Dementia Flashcards
what is dementia
severe loss of memory and other cognitive abilities which leads to impaired daily function
chronic neurodegenerative disease with progressive (slow cognitive decline) and an insidious onset
Heterogenous course
Multiple comorbidities in old age
Younger patients more typical
See Causes for detail
No current cure: acetyl cholinesterase inhibitors
what are risk factors for dementia
aging oral health brain trauma infections or systemic inflammation genetic factors midlife obesity reduced physical activity
what are the most prevalent causes for the 2 types of dementia
1) Young onset
2) late
fAD= frontal alzheimer’s disease
AD = Alzhiermer’s disease
VaD= vascular dementia
FtD= frontal lobe dementia
DLD/PD = lewy body dementia
Dementia can be young onset ( <65 yrs) or late onset ( > 65yrs)
Causes of young onset : Familial autosomal dominant alzheimer’s disease caused by AVP and Presnell mutations, More caused by frontal lobe damage
Causes of late onset : Alzheimer’s most prevalent
what are symptoms of dementia
Symptoms of dementia Head turning sign Forgetfulness / episodic memory ( memory for particular periods of their life ) Get lost easily Disinhibition Changes in personality Poor personal hygiene
what is progression of dementia
Cognitive function decreases with age
In dementia you have a preclinical period : deterioration in cellular function w/o clinical manifestation ie forgetfulness
In Preclinical : increases in amyloid, increases in tau protein inflammation → leads to mild cognitive impairment and dementia
Cognitive function fluctuates up and down - it is not a smooth curve and is dependant on sleep, diet, stress etc
Amyloid tau protein may increase if cause in Alzheimer’s
why is dementia hard to diagnose?
Generally hard to diagnose as :
Disease follow heterogenous course
Old age means disease presentation is of multiple comorbidities ( ie hypertension , diabetes, CVD)
Can have mixed pathologies ( ie can be a lot of molecules causing dementia
Younger present with more typical symptoms
V important to look at clinical history and how the patient changes over time
what is the clinical diagnosis pathway for dementia
1) referral
2) History
3) examination
4) investigation
5) diagnosis
6) management
7 ) repeat
what happens in referal
From GP , therapist , geriatrics doctor ect
what must you ask in the history of dementia
Interview( ask about) :
Must ask about chronology of each ( aka how it’s changed over time ie improve/ deteriorate)
Large deterioration = usually vascular causes of dementia . Small deterioration = alzheimers
( should ask family members = collateral history )
V important to ask about memory esp short term memories Ie what did you have for breakfast today
Delusion : firmly held fixed ideas that can’t be changed
Hallucinations can be auditory , visual, somatic
Confirm with a relative
Look for “head-turning” sign
Vague about recent news events and sports results
Queen square green book
Luria three stage sequence with alternating hand task
See google docs for more ie - memory language maths skills visuospatial skills etc
what examinations of dementia should be conducted
Neurological - Cranial nerve tests . Lower + upper limb tests. Focus tests ie frontal lobe function tests etc
Mental state → appearance , perception , insight ( all the physciologial stuff etc)
what investigations of dementia should be conducted
Neuropsychology : profound impairment of episodic memory esp in relation to recently learned material
MMSE test : +/- ACE III (15 minutes, more memory focussed) Can also do the Cambridge cognitive examination which is more memory focused Or ACE ( addenbrooke's cognitive assessment)
Bloods Full blood count Inflammatory markers Thyroid function Biochemistry and renal function Glucose B12 and folate Clotting Other causes Syphilis serology HIV Caeruloplasmin: wilson’s disease, copper deficiency (at intervals when monitoring a copper related disease or its treatment)
Basic Imagining ie MRI / PET
CSF ( microbiology)
Taken via lumbar puncture + assess for B amyloid and tau protein
what types of MRT/PET should be done for dementia
MRI scan/ structural imaging Left = cognitive normal Middle = mild cognitive impairment Right = alzheimer's disease In AD : Ventricles are dilated and enlarged, hippocampal volume loss - replaced with CSF ( appears black on MRI)
Amyloid PET scans
Cannulate patient
Inject patient with contrast ( ATF) which travels to the brain
Contrast lights up amyloid in the brain
Negative: low likelihood of alzheimer’s (low amyloid, low tau)
what can be possible diagnosis of dementia
See types + causes below Differential list ie : Alxheimers Vascular Lewy body FTD Depression Delirium None ?
what are the management strategies of dementia
See below !
ACHase inhibitors
Watch and wat ( should see deterioration of patient > 6 months)
Treat behaviour and physiological symptoms
OT / social services
Specialist therapy
what are the different types of dementia
In order to diagnose dementia must rule out other conditions
First rule out other conditions: delirium vs dementia vs depression
1) Alzheimer’s
2) vascular dementia
3) dementia with Lewy bodies
4) frontal temporal dementia
5) rapidly progressing dementias
