Clinical Aspects of Dementia Flashcards
What is Dementia? (4)
- progressive GLOBAL cognitive decline
- irreversible
- decline in FUNCTIONING
- it is a SYNDROME (not disease)
What is key for management of Alzheimer’s? (4)
- should start ASAP
- plan for FUTURE care
- PEER support
- plan for FUTURE decision-making (power of attorney)
- ensure pt UNDERSTANDS the illness and how to manage
How is cognitive testing done?
- ACE-III (Addenbrooker Cognitive Assessment)
- MoCA (shorter, several versions)
- FAB
What specific questionnaire is given to a relative/friend for them to fill in, to get a COLLATERAL hx?
Short Informant Questionnaire on Cognitive Decline in the Elderly
(Short IQCODE)
What is assessment is conducted to see how well a dementia pt fxns at home ?
Occupational Therapy Assessment
—-observation of activites
What are reversible causes of COGNITIVE impairment?
Vascular Infection, inflammation (NEURO) Neoplasia Drugs, Iatrogenic Congenital Allergy, alcoho Trauma Endocrine (THYROID)
What is seen in Mild Cognitive Impairment?
- noticeable cognitive impairment
- Little deterioration of FUNCTION
- ACE-III: 75-90
- MoCA: 24-26
What is Subjective Cognitive Impairment?
- pt FEELS they are cognitively IMPAIRED, but day-to-day fxn and cognitive tests are normal (hard to convince them otherwise)
- a/w ANXIETY (increased> memory lapses), DEPRESSION or stress
- —-they usually have a relative/ friend with DEMENTIA
What is seen with Alzheimer’s Disease?
- short term memory loss (one of the first symptoms)
- dysphasia
- dyspraxia (hard to coordinate body movements)
- agnosia
What is seen on MRI or CT of the brain?
- normal
- may have Medial temporal lobe ATROPHY
- post. cortical atrophy
What symptoms are seen with Vascular dementia?
- dysphasia
- dyscalculia
- frontal lobe symptoms
- affective symptoms
- —FOCAL neurological signs
- STEP WISE decline
- vascular risk factors
What is seen on IVX of Vascular dementia?
- moderate-severe SMALL vessel disease (multiple LACUNAR infarcts)
- SPECT—-patchy reduction in tracer UPTAKE THROUGHOUT the brain
Name the 3 syndromes of Fronto-Temporal Dementia.
- Behavioural Variant
- Primary Progressive Aphasia
- Semantic Dementia
What is seen in the Behavioural variant Dementia?
- behavioural changes
- executive DYSFXN
- Impulsivity
- loss of SOCIAL skills
- disinhibition
- apathy, obessions
- change in diet
What is seen in Semantic Dementia? (3)
- impaired meaning of WORDS
- empty speech, but fluent
- can’t retrieve NAMES
What is seen in Primary Progressive Dementia?
- effortful NON-fluent speech
- speech sound errors
- lack of grammar
- lack of words
What is seen on ivx of Frontotemporal Dementia?
- CT/MRI: frontotemporal ATROPHY
- SPECT: frontotemporal REDUCTION in tracer uptake
What is symptoms are seen in LEWY body dementia?
- INATTENTION
- poor executive function
- poor VISUOSPATIAL skills
What is diff. in the presentation of LB dementia?
- VISUAL hallucinations
- fluctuating cognition
- REM sleep disorder
- Parkinsonism
- positive DAT scan
When does dementia in Parkinsons set in?
- 80% get dementia after 15-20 years of PD
- must have parkinsons for at least 1 year to dementia onset
- PD dementia and LB dementia —–diff. pathology
When is a CT scan performed?
- to R.O tumor/bleed/large stroke
- to quantify vascular changes
- to see structural changes of Alzheimers
When is an MRI performed?
- when pt is YOUNG
- fast progression of symptoms
When is SPECT performed ?
- used to check for FRONTOTEMPORAL dementia
- to clarify Alzheimers dx
When is DAT performed?
- to differentiate DLB from DPD
