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y3 - psych > Dementia > Flashcards

Dementia Flashcards

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1
Q

What is dementia?

A

An acquired, progressive impairment of cognition without clouding of consciousness that has been present for at least 6 months
The impairment needs to be present in at least 2 cognitive domains

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2
Q

What are the cognitive domains?

A 
Language
Movement
Behaviour
Memory
Visuospatial
Executive function
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3
Q

What are the features of cognitive decline?

A 
Memory loss
Reduced attention and concentration
Slow and muddled thinking
Loss of insight into actions
Disorientation in space and time
Muddled speech and difficulty understanding what is being said
Repetitive purposeless movements
Restlessness and wondering
Odd and disorganised behaviour
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4
Q

What are primary degenerative conditions that cause dementia?

A

Alzheimer’s disease
Lewy body
Picks disease

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5
Q

What are secondary causes of dementia?

A

Vascular dementia
Depression
Infective (HIV, syphilis, encephalitis, CJD (mad cow))
Neurological (huntington’s parkinson’s, motor neurone disease, intracranial tumour)
Alcohol abuse
Head injury

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6
Q

What is the most common cause of dementia?

A

Alzheimer’s disease

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7
Q

What are the genetic changes in Alzheimer’s disease?

A

Polymorphisms in the ApoE gene

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8
Q

What are the macroscopic changes in Alzheimer’s disease?

A

Cortical atrophy with thinning of sulci and gyri, with the occipital lobe being spared
Compensatory ventricular enlargement

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9
Q

What are the histological changes in Alzheimer’s disease?

A

Extra cellular and peri-vascular deposition of B-amyloid plaques

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10
Q

What are the neurotransmitter changes in Alzheimer’s disease?

A

Reduced acetylcholine in the nucleus basalis of Meynert

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11
Q

What age does Alzheimer’s disease typically present?

A

Over 60s

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12
Q

What are the symptoms of Alzheimer’s disease?

A

Progressive memory loss
Disorientation - especially somewhere new
Speech - trouble getting words out and understanding speech
Behaviour - wondering, restless, agitation, frustration, aggressive outbursts

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13
Q

What is vascular dementia?

A

Cognitive decline as a consequence of multiple small vessels infarcts within the brain

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14
Q

What is the pattern of onset of vascular dementia?

A

Sudden onset with stepwise progression of symptoms

symptoms develop, plateau, suddenly get worse then plateau again

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15
Q

What symptoms are seen in vascular dementia?

A

Functional deficits - gait disturbance, urinary incontinence
Mood and personality disturbance, mood disorders
Memory loss
Preservation of insight

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16
Q

How is vascular dementia diagnosed?

A

Clinical assessment

SPECT scan shows reduced attenuation throughout the brain

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17
Q

What is lewy body dementia?

A

Cognitive decline caused by levy body deposition in the substantia nigra

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18
Q

What are the characteristic clinical features in lewy body dementia?

A

Fluctuating cognitions with lucid periods and recurrent visual hallucinations

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19
Q

What are the symptoms of lewy body dementia?

A 
Difficulty with executive function (multi-tasking and complex tasks)
Parkinsonism
Psychosis
REM sleep disorders
Memory loss in late disease
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20
Q

What worsens the symptoms of lewy body dementia?

A

Typical antipsychotics

21
Q

What is the difference between the clinical features of Parkinson’s and lewy body dementia?

A

Time of onset of cognitive decline:
Parkinson’s - cognitive decline at least a year after the onset of parkinsonism
Lewy body - cognitive decline before or at the same time as onset of parkinsonism

22
Q

How is lewy body dementia diagnosed?

A

SPECT scan shows low dopamine uptake in the basal ganglia

23
Q

What is frontotemporal dementia?

A

Dementia causing behavioural and speech problems that affects the frontal and temporal lobes

24
Q

What is the age of onset of frontotemporal dementia?

A

Younger - <70

25
Q

What is a specific examples of frontotemporal dementia?

A

Pick’s disease

26
Q

What is the pathophysiology of Pick’s disease?

A

Picks cells - swollen neurones

Pick bodies - intracytoplasmic filamentous inclusions

27
Q

What is the presentation of frontotemporal dementia?

A

Change in behaviour and personality - decline in interpersonal skills
Apraxia - progressive decline in understanding of words and ability to produce speech
Insight is lost relatively quickly but memory is preserved

28
Q

What is the presentation of dementia in Huntington’s disease?

A

Emotional disturbance
Cognitive decline
Motor disturbance - clumsiness, chorieform movements

29
Q

What is normal pressure hydrocephalus?

A

A potentially reversible cause of dementia seen in those aged 50-70

30
Q

What are causes of normal pressure hydrocephalus?

A

Subarachnoid haemorrhage
Trauma
Idiopathic

31
Q

What is the presentation of normal pressure hydrocephalus?

A

Ataxia
Urinary incontinence
Reduced cognitive function

32
Q

How is normal pressure hydrocephalus diagnosed?

A

CT - hydrocephalus seen

Lumbar puncture would show normal opening pressures

33
Q

What is the management of normal pressure hydrocephalus?

A

VP shunt

34
Q

What are the cognitive assessment tools - and when should they be used?

A

Mini mental state exam - to guide whether a pt needs more assessment
MOCA and ACE III - both for more in depth assessment

35
Q

What is the non-pharmacological management of dementia?

A

Support groups
Address concerns of the individual
Reassurance
Measures to maximise QoL - care services, OT assessment, community alarm

36
Q

What are the options for pharmacological management of dementia?

A

Cholinesterase inhibitors
NMDA antagonist
Non-specifics: antidepressants, anticonvulsants, benzodiazepines - for associated depression or behavioural disturbance

37
Q

What are examples of cholinesterase inhibitors?

A

Rivastigmine
Donepezil
Galantamine

38
Q

How do cholinesterase inhibitors work?

A

Inhibit acetyl cholinesterase - this increases the amount of ACh in the synapse
Not a treatment but can slow cognitive decline and improve behaviour

39
Q

In which conditions are cholinesterase inhibitors most effective?

A

Alzheimers disease

Also used in lewy body dementia

40
Q

What are the side effects of cholinesterase inhibitors?

A 
GI upset
Hyper-salivation
Vivid dreams
Sleeplessness
Urinary incontinence
41
Q

What is an example of NMDA antagonists?

A

Memantine

42
Q

What conditions can NMDA antagonists be used in?

A

Severe Alzheimer’s

Second line to cholinesterase inhibitors

43
Q

What are side effects of NMDA antagonists?

A

Drowsiness
Dizziness
Constipation
Balance disorders

44
Q

What is delirium?

A

Impaired consciousness with intrusive abnormalities of perception and affect of acute onset and fluctuating course

45
Q

What are the clinical features of delirium?

A 
Impairment of consciousness
Disturbance of cognition
Psychomotor disturbance
Disturbance of sleep-wake cycle
Emotional disturbance
46
Q

What are some drugs that can cause delirium?

A 
Anticholinergics
Anticonvulsants
Anti-parkinsonism drugs
Steroids
Opiates
Sedatives
47
Q

What are risk factors for delirium?

A 
Increasing age
Dementia or other cognitive deficit
Previous episode of delirium
Peri-operative
Existing sensory deficits
Immobility
Social isolation
New environment
Stress
48
Q

What is the management of delirium?

A

Identify and treat cause
Corroborative history
Manage environment, provide support
Pharmacological - haloperidol, lorazepam (start low and go slow)

49
Q

What is the prognosis of delirium?

A

Mean duration 1-4 weeks

Minority can become chronic

y3 - psych (12 decks)

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