dementia Flashcards
epidemiology of dementia
46 mill ppl live with it worldwide
is there a cure demetia
no but can use acetyl cholinesterase inhibitors
what is the most common cause of dementia
alzheimers disease
what is a illness that can mimic dementia
depression
alcohol related brain damage
endocrine causes
b1,12 and 6 deficiency
what are some other factors that can affect cognition
infection
sleep
eating and drinking properly?
why is it hard to accurately diagnose dementia
follows heterogenous course
in old age there are multiple co morbidities
uncertain history
what causes alzheimers disease
build up of amyloid plaques
what is clinic process for dementia
referral history examination investigations diagnosis Management
checklist to interview patients and collateral
memory language numerical skills executive skills visuospatial skills sexual behaviour eating mood personality and social conduct anxiety activities of daily living delusions/hallucinations *and chronology of each
what is dementia
severe loss of memory and other cognitive abilities which leads to impaired daily function - regardless of underlying cause
what are some investigations that can be done to test for dementia
neuropsychology examination
mri
pet
bloods
what is mmse
test that you can do on test or ace 11 which is a more memory tested
what do we check bloods for
inflammatory markers thyroid function biochemistry and renal function glucose b12 and folate clotting hiv caeruloplasmin syphilis serology
what can we use amyloid pet scans for
check for alzheimers
what are the differential diagnosis for dementia symptoms
alzheimers vascular lewy body ftd depression delirium non
how to manage dementia
acetylcholinesterase inhibitors
watch and wait
treat behaviour e.g antipsychotics
specialist therapy
what is vascular dementia related to and how does it present
cerebrovascular disease with classical step wise deterioration possible with multiple infarcts
how does alzheimers present
subtle, insidious amnestic/non amnestic presentations
how does demential with lewy bodies present
cognitive impairment before/within 1 year of parkinsonian symptoms, visual hallucinations and fluctuating cognition
how does frontotemporal dementia present
behavior variant ftd, smenatic dementia
progressive non fluent aphasia
what does a typical case of probable alzheimers look like
patient asks same questions everyday makes mistakes incl taking meds cant make their way to familiar places watching tv programmes/film for second time increasingly irritable
how do you examine a patient
head- turning sign - when theyve been asked a question vague about recent events/sports not certain about route to hospital mini mental state examination adenbrookes cognitive assessment
what is episodic memory
memory for particular episodes in life
dependent on medial temporal lobes incl hippocampus
what might you see in an mri of someone with alzheimers
shrinkage of hippocampus space replaced by csf - atrophy
more prominent gyri
brain looks shrinked
why is diagnosis of alzheimers probable
diagnosis can only be made certain post mortem
how can we trace amyloid plaques
use tracer called atf and use pet scan to trace plaques
can also look at csf via lumbar puncture
what is alzheimers disease
most common cause of neurodegenerative dementia
typically involves initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures (entohinal cortex and hippocampus)
typical case of presentation of lewy body dementia
able to do less than previously
seems disorientated on some days but fine on others
memory not specifically an issue
can have daily visual hallucinations
follow up appointment - develop shuffling gait with reduced facial expressions
hallucinations decreased with rivastigmine
what would you see in examination in someone with lewy body
aware of recent news events no evidence of altered behaviour mmse 28/30, errors on attention no evidence of parkinsonism investigations arranged
describe dementia with lewy bodies
associated with fluctuating cognition often visual hallucinations rem sleep disorder high risk of falls development of symptoms associated with parkinsons disease
what can be seen in investigations in ftd
blood tests
mri showed extensive volume loss in temporal lobes and frontal opercula
expect to see in ftd
anger fusration
rude
lack of hygiene
frequent paraphrasic errors
