dementia Flashcards
how many people in the world live with dementia?
46 million
commonest cause of dementia?
Alzheimer’s disease
- characterised by progressive cognitive, social and functional impairment
Cure for dementia?
non currently
- Acetylcholinesterase inhibitors having modest symptomatic benefit in early stages (MMSE = 1)
- diagnosis in life is only probable but it’s changing
types of dementia
familial autosomal dominant alzheimer's disease vascular dementia Dementia with lewy bodies/parkinson's disease Frontotemporal dementia
what is the main condition that can present as dementia?
depression
deficiencies of what B vitamins can lead to potentially reversable cognitive deficits?
- 1, 6, 12 - especially B12
Disease course of dementia
- 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
how is dementia diagnosed
- history taking
- lots of variation in scans
Things to check when interviewing dementia patients?
- 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
what is dementia?
severe loss of memory and other cognitive abilities which leads to impaired daily function
what investigations do you do for dementia?
- neuropsychology
- Bloods
- MRI
- PET
Example of cognitive test used on the wards
MMSE ( mini mental state examination)
+/- ACE III (15 mins and more memory focused)
things to look at in blood for dementia
- FBC
- inflammatory markers
- Thyroid function
- Biochemistry and renal function
- Glucose
- B12 and folate
- Clotting
- Syphilis serology
- HIV
- Caeruloplasmin
what kind of MRI do you do to image the brain in dementia and what can they show?
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
what is the newer type of dementia imaging and what do they show us?
florbetapir in vivo and amyloid post-mortem PET scans
Increased post- mortem beta amyloid present with those with alzheimer’s
Other things that present like dementia
- Depression
- Delirium
- Idiopathic
features of alzheimer’s dementia
- subtle, insidious amnestic/non amnestic presentation
features of vascular dementia
- related to cerebrovascular disease with a classical stepwise deterioration +/- multiple infarcts/strokes
features of dementia with Lewy bodies
- cognitive impairment before/within 1 year of Parkinsonian symptoms, visual hallucinations and fluctuating cognition
features of frontotemporal dementia
- behavioral variant FTD, semantic dementia (cant match words with images), progressive non-fluent aphasia (Broca’s aphasia)
obs by family members for alzheimers?
patient:
- repeats the same questions each day
- makes mistakes with respect to taking medication
- increasingly irritable
- will rewatch things without realising
what does the head turning sign indicate during an examination?
- patient is unsure
- patient is looking for verification
- indicates cognititve impairment
- accompanied by episodic memory
tests to assess brain function in alzheimers
- MMSE
- ACE
what is episodic memory?
- memory for particular episodes in life
- dependent on the medial temporal lobes; inc hippocampus
when can a definitive diagnosis of alzheimer’s be made definitively?
- post mortem
- previously only a probable diagnosis but this is changing with new ways of looking at in-vivo pathology
biomarkers in alzheimers
- low CSF B amyloid
- high CSF tau
- high B amyloid in brain
what is the commonest cause of neurodegenerative disease?
alzheimers
- typically involves initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures (entorhinal cortex and hippocampus)
what is rapidly progressing dementia?
another type of dementia
do patients with dementia with lewy bodies always show parkinsonian symptoms?
not always
Symptoms of dementia can show before parkinson symptoms
what decreases hallucinations in lewy body dementia?
cholinesterase inhibitor rivastigmine
features of lewy body dementia
- 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
what causes dementia with lewy bodies
aggregation of alpha synuclein
What can we see on scans for a patient with dementia of lewy bodies?
MRI:
Preserved hippocampus volume and medial temporal lobe volume (different to AD)
DaTscan:
Less dopamine transporters in caudate and putamen
What observations can we make from a blood test and an MRI for FTD
Normal blood test results
MRI:
- volume loss in temporal lobe and frontal opercula
- may be more on right side to suggest FTLD
What are symptoms of frontotemporal lobe dementia?
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
