dementia Flashcards
what is some background of dementia?
46 million people live with dementia worldwide
The cost to the global economy is $818 billion/year.
The commonest cause of dementia is Alzheimer’s disease (AD).
This fatal neurodegenerative disorder is characterised by progressive
cognitive, social and functional impairment.
There is no current cure, with acetylcholinesterase inhibitors having
modest symptomatic benefit in early stages (ΔMMSE = 1).
Diagnosis in life is only probable however this is changing (more likely)
what are the most common types of dementia?
alzheimers dementia
vascular dementia
frontotemporal dementia
dementia with lewy bodies
what are some potentially reversible causes of dementia?
depression alcohol related brain damage endocrine benign tumours B12 deficiency
what is the progression of dementia like?
slow decrease in cognition with age.
this happens more quickly and more steeply in those with dementia
there is a preclinical phase when symptoms wont be immediately apparent
preclinical -> MCI -> dementia
in practice, the line isnt that smooth, cognition can vary day to day based on sleep ect
(vascular dementia has a stepwise progression)
is dementia easy to diagnose?
no
The disease follows a heterogenous
course
In old age the disease presentation is of
multiple co-morbidities
Lots of mixed and uncertain pictures
Younger patients are more typical
Clinical history, the function of the patient
and how they change is paramount
how does clinical diagnosis of dementia occur?
mostly in the history taking
referral -> history (checklist flashcard)-> examination (for neurological and mental state) -> investigations -> diagnosis -> management
this process may take 6 months - two years
and may go round and round
what is a checklist of what to ask patients when taking their history (name at least 5)?
Memory Language Numerical Skills Executive skills Visuospatial skills Neglect phenomena Visual perception Route finding and landmark identification Personality and social conduct Sexual behaviour Eating Mood Motivation/Apathy Anxiety/Agitation Delusions/Hallucinations Activities of daily living \+ Chronology of each
and dont forget collateral
what is dementia?
Dementia - severe loss of memory and other cognitive abilities which
leads to impaired daily function (regardless of the underlying cause)
what happens in the examination stage of dementia diagnosis?
neurological exam: cranial nerves upper and lower limb gait focus tests
mental state examination
(MMSE - orientation, registration, attention and calculation, recall, language, copying)
what investigations are done for dementia diagnosis?
neuropsychology
bloods
MRI
PET (can be an amyloid pet scan - light up more with more amyloid, this has higher likelihood of alzheimers)
what bloods are done foe dementia?
full blood count Inflammatory Markers Thyroid Function Biochemistry and renal function Glucose B12 and folate Clotting
Syphilis serology
HIV
Caeruloplasmin
what will dementia look like on MRI?
MCI - less brain tissue visible
dementia - more volume loss, larger sulci, ventricles enlarged too (look black) hippocampus atrophy (look black)
(compared to a normal brain MRI)
what is a differential diagnosis for dementia?
Alzheimer’s Vascular Lewy Body FTD Depression Delirium None mixture functional neurological disorder
how is dementia managed?
Acetylcholinesterase inhibitors Watch and wait Treating behavioural/psychological symptoms OT/Social services Specialist therapies
how do you rule in and out other causes of dementia?
Delirium vs dementia vs depression
Dementias and atypical variants?
Alzheimer’s
(subtle, insidious amnestic/non amnestic presentations)
Vascular dementia (related to cerebrovascular diseases with a classical step-wise deterioration +- multiple infarcts)
Dementia with Lewy bodies
(cognitive impairment before/within 1 year of Parkinsonian symptoms, visual hallucinations and
fluctuating cognition, REM sleep disorder)
Frontotemporal dementia
(behaviour variant FTD, semantic dementia,
progressive non-fluent aphasia)
Rapidly progressing dementias
