Dementia Flashcards
Dementia - Domains that decline vs preserved in normal aging
Dementia - Apporach to assessment
Dementia - Diagnostic criteria
Dementia= major neurocognitive disorder
•Cognitive deficit in 2 or more domains: learning/memory, executive dysfunction, visuospatial, language, attention, social cognition
•note: DSM 5 is different = only need 1 domain
•At least 1 impaired IADL
•Not attributed to delirium, depression, psychosis
Dementia - Severity staging: MCI vs mild dementia vs moderate dementia vs severe dementia
Dementia - Cognitive domains and associated questions to assess domains
Dementia - Cognitive testing tools (MMSE / MOCA / RUDAS) and specific domains assessed
Dementia - Work up
Dementia - work up: when to order brain imaging
BrAIN
- B - Bleeding risk (head trauma, anticoag use / bleeding disorder
- A- Abnormal presentation
- Age <60 years
- Rapid unexplained decline 1-2 months
- Shorter duration of dementia (<2 years)
- unsual or atypical cognitive presentation
- I- Intracranial lesion
- History of cancer
- Unexplained focal neuro sign
- N- NPH (Gait disturbance, incontinence)
Dementia - Alzheimers dementia
Diagnostic criteria
- Core criteria for dementia AND
- Insidious onset
- Initial and most prominent deficits:
- Amnestic (most common)
- Non-amnestic (language, visuospatial, executive)
- Not due to something else (eg. if early prominent behavioural ? FTD)
- Increased certainty if documented decline over time
Dementia - Vascular dementia
- Progressive cognitive and associated functional decline AND
- Focal neurological signs OR
- Imaging evidence of cerebrovascular disease (e.g., multiple infarctions involving cortex or underlying white matter) judged to be etiologically related
Dementia - Dementia with lewy body
- At least 2/4 core features:
- Fluctuating cognition with pronounced variation in attention and alertness
- Marked fluctuations, from one extreme to almost normal within a few hours
- Episodes of confusion, decreased LOC/profound somnolence and incoherent speech
- Recurrent visual hallucinations - Typically well formed and detailed
- REM behavioural sleep disorder - Can precede other sx by decades
- 1+ spontaneous features of parkinsonism - Bradykinesia and rigidity but less often tremor
- Fluctuating cognition with pronounced variation in attention and alertness
Dementia - Dementia associated with parkinsonianism subtypes
Dementia - Frontotemporal dementia
Dementia - MSA features
- Progressive cognitive decline
- Variable degree of parkinsonism (MSA-P)
- Cerebellar ataxia (MSA-C)
- Autonomic failure
- Classic OH, sBP supine 140 – drops to sBP 60 standing after 3 minutes
- Falls falls falls
- Urinary incontinence
Dementia - Principles of management
- General medical care
- Falls / Mobility
- Dysphagia / aspiration
- Nutrition / weight loss
- Constipation
- Incontinence
- Sleep
- Behaviour and psychological symptoms of dementia (BPSD)
- Screen each visit
- Non pharm first
- Safety
- Home - environmental mods (OT home safety, fire safety), support services (PSW for ADL assistance, PT for mobility and home exercises, RN if medical needs), elder abuse
- Hobbies and habits - smoking, alcohol, power tools and guns
- Meds - blister packs, assisted supervision
- Wandering - bracelet registration
- Driving - duty to report
- Financial - scams, POA for property, tax credits (refer to SW)
- Caregiver support - Assess caregiver burden, provide education and support (referral to alzheimers society first link program, respite care)
- Future planning - discuss natural history of disease, goals of care / future wishes (feeding tubes), code status, POA for personal care
Dementia - Pharmacotherapy for each dementia subtype
Dementia - Pharmacologic management (ChEIs) indications, side effects, and contraindications
Dementia - Pharmacologic management (Memantine) indications
Dementia - subtypes and main features
