Dementia Flashcards
What is the definition of dementia?
•Progressive cognitive decline
•The cognitive or behavioural impairment involves a minimum of two of the following:
- memory
- executive function
- language
- apraxia/visuospatial
•Interferes with the ability to function at work or at usual activities and represents a decline from previous levels of functioning and performing
•Is not explained by delirium or major psychiatric disorder
•In summary, severe, acquired and must involve more than one brain region
What are the mimics of dementia?
- Vascular disease including stroke
- Trauma
- Cancer
- major mental health issues
What comes under ‘memory’ in a cognitive history?
•Impaired ability to acquire and remember new information
•Symptoms include:
- Repetitive questions or conversations
- misplacing personal belongings
- forgetting events or appointments
- getting lost on a familiar route
What comes under ‘executive function’ in a cognitive history?
•Impaired reasoning and handling of complex tasks, poor judgement
•Symptoms include:
- poor understanding of safety risks
- inability to manage finances
- poor decision making ability
- inability to plan complex or sequential activities
What comes under ‘visuospatial’ in a cognitive history?
•Impaired visuospatial abilities
•Symptoms include:
- inability to recognise faces or common objects or to find objects in direct view despite good acuity
- inability to operate simple implements or to orient clothing to the body
What comes under ‘language’ in the cognitive history?
•Impaired language functions (speaking, reading, writing)
•Symptoms include:
- difficulty thinking of common words while speaking
- hesitations
- speech
- spelling
- writing errors
Name 2 cognitive assessments
- Folstein MMSE (30)
* Addenbrookes cognitive assessment (100)
What does addenbrookes examine?
- Executive function
- Memory
- Language
- Visuospatial
What is the purpose of addenbrookes?
- Assess severity
* Assess pattern of impairment
What are the facets of executive function?
- Behaviour aspect- orbitofrontal
- Attention/working memory - dorsolateral prefrontal cortex
- Motivation/goal driven - anterior cingulate
What are the symptoms of dementia affecting the orbitofrontal cortex?
- disinhibited
* Loss of social awareness
What is the dorsolateral prefrontal cortex responsible for?
- Working memory
- Cognitive estimates
- Planning
- Understanding proverbs
What is attention/concentration?
Component of consciousness which allows filtering of information to allow one to focus on a particular stimuli
How can you test attention/concentration/orientation?
- Orientation: day/date/month/year/season, which building/floor/town/county/country
- 3 words, repeat back and memorise and ask again 5 minutes later
- serial 7s
How can you test executive function?
- Trail making
- look for regional atrophy on MRI
- Proverbs, verbal fluency, estimates and planning
What are the types of memory
•Declarative (explicit) memory is split into:
- episodic
- semantic
- working
What pathological processes affect episodic memory?
- Alzheimers
* Limbic encephalitis
Where does Alzheimers start and how does it spread
- Classically starts in the temporal lobe
* Spreads to parietal and frontal lobes
How do you test semantic memory?
Ask general knowledge questions
What is the sign of impaired semantic memory on addenbrookes CE?
- Marked reduction in the category verbal fluency (list of animals in one minute)
- Impairment of irregular words (dyslexia) e.g. pint
- loss of knowledge = semantic memory
What does ‘visuospatial’ involve?
- Visual processing - what and where
* Accurately localise objects
What are the signs of reduced visuospatial awareness?
- Inability to recognise faces or common objects in direct view despite good acuity
- Inability to operate simple implements, or orient clothes to the body
Explain the anatomy of visual processing
- dorsal stream = Where pathway in the occipital parietal region, position of object in space and picking an object from a scene
- Ventral stream = What pathway to temporal lobe: object recognition, facial recognition
How does the Addenbrookes cognitive exam test visuospatial-parietal lobe function?
- Pentagons
- Cubes
- 3D letters
- dots counting
How is language tested in addenbrookes?
- naming
- Repetition
- 3 stage command (comprehension)
- Reading
What are the 3 main patterns of summary language disorders?
- Semantic variant
- Logopenic variant
- Non-fluent variant
Explain semantic variant of summary language disorder
- Poor confrontation naming
- impaired single word comprehension
- Poor object/person recognition, surface dyslexia
Explain logopenic variant of language disorders
- Impaired single word retrieval (thinking of right word)
* Impaired repetition, speech sound errors, spared object/person recognition, single word recognition
Explain non fluent variant of language disorders
- Effortful, halting speech
- Phenomic errors
- Spared object/person recognition, single word recognition
What language disorder pattern is as a result of semantic dementia?
Semantic variant
What language disorder is seen in Alzheimers?
Logopenic
What type of language disorder is seen in progressive non fluent aphasia?
Non fluent variant
What score of addenbrookes excludes dementia?
> 88
What score of addenbrookes supports a diagnosis of dementia?
<83
What is the likely disorder if there is a deficit in episodic memory in ACEr?
Alzheimers
What is the likely disorder if there is a deficit in semantic memory in ACEr?
Semantic dementia
What is the likely disorder if there is a deficit in attention/concentration in ACEr?
Delirium
What is the likely disorder if there is a deficit in fluency in ACEr?
Non fluent aphasia
What is the likely disorder if there is a deficit in visuospatial in ACEr?
Parkinsons plus syndrome or variants Alzheimers disease
