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Medicine: PBL wrap-ups > Unit 6 Week 3: Alzheimer's Disease > Flashcards

Unit 6 Week 3: Alzheimer's Disease Flashcards

1
Q

what are the stages of Alzheimers

A

pre clinical
early/mild
middle/ moderate
late/severe

these stages may overlap, each patient progresses through them differently

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2
Q

early stages

A

main symptoms is memory lapses
forget recent conversations/events, misplacing items, forgetting names, struggling to think of right word, ask questions repetitively, poor judgement, harder to make decisions, less flexible

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3
Q

middle stages

A

memory problems increase
may not remember names of family
usually need help with daily living
other symptoms may also develop: increasing confusion and disorientation, obsessive/repetitive/impulsive behaviour, speech/language problems, disturbed sleep

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4
Q

late stages

A

hallucinations and delusions worsen
increasingly agitated
dysphagia
sometimes severe weight loss
urinary incontinence/ bowel incontinence

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5
Q

progressive stages

A

to begin with only one area of the brain is affected
as dementia develops, more areas affected, symptoms worsen
original affected areas also worsen during this time
can be affected by several factors: age of onset (early is more likely to progress quickly), types of dementia have different rates of progression, co-morbidities

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6
Q

risk factors for Alzheimers

A

physical inactivity
smoking
unhealthy diets/ obesity
social isolation
alcohol
hypertension
diabetes
hypercholesterolemia
genetic mutations in APP (amyloid precursor protein)
cognitive imactivity
depression, can cause inflammation medication use
older age
females

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7
Q

investigations for alzheimers

A

ask patient/ family/ friend questions
memory/ personality test
blood/urine tests for alternative cause of symptoms
performs brain scans, PET scans, MRI, computed tomography
AD that looks amount of beta amyloid and Apo E in blood

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8
Q

why is an early diagnosis important

A

can help diagnoses other causes of memory problems
plan for future, financial and legal matters, learn living agreements, can provide opportunities to participate in clinical trials/ other research studies

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9
Q

what are the different types of dementia

A

alzheimers
vascular
Lewy body
frontotemporal
mixed

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10
Q

alzheimers

A

most common type
no cure but medicine can slow progression
symptoms: difficulty remembering recent events (often retaining good memory for past events), poor concentration, difficulty reorganising people or objects, poor organisational skills, confusion

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11
Q

vascular dementia

A

second most common type
occurs if oxygen supply to the brain is reduced because of narrowing or blockage of blood vessels
causes some brain cells to become damaged or die
symptoms: language, reading, writing, sudden changes in mood, walking, bladder control

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12
Q

Lewy body dementia

A

progressive condition affecting movement and motor control
memory loss is less affected
symptoms: prone to falls, sudden bouts of confusion, tremors, trouble swallowing, experience, disrupted sleep patterns due to intense dreams/ nightmares and auditory hallucinations

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13
Q

frontotemporal dementia

A

affects fontal lobes of the brain, controls behaviour, learning, personality and emotions
difficult to diagnose as sometimes complicated with depression, stress, anxiety, psychosis, OCD
can cause inappropriate social behaviour and lack of inhibitions
eating patterns can be affected

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14
Q

mixed dementia

A

when someone has more than one type of dementia and a mixture of the symptoms
possible to have 2 types of dementia at once
most commonly AD and vascular dementia

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15
Q

differential diagnosis for dementia

A

delirium
depression
drugs
normal age-associated memory changes
mild cognitive impairment

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16
Q

complications

A

alzheimers is life-limiting and people normally die from another cause:
aspiration
chest infections
lack of appetite and difficulty eating

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17
Q

how to break bad news

A

SPIKES
setting up
patients perception
invitation, accept patients
knowledge and information
emotions and empathy
strategy, summary and support

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18
Q

epidemiology

A

55 million globally
rise to 139 million expected by 2050
alzheimers account for 60-70% of dementia cases

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19
Q

treatment and management strategies

A

memory clinic
medication alzheimers
medication non alzheimers
medication challenging behaviour
coping strategies
non pharmacological treatment
end of life medication
anticipatory prescribing
palliative care
support groups
care homes
specialist care homes

