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BRS Year 2 > dementia > Flashcards

dementia Flashcards

1
Q

how many people in the world live with dementia?

A

46 million

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2
Q

commonest cause of dementia?

A

Alzheimer’s disease

- characterised by progressive cognitive, social and functional impairment

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3
Q

Cure for dementia?

A

non currently

  • Acetylcholinesterase inhibitors having modest symptomatic benefit in early stages (MMSE = 1)
  • diagnosis in life is only probable but it’s changing
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4
Q

types of dementia

A 
familial autosomal dominant
alzheimer's disease
vascular dementia
Dementia with lewy bodies/parkinson's disease
Frontotemporal dementia
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5
Q

what is the main condition that can present as dementia?

A

depression

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6
Q

deficiencies of what B vitamins can lead to potentially reversable cognitive deficits?

A
  • 1, 6, 12 - especially B12
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7
Q

Disease course of dementia

A
  • follows a heterogenous course (has several causes)
  • In old age the disease presentation is of multiple comorbidities
  • Lots of mixed and uncertain pictures
  • Younger patients are more typical
  • Clinical history; function of the patient and how they change is paramount
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8
Q

how is dementia diagnosed

A
  • history taking

- lots of variation in scans

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9
Q

Things to check when interviewing dementia patients?

A
  • 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
  • delusions
  • activities of daily living
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10
Q

what is dementia?

A

severe loss of memory and other cognitive abilities which leads to impaired daily function

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11
Q

what investigations do you do for dementia?

A
  • neuropsychology
  • Bloods
  • MRI
  • PET
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12
Q

Example of cognitive test used on the wards

A

MMSE ( mini mental state examination)

+/- ACE III (15 mins and more memory focused)

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13
Q

things to look at in blood for dementia

A
  • FBC
  • inflammatory markers
  • Thyroid function
  • Biochemistry and renal function
  • Glucose
  • B12 and folate
  • Clotting
  • Syphilis serology
  • HIV
  • Caeruloplasmin
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14
Q

what kind of MRI do you do to image the brain in dementia and what can they show?

A

sMRI

In those with alzheimer’s disease we can see narrow gyri and wider sulci and dilated/enlarged ventricles. There is medial temporal volume loss and the hippocampus is shrunken and replaced with CSF

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15
Q

what is the newer type of dementia imaging and what do they show us?

A

florbetapir in vivo and amyloid post-mortem PET scans

Increased post- mortem beta amyloid present with those with alzheimer’s

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16
Q

Other things that present like dementia

A
  • Depression
  • Delirium
  • Idiopathic
17
Q

features of alzheimer’s dementia

A
  • subtle, insidious amnestic/non amnestic presentation
18
Q

features of vascular dementia

A
  • related to cerebrovascular disease with a classical stepwise deterioration +/- multiple infarcts/strokes
19
Q

features of dementia with Lewy bodies

A
  • cognitive impairment before/within 1 year of Parkinsonian symptoms, visual hallucinations and fluctuating cognition
20
Q

features of frontotemporal dementia

A
  • behavioral variant FTD, semantic dementia (cant match words with images), progressive non-fluent aphasia (Broca’s aphasia)
21
Q

obs by family members for alzheimers?

A

patient:

  • repeats the same questions each day
  • makes mistakes with respect to taking medication
  • increasingly irritable
  • will rewatch things without realising
22
Q

what does the head turning sign indicate during an examination?

A
  • patient is unsure
  • patient is looking for verification
  • indicates cognititve impairment
  • accompanied by episodic memory
23
Q

tests to assess brain function in alzheimers

A
  • MMSE

- ACE

24
Q

what is episodic memory?

A
  • memory for particular episodes in life

- dependent on the medial temporal lobes; inc hippocampus

25
Q

when can a definitive diagnosis of alzheimer’s be made definitively?

A
  • post mortem

- previously only a probable diagnosis but this is changing with new ways of looking at in-vivo pathology

26
Q

biomarkers in alzheimers

A
  • low CSF B amyloid
  • high CSF tau
  • high B amyloid in brain
27
Q

what is the commonest cause of neurodegenerative disease?

A

alzheimers
- typically involves initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures (entorhinal cortex and hippocampus)

28
Q

what is rapidly progressing dementia?

A

another type of dementia

29
Q

do patients with dementia with lewy bodies always show parkinsonian symptoms?

A

not always

Symptoms of dementia can show before parkinson symptoms

30
Q

what decreases hallucinations in lewy body dementia?

A

cholinesterase inhibitor rivastigmine

31
Q

features of lewy body dementia

A
  • Associated with fluctuating cognition
  • Often visual hallucinations (people/animals)
  • REM sleep disorder (shouting/talking at night)
  • High risk of falls
  • Development of symptoms associated with parkinson’s disease
32
Q

what causes dementia with lewy bodies

A

aggregation of alpha synuclein

33
Q

What can we see on scans for a patient with dementia of lewy bodies?

A

MRI:
Preserved hippocampus volume and medial temporal lobe volume (different to AD)

DaTscan:
Less dopamine transporters in caudate and putamen

34
Q

What observations can we make from a blood test and an MRI for FTD

A

Normal blood test results

MRI:

  • volume loss in temporal lobe and frontal opercula
  • may be more on right side to suggest FTLD
35
Q

What are symptoms of frontotemporal lobe dementia?

A

Broca’s aphasia- comprehension intact but speech production impaired

  • unable to speak properly
  • behavioral changes- more rude
  • self neglect/ loss of hygiene
  • unable to yawn on command
  • difficulty copying hand gestures
  • neurological examinations NAD

BRS Year 2 (110 decks)

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