CSFC Dementia Flashcards

1
Q

Which gender is more affected by suicide?

How many of those who have committed suicide have been in recent contact with a health care professional

A

Male suicides account for 3/4 of suicides

1/4 of those who commit suicide have been in contact with a healthcare professional in the previous week, and most within the past month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name seven risk factors for suicide

A
  1. Male
  2. Older
  3. Widowed/separated/single
  4. Living alone/social isolation
  5. Low income
  6. Certain occupations (doctor, farmer)
  7. FH
  8. Previous attempt
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name six ‘diagnoses’ that greatly increase one’s risk of suicide (by multiple fold)

A
  1. Previous attempt
  2. Anorexics
  3. Hemodialysis
  4. Recreational opiate use/dependence
  5. Alcohol dependence
  6. Acute mental disorder (schizophrenia, severe depression)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name five things you might assess to determine whether a patient is planning their suicide

A

Are they..

  1. Researching methods
  2. Final acts like writing a will
  3. Precautions taken against being found
  4. Patient is resisting/trying to evade medical intervention
  5. Downplaying the seriousness of suicidality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name four ‘protective factors’ that cam prevent a patient from committing suicide

A
  1. Positive family support
  2. Children at home (or a sense of responsibility for others)
  3. Strong religious faith
  4. Problem solving skills
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What characterizes dementia?

A
  1. Decline in memory
  2. Failure of higher cognitive function (analysis, judgement, etc)
  3. Consciousness isn’t impaired
  4. Can result in challenging behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name the six main subtypes of dementia within young or late-onset

A

Divided into Young-onset and late-onset

  1. Alzheimer’s
  2. Vascular dementia
  3. Dementia with levy bodies
  4. Frontotemporal
  5. Parkinson’s disease
  6. Creutzfelldt-Jakob disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which subtype of dementia is most prevalent? What can trigger it? What rarely causes it?

A

Alzheimer’s dementia
Caused by complex gene and environmental interactions
Early onset is rarely caused by single gene mutation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the histopathological findings in Alzheimer’s

A

Amyloid plaques (beta-amyloid proteins) and tau protein neurofibrillary tangles - which accumulates as insoluble tangles that damages microtubules and cell signalling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What gene might specifically risk your increase of Alzheimer’s? What is this gene involved in?

A

Carriers of apolipoprotein E gene (APOE protein) involved in lipid metabolism (cholesterol transport)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name the second most common subtype of dementia. What causes it and which other subtype is it commonly associated with?

A

Vascular dementia: the vascular supply to the brain is damaged leading to cell death and declined cognitive function
Commonly associated with Alzheimer’s dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Name four risk factors for developing vascular dementia

A

Primary CVS RFs

  1. Hypertension
  2. Diabetes
  3. Smokers
  4. Hyperlipidemia
    * age also increases the development of these risk factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which occupations are at a higher risk of developing dementia?

A
  1. Jobs with low pay and job security can induce familial and financial stress
  2. Publicans (owns a pub)
  3. Access to or knowledge of a method of suicide; doctors, dentists, agricultural workers, easy access drugs/firearms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some early signs of vascular dementia?

What do the signs depend on?

A

Signs depend on the location and size of the vascular injury; multiple lacunar (Small penetrating blood vessels), multi infarct (med sized blood vessels) and strategic single infarct (in crucial area, suddenly causes dementia symptoms)

  1. Impaired judgement, planning and decision making
  2. Motor function deficiencies; slow gait and poor balance
  3. Language impairment
  4. Can also be asymptomatic due to multiple little lacunar infarctions which only cause symptoms once they accumulate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most common form of ischemic stroke?

A

Multiple lacunar infarctions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is Binswanger dementia/subcortical vascular dementia? What is it associated with and what can be damaged?

A

Form of small vessel disease, associated with poorly controlled hypertension and atherosclerosis, can have diffuse changes which fundamentally affects the white matter

17
Q

What are lewy bodies?

A

Abnormal clumpings of protein in the cerebral cortex

18
Q

What diseases are Lewy bodies commonly associated with?

A

Parkinson’s and dementia

19
Q

Name __ possible early signs of dementia with Lewy bodies

A

Starts with behavioural

  1. Visual hallucinations
  2. Visuospatial impairment (lost sense of “whereness”)
  3. Marked cognitive fluctuations
  4. Dream enactment behaviour (sleep walking, talking, etc)
20
Q

How do the onset of symptoms differ between Parkinson’s and dementia with Lewy bodies?

