memory probs Flashcards by holly strachan

what is anterograde amnesia

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

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what is retrograde amnesia

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

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what is dementia

a syndrome due to disease of the brain, usually chronic or progressive in nature, in which there s disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement

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diagnostic criteria 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

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features of dementia in terms of onset, duration, course, alertness, orientation and memory

onset: insidious
duration: months/years
course: stable, progressive, step-wise
alertness: normal
orientation: normal or impaired to time/place
memory: recent and remote impaired

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features of delirium in terms of onset, duration, course, alertness, orientation and memory

onset: acute
duration: hours/days/weeks/months
course: fluctuating
alertness: impaired
orientation: impaired
memory: recent impaired

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features of depression in terms of onset, duration, course, alertness, orientation and memory

onset: gradual
duration: weeks/months
course: diurnal
alertness: normal
orientation: normal
memory: remote intact, concentration is poor

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features of dementia in terms of thinking, perception, emotions and sleep

thinking: slowed, reduced interest
perception: hallucinations (30-40%)
emotions: shallow, labile, irritable
sleep: nocturnal wandering and confusion

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features of delirium in terms of thinking, perception, emotions and sleep

thinking: can be paranoid and bizarre
perception: visual and auditory hallucinations common
emotions: irritable, aggressive and fearful
sleep: nocturnal confusion

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features of depression in terms of thinking, perception, emotions and sleep

thinking: slow and preoccupied
perception: mood congruent auditory hallucinations
emotions: flat, unresponsive and sad
sleep: early morning wakening

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what aspects of background history are important to touch on when assessing cognitive function

presenting problems 
medical history 
psychiatric history 
substance use/misuse 
family history 
corroborative history

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features of PMH that may be relevant to memory problems

strokes 
diabetes 
heart problems 
parkinson's 
vascular disease

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useful questions to assess daily functioning

any problems in the kitchen
can you still use remote control/washing machine etc 
do you follow the news
do you ever get lost or disorientated 
can you still enjoy golf/bridge etc

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which aspects need to be assessed in cognitive screening

memory
attention and concentration 
executive functioning 
visuospatial functioning 
language

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what are the 4 parts of the 4AT

alertness (normal, mild sleepiness, clearly abnormal)
AMT-4 (age, DOB, place, current year)
attention (months backwards)
acute or fluctuating course

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advantages of MMSE

quick
different languages
only requires pen and blank paper
memorisable

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disadvantages of MMSE

not adjusted for age
poor examination of executive functioning
poor in severe impairment
poor in high morbidity functioning
may not indicate problems in early stages
significant focus on verbal functioning

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what cognitive function tests are available

ACE-III
MoCA
FAB

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causes of cognitive impairment

alcohol
depression
medication 
thyroid and other endocrine/metabolic disorders 
brain lesions 
neuro infections/inflammation

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signs of Alzheimer’s disease

memory loss, particularly short term
dysphasia
dyspraxia
agnosia

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CT/RI findings in AD

normal
medial temporal lobe atrophy
temporoparietal atrophy

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signs of vascular dementia

dysphasia, dyscalculia
forntal lobe symptoms and affective symptoms more common than in AD
focal neurological signs 
vascular risk factors 
step wise decline

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CT/MRI findings in vascular dementia

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moderate-severe small vessel disease or multiple lacunar infarcts

SPECT findings in vascular dementia

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patchy reduction in tracer uptake throughout the brain

what are the 3 syndrome of frontotemproal dementia

behavioural variant primary progressive aphasia semantic dementia

signs of behavioural variant FTD

``` behavioural changes executive dysfunction disinhibition impulsivity loss of social skills apathy obsessions change in diet ```

signs of primary progressive aphasia

effortful non-fluent speech speech sound/articulatory errors lack of grammar lack of words

signs of semantic dementia

impaired understanding of meaning of words fluent but empty speech difficulty retrieving names

imaging results in FTD

CT/MRI frontotemproal atrophy | SPECT frontotemproal reduction in tracer uptake

diagnosis of dementia with Lewy bodies

``` signs of dementia plus two of; visual hallucinations fluctuating cognition REM sleep behaviour disorder Parkinsonism (not more than 1 year prior to onset of dementia) positive DAT scan ```

diagnosis of dementia in Parkinson's disease

signs of dementia must have Parkinsonism for at least 1 year prior to onset of dementia positive DAT scan

'red flags' in cognitive impairment

``` fast progression young patient neurological signs FH of rare or young dementia clues in PMH eg HIV ```

who gets a CT scan

everyone

who gets an MRI scan

young fast progression other atypical features

who gets a SPECT scan

signs of FTD

who gets a DAT scan

Parkinsonism

use of cholinesterase inhibitors

slow cognitive decline

drugs for AD

donepezil rivastigmine galantamine

drugs for DLB and DPD

``` rivastigmine donepezil (unlicensed) ```

side effects of cholinesterase inhibitors

``` nausea/diarrhoea headache muscle cramps bradycardia worsen COPD/asthma ```

what are the guideline in place for driving with dementia

DVLA must be notified | DVLA requests report from doctor, who decides if patient can continue driving

behavioural and psychological symptoms of dementia (BPSD)

``` hallucinations delusions insomnia depression aggression agitation disinhibition anxiety ```

what is the most common cause of dementia

Alzheimers disease

describe the role of amyloid precursor protein in the pathophysiology of Alzheimer's

beta-secretase replaces alpha-secretase to breakdown amyloid precursor protein the resulting amyloid-beta protein is insoluble, and form beta-amyloid plaques around the neurone the plaques get in the way of neurone and prevent communication between the neurons

describe the role of tau protein in the pathophysiology of Alzheimer's

tau protein is present in the microtubules within the neurone, preventing them from breaking up phosphorylation of the tau protein causes them to release from the microtubule and form neurofibrillary tangles this can lead to apoptosis

signs of atrophy in AD

narrowed gyri widened sulci enlarged ventricles

features of sporadic AD

late onset | most common

risk factors for sporadic AD

age | genetic factors

features of familial AD

dominant genetic inheritance | less common

mutations associated with early onset AD

PSEN-1/2 | trisomy 21

what are Lewy bodies

alpha-synuclein protein deposits inside neurons

where do Lewy bodies most commonly aggregate

cortex | substancia nigra

symptoms of hyperactive delirium

``` agitation aggression incoherent speech disorganised thoughts hallucinations delusions disorientation ```

symptoms of hypoactive delirium

sluggish drowsy less reactive looks withdrawn

risk factors for delirium

``` recent surgery pain medications dementia constipation UTIs chronic fatigue ```

how to prevent delirium

``` identify people at risk help them feel oriented and comfortable glasses, hearing aids healthy eating/fluids stay active good sleep pattern non-opiate pain medication ```

what are the risks of delirium

higher rates of falls longer hospital stay higher mortality rates

memory probs Flashcards

(57 cards)