Memory Problems: Assessment Flashcards
(33 cards)
What is memory?
Essential to normal human functioning; allows us to recognise people/things, talk, read, write, learn from experience
Types of memory?
- Sensory memory (<1 second)
- 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
Sub-types of declarative memory?
- 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
- Semantic memory - consists of general facts and knowledge we have gathered about the world and language, i.e: for facts and concepts
Stages of memory processing?
- Attention
- Encoding
- Storage
- Retrieval
2 types of memory loss?
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
Comparison of examples of normal memory loss VS mild cognitive impairment VS dementia?
ADD IMAGE
What is dementia?
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
Criteria for diagnosis of dementia?
2 or more of the following: • Forgetfulness • Memory loss • Confusion • Poor reasoning and logic • Personality changes • Poor judgement • Ability to focus • Visual perception
Various causes of dementia?
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
Typical type of memory loss in Alzheimer’s disease?
Initial anterograde amnesia is followed by retrograde amnesia
Comparison of characteristics of dementia, delirium and depression?
ADD IMAGE
Compare thinking, perception, emotions and sleep in dementia, delirium and depression?
ADD IMAGE
Important Qs in the HPC of a patient with memory problems?
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?
Important PMH factors to consider in a patient with memory problems?
Any medical problems, inc. stroke, diabetes, heart disease, Parkinson’s, vascular disease
Purpose of a corroborating Hx from the family?
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
Qs to ask an inpatient with memory problems?
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?
Qs to ask the staff (corroborating Hx) looking after an inpatient with memory problems?
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?
What must be assessed in a cognitive screening?
- Memory
- Attention and conc.
- Executive functioning
- Visuospatial functioning
- Language
NOTE - consider using a screen to rule out co-morbid psychological problems, e.g: depression, delirium
Rapid assessment test for delirium?
4AT (aimed at detecting moderate-severe cognitive impairment)
Constituents of 4AT?
Alertness (normal OR mild sleepiness OR clearly abnormal)
AMT-4 (age, DoB, place, current year)
Attention (months backwards)
Acute or fluctuating course
Cognitive tests available for dementia?
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
Scores in MMSE?
Cut-off is 27/30
If <24/30, this supports a diagnosis of dementia
Advantages of MMSE?
Quick and available in different languages; only requires a blank paper and pen
Disadvantages of MMSE?
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