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20
Q

memory clinic

A

specialist service where people with memory loss are assessed and diagnosed
ran by: neurophysiologists and nurse specialists
complete memory clinic test to assess all lobes of the brain, screening of brain, Addenbrookes cognitive examination, may organise MRI
may return months later to assess progression

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21
Q

alzheimers medication

A

acetylcholinesterase inhibitors
memantine

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22
Q

acetylcholinesterase inhibitors

A

donepezil, rivastigmine, galantamine
mechanism of action:
selectively and reversibly inhibits acetylcholinesterase enzyme, enhances cholinergic transmission OR involved in oppositio of glutamate-induced excitatory transmission via down regulation of amyloid proteins
side effects: aggression, decreased appetite, syncope, hyper salivation, bradycardia

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23
Q

memantine

A

mechanism of action:
uncompetitive (open-channel) NMDA receptor antagonist, preventing glutamate action on the receptor
has a preference for NMDA receptor-operated cation channels
side effects: impaired balance, confusion, embolism and thrombosis, hallucinations, heart failure

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24
Q

donepezil or rivastigmine

A

Lewy bodies (mild/moderate)
consider for severe DwLB

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25
Q

galantamine

A

Lewy bodies (mild/moderate) if above aren’t tolerated

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26
Q

memantine

A

Lewy bodies if AChE inhibitors not tolerated

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27
Q

AChE/memantine

A

vascular with suspected comorbid alzheimers, parkinsons or Lewy bodies

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28
Q

when shouldn’t you use AChE/ memantine

A

for frontotemporal dementia

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29
Q

medications for challenging behaviour

A

try coping strategies first
antipsychotics for extreme distress/aggression e.g. risperidone, haloperidol
antidepressants if depression is a cause of anxiety
alternative therapies= gingo biloba, cucumin, coconut oil

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30
Q

coping strategies

A

find triggers
keep active
provide reassurance
quiet calming environment
activities that give pleasure/ confidence (dance/listening to music)
therapies: animals/music/massages

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31
Q

non-pharmacological

A

cognitive stimulation therapy, CST
cognitive rehabilitation
reminiscence and life story work

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32
Q

pain in palliative care

A

opioids: morphine, diamorphine, oxycodone, affentanil

33
Q

breathlessness end of life medication

A

midazolam or an opioid

34
Q

anxiety end of life medication

A

midazolam

35
Q

delirium/ agitation end of life medication

A

haloperidol, levomepromazine
midazolam, phenobarbital

36
Q

nausea and vomiting end of life medication

A

cyclizine, metoclopramide, haloperidol, levomepromazine

37
Q

noisy chest secretions end of life medication

A

hyoscine hydrobromide
glycopyrronium

38
Q

anticipatory prescribing

A

ensuring someone has access to medicines they’ll need if they develop distressing symptoms at home/care home
symptoms required: pain, anxiety and distress, delirium, breathlessness, agitation, nausea and vomiting, noisy chest secretions

39
Q

palliative care

A

incurable illness
makes you as comfortable as possible by managing pain and other distressing symptoms
last months/ years of life
live as well as possible until you die, die with dignity

40
Q

Age UK

A

have some dementia specific classes such as singing for the brain, dance for dementia, art for dementia, memory cafes, trips and outings

41
Q

singing for the brain

A

brings dementia patients together by singing songs they know and love

42
Q

care homes

A

2 types
residential and nursing

43
Q

residential care homes

A

provide personal care
help with washing, dressing, medications and going to the toilet

44
Q

nursing care homes

A

personal care
24 hour care form qualified nurses

45
Q

specialist dementia care homes

A

simple building plans
coloured doors specific to areas to recognise where they are
easy access to all parts of the building
proper signage
dementia friendly furnishings
sensory gardens
gradual changing lighting

46
Q

communicating with dementia patients

A

VALID
reminiscence therapy
PEARL
SPARK

47
Q

VALID

A

validation
acknowledge feelings

48
Q

reminiscence therapy

A

use memories to stimulate conversations/ happiness

49
Q

PEARL

A

provide simple clear concise information
empathise
active listening
respect
listen

50
Q

SPARK

A

simplifying instructions
prepare environment
addressing emotions
repeat information
keep calm

