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Neuropsychiatric Disorders > Alzheimer's Disease and Dementia > Flashcards

Alzheimer's Disease and Dementia Flashcards

1
Q

What is the most common type of dementia?

A

Alzheimer’s disease (~60%)

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2
Q

What is the second most common type of dementia?

A

Vascular dementia (~20%)

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3
Q

What is the third most common type of dementia?

A

Lewy body dementia (~10%)

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4
Q

What might cause reversible dementia?

A

▪️Chronic alcohol abuse
▪️Deficiencies
▪️Metabolic/endocrine changes
▪️Infection
▪️Neoplastic

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5
Q

What are the three pathological hallmarks of Alzheimer’s disease?

A

▪️Beta amyloid deposition (plaques)
▪️Neurofibrillary tau tangles
▪️Neuronal loss

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6
Q

In Alzheimer’s disease, where is atrophy most apparent?

A

The medial temporal lobes

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7
Q

What is vascular dementia?

A

Arteriosclerosis and neuronal death due to occlusion of the arteries and reduced blood flow to the brain (multiple large cerebral infarcts)

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8
Q

Give examples of cardiovascular events that may lead to vascular dementia.

A

▪️Embolus
▪️Vasculitis
▪️Haemorrhage

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9
Q

What scan would be used to look for Lewy body dementia?

A

DAT scan to look at dopamine uptake, particularly in the basal ganglia and substantia nigra

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10
Q

What is the main pathological finding in Lewy body dementia and which proteins are involved?

A

Lewy bodies - alpha-synuclein and ubiquitin

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11
Q

What are the three main features needed for clinical diagnosis of dementia?

A

▪️Cognifive failure (> 6 months)
▪️Deterioration in functioning
▪️Evidence of progression

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12
Q

What is the pattern of cognitive failure linked to in early stage dementia?

A

The distribution of brain and neurotransmitter dysfunction

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13
Q

At what point in dementia progression would you see regional and global brain atrophy?

A

Later stages

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14
Q

What brain changes would you see in the later stages of dementia?

A

Global brain atrophy

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15
Q

What deficit would be most apparent with medial temporal and hippocampal atrophy?

A

Memory

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16
Q

What deficit would be most apparent with lateral temporal atrophy?

A

Language

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17
Q

What are the four ‘A’s of dementia?

A

Amnesia
Aphasia
Apraxia
Agnosia

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18
Q

What types of memory are better/longer preserved in dementia?

A

Long term memory and motor memory

19
Q

What is apraxia?

A

Inability to preform skilled movememts and intentional acts despite intact motor and sensory systems

20
Q

What activities may be affected by apraxia?

A

Dressing, eating, drawing

21
Q

What is agnosia?

A

Inability to understand the significance of sensory stimuli

22
Q

What tools can be used to test global cognition?

A

▪️MMSE
▪️ACE-III

23
Q

What percentage of individuals with dementia experience behavioural and psychological symptoms?

A

98%

24
Q

What are behavioural and psychological symptoms in dementia associated with?

A

▪️Greater distress (patient and carer)
▪️Worsening cognition
▪️Worsening daily functioning
▪️Increased risk of falls
▪️Earlier institutionalisation and death

25
Q

What is the usual time course of Alzheimer’s disease?

A

▪️Gradual onset
▪️Early memory impairment
▪️Progressive cognitive decline

26
Q

Which type of dementia may be observed with a stepwise deterioration of cognition?

A

Vascular dementia

27
Q

What risk factors may be indicative of vascular dementia?

A

Vascular risk factors such as diabetes, hypertension, history of heart attacks or stroke, atherosclerosis

28
Q

What type of dementia may more commonly present with neurogical signs such as facial nerve palsy?

A

Vascular dementia

29
Q

What criteria is used to diagnose Lewy body dementia?

A

The fourth census criteria - using core criteria and supportive biomarkers to diagnose probably and possible DLB

30
Q

What symptoms are useful for discrominating dementia with Lewy bodies from other dementia types?

A

▪️Cognitive fluctuations
▪️Visual hallucinations
▪️Spontaneous Parkinsonosm
▪️REM sleep behaviour disorder

31
Q

What are the two main variants of frontotemporal dementia?

A

Behaviour and language

32
Q

What is the characteristic sign of frontotemporal dementia?

A

Early decline in social/personal conduct

33
Q

In FTD, memory is typically preserved in the early stages. True or false.

A

True

34
Q

What are some of the key approaches to non-pharmacological management of dementia?

A

▪️Promotion of function and activity
▪️Behavioural therapy
▪️Social help and support groups
▪️Signposy to relevant services
▪️End of life care planning

35
Q

What are the two main drug types used for the pharmacological treatment of dementia?

A

▪️Acetylcholinesterase inhibitors
▪️NMDA antagonists

36
Q

What are pharmacological treatments used for in dementia?

A

Symptomatic relief - e.g. improve mental functioning, manage BPSDs

(NOT disease modification)

37
Q

What is the main NMDA antagonist given in dementia?

A

Memantine

38
Q

For which two types of dementia are acetylcholinesterase inhibitors licensed for?

A

Alzheimer’s and PDD

39
Q

For which type of dementia are acetylcholinesterase inhibitors contraindicated?

A

Frontotemporal dementia

40
Q

When would memantine usually be prescribed?

A

If the patient suffers side effects from acetylcholinesterase inhibitors or in the later stages of disease

41
Q

What is the first line of pharmacological treatment for most dementia?

A

Acetylcholinesterase inhibitors such as donepezil, rivastigmine, and galantamine

42
Q

What is the first line of treatment for behavioural and psychological symptoms of dementia?

A

Behavioural interventions

43
Q

What environmental factors are important to consider in the management of dementia?

A

▪️Physical environment
▪️Carer relationship and stress
▪️Level of stimulation, social activity and routine
▪️Quality of communication

44
Q

Why is safeguarding important for those with dementia?

A

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

Neuropsychiatric Disorders (30 decks)

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