15) Dementia and Epilepsy Flashcards
What is dementia?
Progressive decline in higher cortical function leading to global impairment of memory, intellect and personality which affects activities of daily living
What are some types of dementia?
Alzheimer’s, fronto-temporal, vascular, dementia with Lewy Bodies
What are some reversible causes of dementia?
Depression Trauma Vitamin def. Alcohol Thyroid disorders
What affect does dementia have on memory?
Struggle to learn new information
Short term memory loss
What are some behavioural features of dementia?
Altered personality, disinhibition, wandering
What are some physical signs in dementia?
Incontinence, difficulty swallowing
What investigations can be performed to diagnose dementia?
History and mini-mental state exam
Neurological exam
Blood tests for reversible causes: TFTs, B12
CT/MRI - rule out dementia
What is delirium?
Acute confusional state causing decline in mental function
What are the points on the conduction assessment method?
Acute change of fluctuating mental state
Altered consciousness
Inattention
Disorganised thinking
What might be seen on CT and MRI imaging of someone with dementia?
Dilation of ventricles, generalised atrophy, hippocampal atrophy
Describe the cognitive decline in Alzheimer’s disease, vascular and Lewy Body dementia:
Alzheimer’s: constant
Vascular: sudden drops
LB: varying
What is pathophysiology behind Alzheimer’s?
Loss of cortical and subcortical white matter causing gyral atrophy and ventricular dilation - due to amyloid beta plaques and neurofibrillary tangles
Describe the mild stage of Alzheimer’s:
2-4 years, minor memory loss
Describe the moderate stage of Alzheimer’s:
2-10 years, confusion, difficulty in self care, behavioural changes
Describe the severe stage of Alzheimer’s:
1-3 years, completely incapacitated, retreat into themselves, don’t recognise people, loss of bodily function, violence
Describe the pathophysiology behind Lewy body dementia:
Lewy bodies form in cortex and substiantia nigra causing degeneration
What are the features of Lewy body dementia?
Fluctuations in cognitive impairment, Parkinsonism, visual hallucinations, REM sleep behaviour disorder, falls
What can be the underlying cause of vascular dementia?
Atherosclerosis of BVs supplying brain
Diffuse small vessel disease infarcts
What are some types of frontotemporal dementia?
Frontotemporal lobar degeneration with Tau pathology, Pick’s disease, familial tauopathies
What are some of the features of frontotemporal dementia?
Alteration of social behaviour and personality Agitation Depression Impaired judgement and insight Mutism
How should dementia be managed?
Drugs: cholinesterase inhibitors, memantine
Social care
Memory aids
Therapies - pets, babies
What is a seizure?
Sudden, irregular discharge or electrical activity in the brain causing a physical manifestation
What is a convulsion?
Uncontrolled shaking movements, rapid, repeated contraction and relaxation
What is an aura?
Perceptual disturbance prior to seizure
What is epilepsy?
Neurological disorder marked by sudden recurrent episodes of sensory disturbance, LOC or convulsions
What is status epilepticus?
Epileptic seizures occurring continuously without recovery of consciousness in between
How can seizures be classified?
Partial and generalised
What are some examples of partial seizures?
Simple: same consciousness
Complex: consciousness impaired
Give examples, with a brief description, of generalised seizures:
Tonic-clonic: 1st muscles tense, 2nd convulsions Absence: 'day-dreaming', sudden LOC Myoclonic: brief shock like muscle jerks Atonic: drop attack, fall to floor Tonic: increased tone
What investigations can be done on someone presenting after a seizure?
History, EEG, MRI
Describe the key points to ask on a history of someone presenting with a seizure:
Prior to seizure (trigger, aura)
During (description, duration)
After (post ictal state)
What are some differential diagnoses for seizures?
Stroke, meningitis, SLE, hypoxia, electrolyte imbalance, hypoglycemia, alcohol withdrawal
