moderate-severe cognitive impairment)

20
Q

Constituents of 4AT?

A

Alertness (normal OR mild sleepiness OR clearly abnormal)

AMT-4 (age, DoB, place, current year)

Attention (months backwards)

Acute or fluctuating course

21
Q

Cognitive tests available for dementia?

A
MMSE (screening test for those with suspected cognitive impairment):
• Orientation
• Memory
• Visuospatial
• Language 

To improve upon initial cognitive testing, use the Addenbrooke’s Cognitive Examination

22
Q

Scores in MMSE?

A

Cut-off is 27/30

If <24/30, this supports a diagnosis of dementia

23
Q

Advantages of MMSE?

A

Quick and available in different languages; only requires a blank paper and pen

24
Q

Disadvantages of MMSE?

A

It is a crude test such may not be sufficiently sensitive to pick up impairment in certain conditions, such as Parkinson’s disease

Not adjusted for age

Poor examining of executive functioning

Poor in severe impairment, due to the floor effect

Poor in high pre-morbid functioning

May not indicate problems in early stages

Significant focus on verbal functioning, to exclusion of non-verbal skills

25
Rapid screening assessment available for mild cognitive dysfunction?
Montreal Cognitive Assessment (MoCA); this assesses multiple cognitive domains
26
What is the Addenbrookes Cognitive Examination III?
``` ACE-III; a cognitive test that takes 15 minutes to complete and is scored out of 100, with 5 domains: • Orientation and attention • Memory • Fluency • Language • Visuospatial functioning ```
27
Scoring of ACE-III?
Cut off 88/100 Cut-off 82/100
28
Bedside tests for cognitive impairment?
GPCOG - used in a community setting; checks the following: • Orientation to time • Short-term recall • Clock-drawing 6CIT - checks the following: • Attention • Orientation to time • Short-term recall Clock Drawing Test - checks the following: • Executive functioning • Visuospatial ability • Abstraction (ability to use symbols) • Correlates well with overall cognitive functioning
29
Other factors that are important to consider alongside cognitive scoring tests?
Acute or chronic issue? Patient's current function vs their premorbid function Consider their overall mental state Corroborative Hx is essential NOTE - cognitive assessment is not just a score
30
What is neuropsychological assessment?
Important in determining whether an individual has experienced abnormal intellectual or behavioural decline and whether than decline is related to underlying disease of the CNS This should be used in the diagnosis of dementia, esp. in patient where dementia is not clinically obvious
31
Purposes of a neuropsychological assessment?
ID areas of deficits and preserved functioning in the cognitive profile Aid with diagnosis Provide info on prognosis Obtain a baseline assessment of functioning Inform and facilitate interventions and startegies Monitor change in cognitive functioning Evaluate effectiveness of interventions Provide indicators regarding the rate of recovery
32
Cognitive domains assessed in neuropsychological assessment?
Premorbid functioning Orientation and attention Memory and new learning Visuospatial and constructional functioning Language Executive functioning Emotional status
33
Factors to consider when undertaking cognitive assessments?
Mood Handedness Language and word finding, verbalisations and gestures Fluctuations Response to encouragement, response to failure or success Memory for personal Hz Motor functioning Effects of substances, e.g: alcohol, drugs Sensory and physical impairments Level of cooperation (memory, effor) Though content Conc. and distractabilitiy Practice effect