Alzheimer's Disease and Dementia Flashcards
What is the most common type of dementia?
Alzheimer’s disease (~60%)
What is the second most common type of dementia?
Vascular dementia (~20%)
What is the third most common type of dementia?
Lewy body dementia (~10%)
What might cause reversible dementia?
▪️Chronic alcohol abuse
▪️Deficiencies
▪️Metabolic/endocrine changes
▪️Infection
▪️Neoplastic
What are the three pathological hallmarks of Alzheimer’s disease?
▪️Beta amyloid deposition (plaques)
▪️Neurofibrillary tau tangles
▪️Neuronal loss
In Alzheimer’s disease, where is atrophy most apparent?
The medial temporal lobes
What is vascular dementia?
Arteriosclerosis and neuronal death due to occlusion of the arteries and reduced blood flow to the brain (multiple large cerebral infarcts)
Give examples of cardiovascular events that may lead to vascular dementia.
▪️Embolus
▪️Vasculitis
▪️Haemorrhage
What scan would be used to look for Lewy body dementia?
DAT scan to look at dopamine uptake, particularly in the basal ganglia and substantia nigra
What is the main pathological finding in Lewy body dementia and which proteins are involved?
Lewy bodies - alpha-synuclein and ubiquitin
What are the three main features needed for clinical diagnosis of dementia?
▪️Cognifive failure (> 6 months)
▪️Deterioration in functioning
▪️Evidence of progression
What is the pattern of cognitive failure linked to in early stage dementia?
The distribution of brain and neurotransmitter dysfunction
At what point in dementia progression would you see regional and global brain atrophy?
Later stages
What brain changes would you see in the later stages of dementia?
Global brain atrophy
What deficit would be most apparent with medial temporal and hippocampal atrophy?
Memory
What deficit would be most apparent with lateral temporal atrophy?
Language
What are the four ‘A’s of dementia?
Amnesia
Aphasia
Apraxia
Agnosia
What types of memory are better/longer preserved in dementia?
Long term memory and motor memory
What is apraxia?
Inability to preform skilled movememts and intentional acts despite intact motor and sensory systems
What activities may be affected by apraxia?
Dressing, eating, drawing
What is agnosia?
Inability to understand the significance of sensory stimuli
What tools can be used to test global cognition?
▪️MMSE
▪️ACE-III
What percentage of individuals with dementia experience behavioural and psychological symptoms?
98%
What are behavioural and psychological symptoms in dementia associated with?
▪️Greater distress (patient and carer)
▪️Worsening cognition
▪️Worsening daily functioning
▪️Increased risk of falls
▪️Earlier institutionalisation and death
What is the usual time course of Alzheimer’s disease?
▪️Gradual onset
▪️Early memory impairment
▪️Progressive cognitive decline
Which type of dementia may be observed with a stepwise deterioration of cognition?
Vascular dementia
What risk factors may be indicative of vascular dementia?
Vascular risk factors such as diabetes, hypertension, history of heart attacks or stroke, atherosclerosis
What type of dementia may more commonly present with neurogical signs such as facial nerve palsy?
Vascular dementia
What criteria is used to diagnose Lewy body dementia?
The fourth census criteria - using core criteria and supportive biomarkers to diagnose probably and possible DLB
What symptoms are useful for discrominating dementia with Lewy bodies from other dementia types?
▪️Cognitive fluctuations
▪️Visual hallucinations
▪️Spontaneous Parkinsonosm
▪️REM sleep behaviour disorder
What are the two main variants of frontotemporal dementia?
Behaviour and language
What is the characteristic sign of frontotemporal dementia?
Early decline in social/personal conduct
In FTD, memory is typically preserved in the early stages. True or false.
True
What are some of the key approaches to non-pharmacological management of dementia?
▪️Promotion of function and activity
▪️Behavioural therapy
▪️Social help and support groups
▪️Signposy to relevant services
▪️End of life care planning
What are the two main drug types used for the pharmacological treatment of dementia?
▪️Acetylcholinesterase inhibitors
▪️NMDA antagonists
What are pharmacological treatments used for in dementia?
Symptomatic relief - e.g. improve mental functioning, manage BPSDs
(NOT disease modification)
What is the main NMDA antagonist given in dementia?
Memantine
For which two types of dementia are acetylcholinesterase inhibitors licensed for?
Alzheimer’s and PDD
For which type of dementia are acetylcholinesterase inhibitors contraindicated?
Frontotemporal dementia
When would memantine usually be prescribed?
If the patient suffers side effects from acetylcholinesterase inhibitors or in the later stages of disease
What is the first line of pharmacological treatment for most dementia?
Acetylcholinesterase inhibitors such as donepezil, rivastigmine, and galantamine
What is the first line of treatment for behavioural and psychological symptoms of dementia?
Behavioural interventions
What environmental factors are important to consider in the management of dementia?
▪️Physical environment
▪️Carer relationship and stress
▪️Level of stimulation, social activity and routine
▪️Quality of communication
Why is safeguarding important for those with dementia?
They may have difficulties with:
▪️Preparing food and drink
▪️Self care
▪️Wandering
▪️Ability to deal with finances
All of which leave them vulnerable to exploitation from others
