11. Dementia And Epilepsy Flashcards
What is the definition of dementia?
Progressive decline in higher cortical function leading to a global impairment of memory, intellect and personality which effects the individuals ability to cope with activities of daily living.
Name 3 reversible conditions that can lead to dementia-like symptoms.
Depression, trauma, vitamin deficiency, alcohol, thyroid disorders.
How does dementia present?
Memory deficit, behavioural changes, physical changes eg incontinence, language disorder, visuospatial disorder and apraxia.
What investigations would you carry out if you suspected a patient had dementia?
Full history (collateral from family) and MMSE.
Full neurological examination.
Blood tests for reversible causes eg TFTs and Vit B12.
CT/MRI head.
Memory clinic follow up.
What can be used to distinguish delirium from dementia?
CAM (confusion assessment method) score.
If two or more of the following then is likely to be delirium:
Acute change or fluctuating mental status.
Altered consciousness - hypo/hyperactive.
Inattention.
Disorganised thinking.
What is seen pathologically in Lewy Body dementia?
Lewy Bodies in the cortex and substantia nigra.
What is seen clinically in a patient with Lewy Body dementia?
Substantial fluctuations in the degree of cognitive impairment over time.
Parkinson’s symptoms.
Visual hallucinations.
Frequent falls.
What is seen pathologically in vascular dementia?
Arteriosclerosis of the blood vessels supplying the brain.
Diffuse small vessel disease or infarcts, leading to ischaemia.
What is seen clinically in vascular dementia?
Abrupt, step-wise decline in cognitive function related to vascular episode.
How is vascular dementia managed?
Assess CVS risk and treat hypertension/high cholesterol.
What is seen pathologically in frontotemporal dementias?
Frontotemporal lobar degeneration with tau pathology.
Picks disease - TAU proteins form Pick Bodies in the frontal and temporal lobes.
Familial tauopathies.
What is seen clinically in frontotemporal dementias?
Alteration of social behaviour and personality eg agitation and depression.
Impaired judgement and insight eg gambling, taking off clothes, inappropriate comments.
Speech output falls eventually to a state of mutism.
What can be done to help manage dementia?
Therapies - eg pets and babies.
Social care - eg risk assessment, care needs, mental capacity act.
Memory aids - eg orientation boards, remembrance therapy, life stories.
Drugs - eg cholinesterase inhibitors, memantine.
What is a seizure?
A sudden irregular discharge of electrical activity in the brain causing a physical manifestation such as sensory disturbance, unconsciousness or convulsions.
What is a convulsion?
Uncontrolled shaking movements of the body due to rapid and repeated contraction and relaxation of muscles.
What is an aura?
A perceptual disturbance experienced by some prior to a seizure, eg strange light, unpleasant smell or confusing thoughts.
What is epilepsy?
A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness or convulsions, associated with abnormal electrical activity in the brain.
What is status epilepticus?
Epileptic seizures occurring continuously without recovery of consciousness in between. This is a medical emergency as can become cyanotic.
What is the difference between partial and generalised seizures?
Partial - just one area of the brain affected. Affects one cerebral hemisphere.
Generalised - one main focal point int he brain, but with lots of other little areas affected. Affects both cerebral hemispheres.
What is the difference between simple and complex partial seizures?
Simple - person remains conscious.
Complex - consciousness is impaired.
Temporal lobe epilepsy is the most common cause of partial seizures. When does it tend to occur?
In the first or second decade in most people, following seizure with fever or early injury to the brain. Usually preempted by an aura.
What is a tonic-clonic generalised seizure?
A seizure causing muscle tensing and convulsions.
What is an absence generalised seizure?
Random ‘daydreaming’ eg pause mid conversation, then continue as normal.
What is a myoclonic generalised seizure?
A seizure causing brief shock-like muscle jerks.
What is an atonic generalised seizure?
A seizure where there is a lack of muscle tone - drop attack.
What is a tonic generalised seizure?
A seizure with increased muscle tone.
How would you investigate a patient for suspected epilepsy?
Taking a thorough clinical history including what happened before, during and after the seizure, including collateral history.
EEG - is not diagnostic but supports diagnosis.
MRI - to exclude other suspected causes of seizures eg intracerebral mass.
What drugs can be used for the initial management of seizures?
Benzodiazepines - lorazepam or midazolam.
What are the laws surrounding epilepsy and driving?
When first diagnosed - if suffer from seizures when awake, then licence taken away until 1 year seizure free.
If a medication change causes a seizure - 6 months seizure free.
If seizures are whilst asleep or don’t affect driving or consciousness - assessment of case by DVLA.
If a one-off seizure - wait 6 months seizure free, then assessment by the DVLA.
