Dementia Flashcards
Why is it hard to accurately diagnose dementia?
- heterogenous course
- many presentations overlap with other co-morbidities
What is included in a clinical interview?
- memory
- language
- numerical skills
- executive skills
- visuospatial skills
- neglect phenomena
- visual perception
- landmark identification
- personality
- sexual behaviour
- eating
- mood
- apathy
- anxiety/agitation
- delusions/hallucinations
What is important when doing a clinical interview?
to interview patients and their collateral (who came in with them, etc.)
What is dementia?
severe loss of memory and other cognitive abilities which leads to impaired daily function (irrelevant of the underlying cause)
What investigations should be done to diagnose dementia?
- Bloods
- MRI
- PET
- Neuropsychology
What exams should be done during an examination for dementia?
- MMSE
+/- ACE III
What bloods should be run for a dementia diagnosis?
- FBC
- Inflammatory markers
- TFTs
- Biochemistry and renal function
- Glucose
- B12 and folate
- Clotting
- HIV
- Syphilis serology
- Caeruloplasmin
What are the possible differentials for the presenting symptoms?
- Alzheimer’s disease
- Vascular dementia
- Lewy Body dementia
- Frontotemporal dementia
- Depression
- Delirium
What is the general management plan for these symptoms?
- Acetylcholinesterase inhibitors
- Treat the behavioural/psychological symptoms
- OT/social services
- Specialist therapies
How does Alzheimer’s present?
- subtle
- insidious amnestic/non-amnestic presentations
How does Vascular dementia present?
related to cerebrovascular diseases with step-wise deterioration
How does Lewy Body Dementia present?
- cognitive impairment before/within 1 year of parkinsonisn symptoms
- visual hallucinations
- fluctuating cognition
How does frontotemporal dementia present?
- behaviour variant
- semantic dementia
- progressive non-fluent aphasia
What would be present in a case of probable Alzheimer’s?
- asks the same questions everyday
- mistakes with taking medication
- can drive, but struggles with directions
- can rewatch the same shows
- increasingly irritable
How to see Alzheimer’s on an MRI?
- bigger gaps in the brain
- larger, darker hippocami
What biomarkers are high in those with dementia?
- Abeta Amyloid
- Tau mediated Neuronal Injury and Dysfunction
What is Alzheimer’s disease?
- most common neurodegenerative dementia
- initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures
What in a examination would indicate Lewy Body dementia?
- awareness of recent news
- no altered behavious
- good MMSE (errors on attention)
- no evidence of parkinsonism
- daily visual hallucinations
- shuffling gait
- reduced facial expression
What are the characterisitics of Lewy Body dementia?
- associated with fluctuating cognition
- often visual hallucinations
- REM sleep disorder
- Parkinsonism
- High fall risk
How to identify Lewy Body dementia on a scan?
PET: smaller, duller spot due to less uptake
MRI: more grey matter in the hippocampi
What is typical of probably Frontotemporal dementia?
- memory problems
- speech deterioration
- anomia
- irritable and agitation
- mood changes
How can you identify Frontotemporal dementia on a scan?
volume loss in temporal lobes and frontal opercula
