13. Dementia and Epilepsy Flashcards

1
Q

What is dementia?

A

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.

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2
Q

What are the areas of presentation of dementia?

A

Memory deficit, behavioural, physical, language disorder, visuospatial disorder, apraxia.

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3
Q

What are the memory deficits in dementia?

A

Struggle to learn new information, short term memory loss.

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4
Q

What are the behavioural changes in dementia?

A

Personality, disinhibition, labile emotion, wandering.

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5
Q

What are the physical changes in dementia?

A

Incontinence, reduced oral intake, difficulty swallowing.

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6
Q

What are the language disorders of dementia?

A

Anomic aphasia, difficulty understanding language.

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7
Q

What are the visuospatial disorders of dementia?

A

Unable to identify visual and spatial relationships between objects.

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8
Q

What are the apraxic features of dementia?

A

Difficulty with motor planning so inability to perform learned purposeful movements.

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9
Q

What investigations are needed in dementia?

A

Full history and mini mental score examination; full neurological examination; blood tests; CT/MRI of head; memory clinic follow up.

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10
Q

What is the difference between presentation of delirium and dementia?

A

Delirium has altered mental state but dementia doesn’t.

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11
Q

What does the confusion assessment method look at?

A

Acute change of fluctuating mental status, altered consciousness, inattention, disorganised thinking.

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12
Q

How does the rate of progression of cognitive decline differ in vascular, Alzheimer’s, and lewy body dementia?

A

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.

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13
Q

What are the macroscopic features of Alzheimer’s disease?

A

Loss of cortical and subcortical white matter - gyral atrophy, narrow gyri, wide sulci. Ventricular dilation from loss of white matter.

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14
Q

What is the microscopic pathology of Alzheimer’s disease?

A

Amyloid-beta plaques, neurofibrillary tangles.

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15
Q

What are the three stages of Alzheimer’s disease?

A

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.

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16
Q

What is the pathology of dementia with lewy bodies?

A

Lewy bodies in cortex and substantia nigra.

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17
Q

What are the clinical features of dementia with lewy bodies?

A

Substantial fluctuation in degree of cognitive impairment over time, Parkinson’s symptoms, visual hallucinations, frequent falls.

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18
Q

What are the key clinical features of vascular dementia?

A

Abrupt, step-wise decline in cognitive function related to vascular episodes.

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19
Q

What is the pathology of vascular dementia?

A

Arteriosclerosis of blood vessels to brain, small vessel disease vs infarcts, decreased/cut off blood supply to brain.

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20
Q

How is vascular dementia managed?

A

Cardiovascular risk is assessed - treat hypertension/high cholesterol.

21
Q

What are the clinical features of frontotemporal dementias?

A

Alteration of social behaviour and personality (agitated and depressed); impaired judgement and insight - gambling, taking off clothes, inappropriate comments; speech output falls to mutism.

22
Q

What are the targets for management of dementia?

A

Holistic - social care; drugs; memory aids; therapies (pets + babies).

23
Q

What is a seizure?

A

A sudden irregular discharge of electrical activity in the brain causing physical manifestation like sensory disturbance, unconsciousness or convulsions.

24
Q

What is a convulsion?

A

Uncontrolled shaking movements of the body due to rapid and repeated contraction and relaxation of muscles.

25
Q

What is an aura?

A

Perceptual disturbance prior to a seizure.

26
Q

What is epilepsy?

A

Neurological disorder marker by sudden recurrent episodes of sensory disturbance, LOC or convulsions, associated with abnormal electrical activity in the brain.

27
Q

What is status epilepticus?

A

Epileptic seizures occurring continuously without recovery of unconsciousness inbetween.

28
Q

What are the two broad types of seizure?

A

Partial and generalised.

29
Q

What are the types of partial seizure and the difference between them?

A

Simple (consciousness kept) or complex (consciousness impaired).

30
Q

When does temporal lobe epilepsy most commonly occur?

A

In 1st/2nd decade.

31
Q

What are the features of temporal lobe epilepsy?

A

Auras - auditory hallucinations.

32
Q

What are the features of frontal lobe epilepsy?

A

Abnormal movement when motor areas are affected to contralateral side.

33
Q

What is a tonic clonic seizure?

A

A generalised seizure of two parts - first tonic (increased tone, rigid), then clonic (convulsions).

34
Q

What is an absence seizure?

A

A generalised seizure that presents as daydreaming.

35
Q

What is a myoclonic seizure?

A

A generalised seizure that involves brief shock-like muscle jerks.

36
Q

What is an atonic seizure?

A

A generalised seizure that presents with no tone, drop attack.

37
Q

What is a tonic seizure?

A

A generalised seizure presenting with increased tone.

38
Q

What are the investigations needed in epilepsy?

A

Clinical history, EEG, and MRI.

39
Q

What are the important components of a history from someone with seizures?

A

Before, during, and after the seizure. Collateral history if possible.

40
Q

What should be asked in the before a seizure section of a history?

A

PMH, FH, triggers, aura, first sign/symptom.

41
Q

What should be asked in the during a seizure section of a history?

A

Description of the seizure, duration, abrupt or gradual end?

42
Q

What should be asked in the after a seizure section of a history?

A

Post-ictal state, tongue biting, incontinence, neurological deficit.

43
Q

What are the differential diagnoses of epilepsy?

A

Vascular - stroke, TIA; infection - abscess, meningitis; trauma - intracerebral haemorrhage; autoimmune - SLE; metabolic - hypoxia, electrolyte imbalance, hypoglycaemia, thyroid dysfunction; iatrogenic - drugs, alcohol withdrawal; neoplastic - intracerebral mass.

44
Q

What is the use of EEGs in investigating seizures?

A

Supports diagnosis, assesses risk of seizure recurrence.

45
Q

If an EEG is unclear for epilepsy, what should be considered?

A

Repeated EEG, sleep EEG, long-term video or ambulatory EEG.

46
Q

What does a standard EEG assessment involve?

A

Photic stimulation and hyperventilation.

47
Q

What is the initial management of seizures?

A

ABCDE, if >5 minutes then need medical assistance.

48
Q

What are the rules surrounding driving and epilepsy?

A

If when awake - no license for a year seizure-free. If due to medication change - no license for 6 months seizure-free. If whilst asleep - assessed by DVLA. If one-off seizure - 6 months seizure-free + DVLA assessment.