51
Q

practical strategies to help someone with dementia

A

notes/ prompts
preparing advanced decisions

52
Q

social strategies to help someone with dementia

A

family help, support/ activity groups

53
Q

emotional strategies to help someone with dementia

A

humour
focus

54
Q

health improvement strategies to help someone with dementia

A

exercise
healthier diet

55
Q

support groups for dementia

A

Age UK
carers UK
dementia UK
relate

56
Q

psychological impact of dementia

A

grief
loss
anger
relief
fear
disbelief
irritability
lack of confidence
lack of self esteem
rapid mood changes

57
Q

advance care plans

A

outline patients preferences for their. future medical care if they can no longer have mental capacity to make their own decisions
voluntary process
may include: advance decision to refuse treatment, lasting power of attorney, context specific treatment recommendations
not legally binding but the ADRT and LPA are
prepared with help of HCP, reviewed and updated regularly

58
Q

who is given an advance care plan

A

deteriorating health
declining functional status
key transitions in health
major surgeries/ high risk treatments

59
Q

do not attempt resuscitation

A

when individual is in respiratory or cardiac arrest
decision is made by an individual, Dr or LPA
issued and signed by the Dr when CPR is unlikely to be successful
can be changed at any time
other treatments are still allowed
not legally binding but the ADRT is

60
Q

what does CPR involve

A

chest compressions
defibrillation
artificial ventilation
IV Meds

61
Q

lasting power of attorney

A

legal document
allows an individual to appoint someone they trust to make decisions on their behalf if they’re unable to
can have: health and welfare LPA and property and financial LPA
must be 18+ and have mental capacity
can have more than 1
costs £82 to register
can have decision restrictions

62
Q

generic pathophysiology of dementia

A

majority other than vascular are caused by an accumulation of naive proteins in the brain
not fully understood

63
Q

alzheimers pathophysiology

A

widespread atrophy of cortex
deposition of amyloid plaques
tangles of hyperphosphorylated tau protein in neurones
contribute to degeneration

64
Q

Lewy body pathophysiology

A

intracellular acucmulation of leeway bodies
which are insoluble aggregates of alpha-synuclein in neurons
mainly cortex

65
Q

frontotemporal pathophysiology

A

deposition of ubiquinated TDP-43
hyperphosphorylated tau proteins in frontal and temporal lobes
leads to dementia, early personality/ behavioural changes, aphasia

66
Q

vascular dementia pathophysiology

A

ischaemic injury to the brain e.g. stroke
leads to permanent neuronal death

67
Q

effect of dementia on the hippocampus

A

often involved and contributes to memory loss
cells in this region are normally first damaged in alzheimers, resulting in memory loss
changes in hippocampal volume (reduction) are seen with common ageing patterns but exacerbated in alzheimers

68
Q

anatomy of the brainstem

A
69
Q

cerebral peduncles

A

contains axons of upper motor neurons
descends from primary motor Cortex to spinal

70
Q

olives

A

external protrusions caused by underlying nuclei
inferior olivary nuclei regulate motor co-ordination and learning

71
Q

pyramids

A

bilateral protrusions caused by underlying corticospinal tracts
decussation where fibres swap sides, fibres run transversally between pyramids

72
Q

superior middle and inferior cerebellar peduncles

A

bilateral axon tracts that connect cerebellum and pons

73
Q

superior colliculi

A

involved in attention

74
Q

inferior colliculi

A

involved in auditory processing

75
Q

cross sections of the brain

A
76
Q

cerebral aqueducts

A

channel connecting 3rd and 4th ventricle

77
Q

corticospinal tracts

A

axon tracts involved in voluntary movement
run bilaterally down ventral pons
continuous with cerebral peduncles of midbrain

78
Q

thalamus

A

sits on both sides of the 3rd ventricle
passes through 3rd ventricle by inter thalamic adhesion

79
Q

label the image

A
  1. caudate nucleus
  2. caudate nucleus
  3. putamen
  4. thalamus
  5. caudate nucleus
  6. putamen
  7. globus pallidus
  8. thalamus

Medicine: PBL wrap-ups (21 decks)

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