A

In dementia with lewy bodies the cognitive decline PRECEDES any motor impairments (opposite in Parkinson’s)

21
Q

What is the frontotemporal lobe involved in?

A

Frontal lobes involved in behaviour, emotional control, problem solving, words, names, facial and object recognition

22
Q

How do patients suffering with FTD often present? What is the general epidemiology and aetiology?

A

Present with changes in personality/behaviour and learning difficulties BEFORE memory difficulties

Commonly in younger people, stronger genetic component

23
Q

Name three early symptoms of Parkinson’s disease, how soon does cognitive decline occur in relation to Parkinsonism movement disorder in Parkinson’s dementia?

A

Rigidity, tenor and gait changes

Parkinsonism movement disorder occurs at least 1 year prior to cognitive decline.

24
Q

What causes creutzfeldt Jakob disease?

Name the three ‘types’ and identify which is the most common

A

Abnormal prion protein accumulation in the brain

  1. Sporadic - most common
  2. Familial
  3. Acquired
25
Q

How fatal is creutzfeldt Jakob disease?

A

70% die in one year

26
Q

How might an individual with CJD present?

*including four earlier presentations and four later ones

A
  1. Memory problems
  2. Behavioural changes
  3. Poor coordination
  4. Visual disturbances

Later develop dementia, blindness, weakness, coma and death

27
Q

How is dementia diagnosed?

*including screening tests at the GP

A

History and examination from patient and collateral history from carers

Screening tests at GP: GPCOG and 6 CIT

28
Q

How is dementia screened for in a memory clinic?

A
  1. MMSE
  2. GDS (geriatric depression scale)
  3. Montreal cognitive assessment
29
Q

What tests could be done to provide more information in a patient suspected of having dementia?

A
  1. FBC (anemia)
  2. CRP/ESR (i.e vasculitis)
  3. B12 and folate levels (Required by NS)
  4. Bone (abnormal calcium levels - confusion)
  5. LFT (alcohol related, carcinoma, encephalopathy)
  6. Glucose and HbA1c (low or high glucose - confusion)
  7. TFTs (thyroid problems)
  8. Urea and electrolytes (renal or liver failure - confusion)
30
Q

What investigative tests could be done for a patient suspected of having dementia?

A
  1. Mid-stream urine and culture
  2. CT/MRI: tumour, ischemia damage (stroke/infants), cortical atrophy, hydrocephalus
  3. Special tests (i.e lumbar puncture in CJD)
31
Q

Name two ways dementia is treated, is there a cure?

A

NO cure, medications delay symptoms and improve quality of life

Meds:

  1. Cholinesterase inhibitors: prevent Ach esterase from breaking Ach down
  2. NMDA (n-methyl D aspartate) receptor antagonists: blocks overstimulation from glutamate (which can cause neuronal damage)
32
Q

What does the MMSE evaluate? What is it scored out of?

A

Scored out of 30

  1. Orientation
  2. Registration (immediate memory)
  3. Short term memory
  4. Language functioning
33
Q

Define delirium, how does it develop?

A

Acute, fluctuating syndrome of disturbed consciousness, attention, cognition and perception
Develops over hours-days

34
Q

Is delirium curable?

A

Usually temporary/reversible/treatable

35
Q

How does delirium differ from dementia?

A
  1. Consciousness is disturbed
  2. It’s curable
  3. Delirium fluctuates whereas dementia is progressive
  4. More rapid onset
36
Q

What are the risk factors for developing delirium?

A

Young: to become delirium need high precipitating factors i.e high fever, sepsis, infection

Old: already have high vulnerability factor, only need small precipitating factor (i.e constipation, UTI, change in routine)

37
Q

Name six general mechanisms that likely contribute to the pathogenesis and ‘system integration failure’ of delirium

A
  1. Age related; changes in BBB, etc
  2. Inflammation (i.e infection, cytokines cross BBB)
  3. Cerebral oxidative stress (i.e hypoxia)
  4. Sleep: circadian rhythm disturbance
  5. Glucocorticoids: chronically high
  6. Alteration in neurotransmitters (I.e low Ach, excessive dopamine, etc)
38
Q

Name and briefly describe the three subtypes of delirium

A
  1. Hyperactive: agitation, delusions, hallucinations, wandering
  2. Hypoactive: can mimic depression; sleepy, impaired consciousness, withdrawal, reduced appetite, physical and social functioning
  3. Mixed