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Psychiatry > Clinical Aspects of Dementia > Flashcards

Clinical Aspects of Dementia Flashcards

1
Q

What is the standard test done in most psychiatry of old age departments?

A

ACE - III

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2
Q

Aside from the ACE-III, what other forms of cognitive testing may be done? When?

A

MoCA (montreal cognitive assessment)

Shorter, several versions, validated in many languages

FAB – frontal assessment battery

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3
Q

What kind of history is very important in someone with cognitive impairment?

A

Collateral history

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4
Q

What is given to the person you are taking a collateral history from?

A

Short Informant Questionnaire on Cognitive Decline in the Elderly

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5
Q

What does the OT assessment involve?

A

Cognitive performance testing

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6
Q

Describe cognitive performance testing.

A
  • Observation of activities – washing, dressing, using phone, shopping, making toast, travelling
  • Estimates cognitive level and level of supervision required for daily living
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7
Q

Sometimes, someone may not have dementia but just a….

A

Mild cognitive impairment

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8
Q

There are many reversible causes of cognitive impairment

A

TRUE

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9
Q

List some causes of reversible cognitive impairment?

A

Basically anything that causes a physical disturbance can cause a cognitive impairment

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10
Q

What is mild cognitive impairment?

A

Noticeable cognitive impairment with little deterioration of function

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11
Q

What is the common score for someone with a mild cognitive impairment using ACE-III?

A

80-90

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12
Q

What is the common score for someone with a mild cognitive impairment using MoCA?

A

24-26

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13
Q

What is the annual conversion rate of mild cognitive impairment to dementia?

A

10-15%

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14
Q

How should patients with mild cognitive impairment be managed?

A

With yearly cognitive testing.

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15
Q

What are the 4 key symptoms of Alzheimer’s dementia?

A
  • Memory loss, particularly short term.
  • Dysphasia.
  • Dyspraxia.
  • Agnosia. (inability to interpret sensations/recognise things)
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16
Q

What may be seen on CT/MRI of a patient with Alzheimers?

A

May be normal, or there may be medial temporal lobe atrophy or temporoparietal atrophy

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17
Q

What are the 2 variants of Alzheimers?

A
  • Frontal.

* Posterior cortical atrophy.

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18
Q

What symptoms are more common in vascular dementia than Alzheimers?

A

Dysphasia, dyscalculia, frontal lobe and affective sx

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19
Q

Give an example of an affective symptom that is more common in vascular dementia then Alzheimers?

A

Depression

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20
Q

What type of signs might vascular dementia be associated with?

A

Focal neurological signs

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21
Q

What kind of risk factors do those with vascular dementia have?

A

Vascular risk factors

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22
Q

What type of decline is vascular dementia associated with?

A

Step-wise

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23
Q

Describe step-wise decline?

A

Symptoms stay the same for a while then suddenly get really bad

  • Like a set of stairs going down
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24
Q

What is seen on CT/MRI of someone with vascular dementia?

A

Moderate-severe small vessel disease or multiple lacunar infarcts

25
Q

Moderate-severe small vessel disease or multiple lacunar infarcts is seen in what condition on CT/MRI?

A

Vascular dementia

26
Q

What is seen on SPECT scan of someone with vascular dementia?

A

Patchy reduction in tracer uptake throughout the brain

27
Q

Name the 3 main variants of frontotemporal dementia.

A
  • Behavioural
  • Primary progressive aphasia
  • Semantic dementia
28
Q

What is seen on CT/MRI of someone with frontotemporal dementia?

A

Frontotemporal atrophy

29
Q

What does SPECT scan of someone with frontotemporal dementia show?

A

Frontotemporal reduction in tracer uptake

30
Q

Describe the behavioural variant of frontotemporal dementia.

A

Behavioural changes, executive dysfunction, disinhibition, impulsivity, loss of social skills, apathy, obsessions, change in diet

31
Q

Describe primary progressive aphasia.

A

Effortful non-fluent speech, speech/sound articulatory errors, lack of grammar, lack of words

32
Q

Describe semantic dementia.

A

Impaired understanding of meaning of words, fluent but empty speech, difficulty retrieving names

33
Q

Outline the criteria for dementia with Lewy Bodies.

A
  • Dementia – with common early involvement of reduced attention, executive function and visuospatial skills

+

  • Two of:
  • visual hallucinations
  • fluctuating cognition (delirium-like)
  • REM sleep behaviour disorder
  • Parkinsonism (not more than one year prior to onset of dementia)
  • positive DAT scan
34
Q

After 15-20 years of having Parkinson’s, what % of patients have dementia?

A

80%

35
Q

What must happen with Dementia to be classified as ‘Dementia with Parkinson’s?

A

Must have parkinsonism for at least one year prior to the onset of Dementia

36
Q

What investigation will be positive in dementia with parkinson’s?

A

DAT scan

37
Q

Describe the DAT scan of someone with parkinsonism

A
  1. Comma shaped basal ganglia

2. Full stop shaped basal ganglia

38
Q

Name 3 cholinesterase inhibitors.

A
  • Donepezil.
  • Rivastigmine.
  • Galantamine.
39
Q

When does a patient get a cholinesterase inhibitor?

A

Once they are diagnosed with dementia

40
Q

What cholinesterase inhibitor is used in DLB and DPD?

A

Rivastigmine

41
Q

What effects do cholinesterase inhibitors have in dementia?

A

Slow cognitive decline, and treat BPSD (behavioural and psychological symptoms in dementia)

42
Q

What types of Dementia do these have more effect in? Compared to what?

A

DLB/DPD than Alzheimer’s

43
Q

What side effects are associated with cholinesterase inhibitors?

A

GI (esp. nausea and diarrhoea), headache, muscle cramps, bradycardias, worsen COPD/asthma

44
Q

What should you always do before prescribing a cholinesterase inhibitor?

A

Check pulse

45
Q

When should you never give a cholinesterase inhibitor?

A

In active peptic ulcer or severe asthma/COPD

46
Q

What is memantine licensed in the treatment for?

A

Alzheimer’s

47
Q

What is the effect of memantine?

A

Slow cognitive decline, and may treat BPSD

48
Q

What do the recent BAP guidelines suggest?

A

Memantine should be started soon after diagnosis of Alzheimers dementia.

49
Q

Although this tends to be WELL TOLERATED, what side effects may memantine be associated with?

A 
Hypertension – check BP before starting. 
Sedation. 
Dizziness. 
Headache. 
Constipation.
50
Q

What should always be done before starting memantine?

A

Check BP

51
Q

What is given if patient has visual hallucinations in dementia?

A

Cholinesterase inhibitors, antipsychotics

52
Q

What is given if a patient with dementia suffers from insomnia?

A

Melatonin, Z drugs, benzodiazepines, sedating antidepressants

53
Q

What should NOT be used in Lewy Body Dementia?

A

Antipsychotics

54
Q

What should always be discussed at diagnosis?

A

Driving

55
Q

Does a dementia diagnosis need to be reported to the DVLA?

A

YES!!!!!!

56
Q

Outline what happens once a person’s new diagnosis of Dementia is reported to the DVLA.

A
  1. Patient fills in CG1 form.
  2. DVLA requests a report from the doctor.
  3. Doctor then decides if the pt can drive while investigations are ongoing
57
Q

What investigations are done in determining whether a person with Dementia is safe to drive?

A
  • Rookwood Driving Battery.

* On road test.

58
Q

List reversible causes of cognitive impairment.

A
  • Delirium
  • Depression
  • Other psychiatric disorders

Psychiatry (31 decks)

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