13. Dementia and Epilepsy Flashcards
What is dementia?
Progressive decline in higher cortical function leading to a global impairment of memory, intellect and personality which affects the individuals ability to cope with activities of daily living.
What are the areas of presentation of dementia?
Memory deficit, behavioural, physical, language disorder, visuospatial disorder, apraxia.
What are the memory deficits in dementia?
Struggle to learn new information, short term memory loss.
What are the behavioural changes in dementia?
Personality, disinhibition, labile emotion, wandering.
What are the physical changes in dementia?
Incontinence, reduced oral intake, difficulty swallowing.
What are the language disorders of dementia?
Anomic aphasia, difficulty understanding language.
What are the visuospatial disorders of dementia?
Unable to identify visual and spatial relationships between objects.
What are the apraxic features of dementia?
Difficulty with motor planning so inability to perform learned purposeful movements.
What investigations are needed in dementia?
Full history and mini mental score examination; full neurological examination; blood tests; CT/MRI of head; memory clinic follow up.
What is the difference between presentation of delirium and dementia?
Delirium has altered mental state but dementia doesn’t.
What does the confusion assessment method look at?
Acute change of fluctuating mental status, altered consciousness, inattention, disorganised thinking.
How does the rate of progression of cognitive decline differ in vascular, Alzheimer’s, and lewy body dementia?
Vascular - steady until next vascular insult then sudden decline to new steady state.
Alzheimer’s - consistent rate of fast decline.
Lewy body - fluctuates, can even improve for some time.
What are the macroscopic features of Alzheimer’s disease?
Loss of cortical and subcortical white matter - gyral atrophy, narrow gyri, wide sulci. Ventricular dilation from loss of white matter.
What is the microscopic pathology of Alzheimer’s disease?
Amyloid-beta plaques, neurofibrillary tangles.
What are the three stages of Alzheimer’s disease?
Mild for 2-4 years, minor memory loss; moderate for 2-10 years, withdrawn and confused; severe for 1-3 years, incapacitated, don’t recognise people, can be violent.
What is the pathology of dementia with lewy bodies?
Lewy bodies in cortex and substantia nigra.
What are the clinical features of dementia with lewy bodies?
Substantial fluctuation in degree of cognitive impairment over time, Parkinson’s symptoms, visual hallucinations, frequent falls.
What are the key clinical features of vascular dementia?
Abrupt, step-wise decline in cognitive function related to vascular episodes.
What is the pathology of vascular dementia?
Arteriosclerosis of blood vessels to brain, small vessel disease vs infarcts, decreased/cut off blood supply to brain.