Memory Problems: Clinical Aspects and Management Flashcards Preview

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Flashcards in Memory Problems: Clinical Aspects and Management Deck (37)
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1
Q

what types of advance planning should be encouraged while patients have capacity to decide about future needs?

A

practical and legal advice (eg powers of attorney, driving)

2
Q

in general, what is the diagnostic criteria for dementia?

A

history consistent with global cognitive decline over months-years
cognitive testing consistent with history
decline in level of function
no evidence of reversible cause

3
Q

what are four examples of cognitive tests?

A

ACE-III (standard in most POA depts)
MoCA (shorter, in many languages)
Frontal Assessment Battery
Detailed neuropsychological testing (standardised according to premorbid ability)

4
Q

what type of test can be used to get a collateral history?

A

short informant questionnaire on cognitive decline in the elderly (short IQCODE)

5
Q

what type of occupational therapy assessment is undertook for those with dementia?

A

cognitive performance test

  • observation of activities - washing, dressing, usually a phone, shopping, making toast, travelling
  • estimates cognitive level and level of supervision required for daily living
6
Q

what are common reversible causes of cognitive impairment?

A
delirium 
alcohol 
medication 
thyroid and other endocrine / metabolic disorder
depression 
brain lesions 
neuro infections / inflammation
7
Q

what classifies mild cognitive impairment?

A

noticeable cognitive impairment with little deterioration of function

ACE-III usually 75-90, MoCA usually 24-26

8
Q

what should you do when someone has mild cognitive impairment?

A

repeat cognitive testing yearly

may benefit from home based memory rehabilitation

9
Q

what is subjective cognitive impairment?

A

patient feels that they are cognitively impaired but cognitive testing and day to day function are normal
often associated with anxiety, depression or stress and is often difficult to convince pt they dont have dementia

*cycles of increasing anxiety about memory causing more lapses common

10
Q

what are the features of alzheimers disease?

A

memory loss particularly short term
dysphasia
dyspraxia
agnosia

11
Q

what does alzheimers disease look like on imaging?

A

CT/MRI normal
may show medial temporal lobe atrophy or temporoparietal atrophy

*look on lecture

12
Q

what are the two variants of alzheimers disease?

A

frontal

posterior cortical atrophy

13
Q

what are the features of vascular dementia?

A

dysphasia, dyscalculia, frontal lobe symptoms and affective symptoms more common

may have focal neurological signs, vascular risk factors or step wise decline

14
Q

what does vascular dementia look like on imaging?

A

CT/MRI - moderate / severe small vessel disease or multiple lacunar infarcts

SPECT - patchy reduction in tracer uptake throughout brain

*look on lecture

15
Q

what are the three syndromes of frontotemporal dementia?

A

behavioural variant - behavioural changes, executive dysfunction, disinhibition, impulsivity, loss of social skills, apathy, obsessions and change in diet

primary progressive aphasia - effortful non-fluent speech, speech sound/articulatory errors, lack or grammar or words

semantic dementia - impaired understanding of meaning of words, fluent but empty speech, difficulty retrieving names

16
Q

what does frontotemporal dementia look like on imaging?

A

CT/MRI - frontotemporal atrophy

SPECT - frontotemporal reduction in tracer uptake

*look on lecture

17
Q

what is the criteria which fits dementia with lewy bodies?

A

dementia - common early involvement of reduced attention, executive function and visuospatial skills

two of

  • visual hallucinations
  • fluctuating cognition (delirium-like)
  • REM sleep behaviour disorder
  • parkinsonism (not more than 1 year prior to onset of dementia
  • positive DAT scan
18
Q

when does 80% of parkinsons dementia occur and what is its clinical presentation?

A

15-20 years after parkinsons disease
*must have parkinsonism for at least 1 year prior onset

presentation similar to DLB & positive DAT scan

19
Q

when should you present that something less common is going on in terms of memory impairment?

A
fast progression 
young patient 
neurological signs 
family history of rare or young dementia
clues in PMH eg HIV 
something just doesn't fit
20
Q

what four types of imaging can be used for memory impairment?

A

CT
single photon emission CT (SPECT)
DaT (dopamine active transporter) scan
MRI

21
Q

when would a CT scan be used?

A

currently standard
dont scan if patient is over 80 with typical history of alzheimers
otherwise, helpful in excluding tumour / bleed /large stroke, quantifying vascular changes or identifying structural features

22
Q

when would a MRI scan be used?

A

young, fast progression or other atypical features

23
Q

when would a SPECT scan be used?

A

most useful for frontotemporal

may also be used if trying to clarify alzheimers diagnosis

24
Q

when would a DAT scan be used?

A

for suspected DLB / DPD when a patient doesnt have enough supporting features to be sure of a diagnosis

25
Q

what cholinesterase inhibitors are used in alzheimers?

A

donepezil
rivastigmine
galantamine

26
Q

what cholinesterase inhibitor is the only one licensed for DLB and DPD?

A

rivastigmine

27
Q

in which disease does cholinesterase inhibitors have more effect - DLB/DPD or alzheimers?

A

DLB/DPD

28
Q

what are the common side effects of cholinesterase inhibitors?

A
GI (nausea and diarrhoea most common)
headache
muscle cramps
bradycardias
worsen COPD / asthma
29
Q

bearing in mind the side effect of bradycardia, what should be checked before prescribing or increasing dose of cholinesterase inhibitors?

A

pulse

30
Q

in which conditions should you not prescribe cholinesterase inhibitors?

A

active peptic ulcer

severe asthma / COPD

31
Q

what is memantine licensed for?

A

alzheimers disease

slow cognitive decline, prevents BPSD

32
Q

what are the possible side effects of memantine?

A

well tolerated but may cause:

  • hypertension (check BP before starting)
  • sedation
  • dizziness
  • headache
  • constipation
33
Q

what is the rules surrounding driving with dementia?

A
always discuss at diagnosis 
must be reported to DVLA
patient fills in CG1 form 
DVLA request report from doctor
doctor decides if patient can drive while investigations ongoing 
rockwood driving battery 
on road test
34
Q

what are the behavioural and psychological symptoms (BPSD) which patients often get in later stages?

A
hallucinations 
delusions
insomnia
anxiety
depression
aggression 
agitation 
disinhibition
35
Q

what can be used for the pharmacological management of agitation in alzheimers?

A

antipsychotics, citalopram, memantine, analgesia, dextromethorphan

36
Q

what can be used for pharmacological management of agitation in FTD?

A

trazodone

37
Q

what other pharmacological treatments are used in practice for BPSD?

A

anxiety - antidepressants, benzodiazepines, pregabalin

visual hallucinations - cholinesterase inhibitors, antipsychotics

other psychotic symptoms - antipsychotics

insomnia - melatonin, Z drugs, benzodiazepines, sedating and antidepressants

agitation and aggression - benzos, antipsychotics, sedating antidepressants, cholinesterase inhibitors, memantine, pregabalin