1) Organic Disorders Flashcards
Define the term dementia clinically with reference to it’s presentation.
Progressive decline of global cognitive function (6 months or over) with:
- Memory decline
- Decline in intellect
- Loss of emotional control and socio-behavioural problems
- Effects on daily living
What are the four A’s of Alzheimer’s disease?
- Aphasia
- Agnosia
- Apraxia (can’t carry out previously learnt movements)
- Amnesia
Describe the pathology underlying Alzheimer’s disease.
Cortical dementia of temporal and parietal lobes with atriophy of hippocampus where there is:
- Neurofibrillary tangles of Tau protein which have become hyperphosphorylated, stable and twisted
- Senile plaques of enlarged axons, synaptic terminals & dendrites with deposited amyloid protein (Beta amyloid)
Which allele is found in 15-20% off Alzheimer’s disease patients?
apoE4 allele
Suggest three gross features that may be found on examination of a patient with dementia.
- Wide sulci
- Enlarged ventricles
- Atrophied/shrunken gyri
Suggest FOUR risk factors for dementia.
- Genetic
- Vascular causes such as:
+ Smoking, alcohol
+ Cholesterol
+ Diabetes
+ Hypertension - Psychological (stress, mental disorders)
Suggest FOUR protective factors against dementia.
- Antioxidants
- Vitamins
- Mental activity (crossword, sudoku)
- Physical activity
What type of dementia occurs below the age of 65?
Pre-senile
Suggest TWO possible things that may be found in the CSF of a patient with dementia.
- Beta amyloid
- Tau protein
Suggest THREE reversible causes of dementia.
- Neurosyphillis
- Thiamine/B12 deficiency
- Hypothyroidism
- Normal pressure hydrocephalus
Suggest TWO neurological causes of subcortical dementia.
- Idiopathic parkinson’s disease
- Huntingdon’s disease
What is Pick’s disease? How does it present?
Selective atrophy of frontal & temporal lobes
What is the first line treatment for Alzheimer’s disease?
Acetylcholineesterase inhibitors
Describe the presentation of dementia with Lewy bodies.
- Visual hallucinations (may see little/big people - lilluputian )
- Parkinsonism
- Fluctuation in alertness
- Memory loss can be a LATE feature
Describe the underlying pathology of dementia w/ Lewy bodies.
Alpha synuclein & ubiquitin become deposition in limbic areas
Describe how acetylcholineesterase inhibitors work in dementia.
In dementia there is degradation of cholingeric neurones which means there is ACh, which is why giving drugs to increase it slows the progress of dementia.
Why are antipsychotics contra-indicated in dementia with Lewy bodies patients?
Neuroleptic sensitivity - risk of neuroleptic malignant syndrome
Which TWO dementias are acetylcholineesterase inhibitors thought to be most effective?
- Alzheimer’s disease
- Dementia with Lewy bodies
Describe the pattern of progression of vascular dementia.
Stepwise deterioration with sudden drops in cognition followed by plateaus.
In which gender is Alzheimer’s disease more common? How much by?
Women - almost twice as common
Other than the 4 As of Alzheimer’s suggest THREE other parts of the clinical presentation.
- Behavioural changes
- Depression
- Hallucinations & delusions are possible
Define the term delirium.
Acute global impairment of cognition resulting in disturbances of attention and conscious level. It can be predominately hypoactive, hyperactive or switch between the two
Suggest THREE possible causes of delirium.
- Infection (common)
- Drugs
- Acute systemic illness
- Acute CNS disorders (stroke, encephalitis)
Suggest FOUR drugs that may be cause delirium.
- Opiates
- Anaesthetics
- Steroids
- Diuretics
- Anticholinergic & antiparkinsonian
- Psychotropic drugs (antidepressants, antipsychotics & BZDs)
What type of hallucinations may accompany delirium?
Visual
At what point of the day is delirium commonly worse?
Night
Suggest some of the possible risk factors for developing delirium.
- Hip fracture (current)
- Extremes of age
- Pre-existing dementia/cognitive impairment
Suggest TWO ways
- AMT or clock drawing
- Inattention test
Contrast hypoactive (majority of cases) with hyperactive delirium.
- Hypoactive patients who are usually quiet, sleepy and inactive
- Hyperactive patients are more aroused and can be found wandering in restless, irritable agitation.
What tool can be used to screen for delirium?
Confusion assessment method (CAM)
How can delirium be treated?
- Treat underlying condition
- Maintain hydration & nutrition
- Low dose haloperidol or olanzapine (as there is less chance of sedation)
