1B dementia Flashcards
What is the commonest cause of dementia?
Alzheimer’s disease- a fatal neurodegenerative disorder characterised by progressive cognitive, social and functional impairment
Is there a cure to dementia?
No current cure, with acetylcholinesterase inhibitors having modest symptomatic benefit in early stages
What is the difference in prevalence of causes of dementia in young onset dementia (YOD) sufferers vs late onset dementia (LOD) sufferers?
- YOD sufferers have slightly more prevalence of familial autosomal dominant Alzheimer’s (fAD)
- Alzheimer’s disease is most common cause in both but way bigger proportion in LOD
- Lewy body dementia and other causes of dementia are more common in YOD
What are the most common causes of dementia?
- Alzheimer’s disease
- Vascular disease
- Frontotemporal dementia
- Lewy body dementia
What are some reversible causes of dementia?
- Alcohol related brain damage
- Benign tumours
- Infections e.g. HIV/syphilis
- Endocrine e.g. hypothyroidism
What does the continuum of dementia look like?
Anything that shifts that line up towards normal ageing is beneficial for that individual and for society
What does the continuum of dementia look like in reality and why?
These small ups and downs can be due to changes in eating or drinking, whether they had an infection at one time etc
Why is it difficult to diagnose dementia in clinic?
- The disease follows a heterogenous course
- In old age the disease presentation is of multiple comorbidities
- There are lots of mixed and uncertain pictures
- Younger patients are more typical
What is the most important thing for doctors to do in clinic with dementia patients?
- Get a clinical history
- See how well the patient is functioning
- How they change
What is the path a dementia patient takes through NHS?
1) Referral e.g. by GP or psychiatrist
2) History- with clinical interview
3) Examination
4) Investigations
5) Diagnosis
6) Management
What things do we ask or check during the interview with dementia patients?
Do a collateral too with children of sufferer
Look at chronology of each of these too to see how symptoms have changed over time
Define dementia
Severe loss of memory and other cognitive abilities which lead to impaired daily function (regardless of underlying cause)
What examinations happen after the interview with dementia patients?
- CN test, upper limb and lower limb nerve test
- Mental state e.g. speech, mood, behaviour, perception
What investigations are done for a dementia patient after examination?
- Neuropsychology
- MRI
- PET
- Bloods
- FBC
- inflammatory markers
- TFTs
- Biochemistry and renal function
- Glucose
- B12 and folate
- Clotting
- HIV
- Syphilis serology
- Caeruloplasmin
Describe the imaging.
Include a description of what you see as the disease progresses.
Image of sMRI of normal, MCI and AD patients
As the disease progresses:
- narrowed gyri
- widened sulci
- dilated & enlarged ventricles
Describe these imagings.
MRI shows that unlike Alzheimer’s, hippocampal volume and medial temporal lobe volume generally preserved.
PET scan show :
- Alzheimer’s → caudate and putamen lit up, lots of dopamine transporters available
- Lewy Body → less lit up due to less available dopamine transporters (less dopamine therefore cause Parkinsonian symptoms)- characteristic of Lewy Body
Describe the pathology of dementia with Lewy Bodies
Caused by the aggregation of alpha-synuclein which leads to deposition of Lewy Bodies → symptoms
Describe differentials for frontotemporal dementia
- Highly suggestive of frontotemporal dementia
- Changes in personality and behaviour
- Perisylvian fissure loss → correlate with increase behavorial disturbances, agitation, reduced speech output
- Loss of temporal lobe and frontal opercula volume
