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

Unit 6 Week 3: Alzheimer's Disease Flashcards

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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
galantamine
Lewy bodies (mild/moderate) if above aren't tolerated
26
memantine
Lewy bodies if AChE inhibitors not tolerated
27
AChE/memantine
vascular with suspected comorbid alzheimers, parkinsons or Lewy bodies
28
when shouldn't you use AChE/ memantine
for frontotemporal dementia
29
medications for challenging behaviour
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
30
coping strategies
find triggers keep active provide reassurance quiet calming environment activities that give pleasure/ confidence (dance/listening to music) therapies: animals/music/massages
31
non-pharmacological
cognitive stimulation therapy, CST cognitive rehabilitation reminiscence and life story work
32
pain in palliative care
opioids: morphine, diamorphine, oxycodone, affentanil
33
breathlessness end of life medication
midazolam or an opioid
34
anxiety end of life medication
midazolam
35
delirium/ agitation end of life medication
haloperidol, levomepromazine midazolam, phenobarbital
36
nausea and vomiting end of life medication
cyclizine, metoclopramide, haloperidol, levomepromazine
37
noisy chest secretions end of life medication
hyoscine hydrobromide glycopyrronium
38
anticipatory prescribing
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
palliative care
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
Age UK
have some dementia specific classes such as singing for the brain, dance for dementia, art for dementia, memory cafes, trips and outings
41
singing for the brain
brings dementia patients together by singing songs they know and love
42
care homes
2 types residential and nursing
43
residential care homes
provide personal care help with washing, dressing, medications and going to the toilet
44
nursing care homes
personal care 24 hour care form qualified nurses
45
specialist dementia care homes
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
communicating with dementia patients
VALID reminiscence therapy PEARL SPARK
47
VALID
validation acknowledge feelings
48
reminiscence therapy
use memories to stimulate conversations/ happiness
49
PEARL
provide simple clear concise information empathise active listening respect listen
50
SPARK
simplifying instructions prepare environment addressing emotions repeat information keep calm
51
practical strategies to help someone with dementia
notes/ prompts preparing advanced decisions
52
social strategies to help someone with dementia
family help, support/ activity groups
53
emotional strategies to help someone with dementia
humour focus
54
health improvement strategies to help someone with dementia
exercise healthier diet
55
support groups for dementia
Age UK carers UK dementia UK relate
56
psychological impact of dementia
grief loss anger relief fear disbelief irritability lack of confidence lack of self esteem rapid mood changes
57
advance care plans
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
who is given an advance care plan
deteriorating health declining functional status key transitions in health major surgeries/ high risk treatments
59
do not attempt resuscitation
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
what does CPR involve
chest compressions defibrillation artificial ventilation IV Meds
61
lasting power of attorney
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
generic pathophysiology of dementia
majority other than vascular are caused by an accumulation of naive proteins in the brain not fully understood
63
alzheimers pathophysiology
widespread atrophy of cortex deposition of amyloid plaques tangles of hyperphosphorylated tau protein in neurones contribute to degeneration
64
Lewy body pathophysiology
intracellular acucmulation of leeway bodies which are insoluble aggregates of alpha-synuclein in neurons mainly cortex
65
frontotemporal pathophysiology
deposition of ubiquinated TDP-43 hyperphosphorylated tau proteins in frontal and temporal lobes leads to dementia, early personality/ behavioural changes, aphasia
66
vascular dementia pathophysiology
ischaemic injury to the brain e.g. stroke leads to permanent neuronal death
67
effect of dementia on the hippocampus
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
anatomy of the brainstem
69
cerebral peduncles
contains axons of upper motor neurons descends from primary motor Cortex to spinal
70
olives
external protrusions caused by underlying nuclei inferior olivary nuclei regulate motor co-ordination and learning
71
pyramids
bilateral protrusions caused by underlying corticospinal tracts decussation where fibres swap sides, fibres run transversally between pyramids
72
superior middle and inferior cerebellar peduncles
bilateral axon tracts that connect cerebellum and pons
73
superior colliculi
involved in attention
74
inferior colliculi
involved in auditory processing
75
cross sections of the brain
76
cerebral aqueducts
channel connecting 3rd and 4th ventricle
77
corticospinal tracts
axon tracts involved in voluntary movement run bilaterally down ventral pons continuous with cerebral peduncles of midbrain
78
thalamus
sits on both sides of the 3rd ventricle passes through 3rd ventricle by inter thalamic adhesion
79
label the image
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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