13 - Dementia Flashcards
What types of dementia are there?
What are the most common types of dementia in the UK?
What are the differentials for dementia?
Delirium
Depression
Amnesia
Aphasia
Normal memory decline with age
What is Alzheimer’s disease?
- Chronic and progressive neurodenegerative disease
- Caused by neurofibrillary tangles & plaques
Causes memory loss and reduction in executive function
How is AD diagnosed?
Cognitive testing
Dementia blood screen
CT/MRI head shows general atrophy
Structural imaging - e.g. FDG-PET scan
What are the RF for AD?
Age
FHx
Poss link to Down’s
Lifestyle
Poor school education
Link with cerebrovascular disease
What is the treatment for AD?
Support
ACh Inhibitors = e.g. donepezil, galantamine, rivastigmine (memantine is 2nd line)
Manage Sx
What is vascular dementia?
Chronic progressive
Some overlap with AD
Executive function more affected than memory
Slowed processing - poor attention and apathy
Loss of brain parenchyma
How is vascular dementia diagnosed?
Cog testing
Demential bloods
CT/MRI Head
ECG / carotid dopplers
What are the RF for vascular dementia?
Age, obesity, HT, smoking
PHx stroke
DM, hypercholesterolaemia
What is the Rx for vascular dementia?
Prevent further cerebrovascular disease - anti-platelet therapy, aspirin and coagulation
If mixed with AD - cholinesterase inhibitors
Psychological intervention
What are the Sx of DLB?
Progressive neurogeneration
Hallucinations
Behavioural and sleep problems
Poss anxiety and depression
Orthostatic hypotension +/- falls
Urinary Sx
Constipation
May develop Parkinsonism - bradykinesia, resting tremor, rigidity
How is DLB diagnosed?
Cognitive testing
Demential bloods
CT / MRI - cortical atrophy
Consider SPECT scan
What is the prognosis of a P with DLB?
Approx 5 years
What are the Sx of FTD?
Change in behaviour and personality
Loss of social inhibition
Self neglect, isolation
Loss of language - fluency, understanding
How is FTD diagnosed?
Cognitive testing
Dementia bloods
CT/MRI - areas of atrophy
Consider FDG-PET
What age do Ps usually get FTD?
45-65
What is the prognosis for Ps with FTD?
6-13 years
What is the Rx for FTD?
Supportive
No evidence of meds for FTD Sx. Medicate if agitation / aggression - poss benzos or APs
Behavioural management
How does a dementia Hx differ from a normal Hx?
Ask about deterioration
Are family coping? Do they have concerns?
Is current home care plan suitable? Or do they need a package of care?
What is the purple flower scheme that indicates a P has dementia?
Forget me not scheme
What document can detail a P info, likes and dislikes for Ps with dementia to help improve their care?
Patient passport
What sticker scheme is in place to identify Ps with dementia (insect related)…
Butterfly scheme
What can cause agitation in elderly Ps with dementia?
What are the associated risks of being in hospital for elderly Ps?
Which model of unmet needs is used in managing elderly Ps?
Cohen Mansfield Model of Unmet Needs
Which pain scale is used in elderly Ps with dementia who cannot verbalise?
Abbey Pain Scale
What do MOCA scores below indicate?
- <10
- 10-20
- 20-25
- 26+
What is the triad of Sx for normal pressure hydrocephalus?
Wet, wacky, wobbly
Gait deviation, dementia, and urinary incontinence
What are potential causes of reversible cognitive decline?
DEMENTIA
D = Drugs (Anticholinergics)
E = Emotional (depression)
M = Metabolic or endocrine
E = Eyes/Ears declining
N = Normal Pressure Hydrocephalus
T = Tumour or space occupying lesion
I = Infection (syphyllis, HIV)
A = Anaemia (B12 or folate deficiency)
