Dementia Flashcards
Describe features of dementia according to DSM 5
Now Neurocognitive disorder
- Major
- Mild (not ‘minor’)
Decline in at least one neurocognitive domain
For Alzheimer diagnosis decline in twoor more cognitive domains.
List the neurocognitive domains
Complex Attention Learning and memory Executive function Perceptual-motor Language Social cognition
Mnemonic - CALL ME PLS
Describe Major neurocognitive disorder according to DSM 5
Significant cognitive decline
One or more cognitive domains (“Call me pls”)
The cognitive deficits:
- interfere with independence in everyday activities
- not exclusively in the context of a delirium
- not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).
Neurocognitive disorder could be caused by several factors. List some of the possibilities.
Alzheimer’sdisease Vascular disease Traumatic brain injury HIV infection Substance/medication use Frontotemporal lobar degeneration Lewy body disease Prion disease Parkinson’s disease Huntington’s disease Another medical condition Multiple aetiologies Unspecified
Prevalence of Alzheimer’s in dementia patients
60-70% of dementia over age 60
Characteristics of dementia
↓short-term memory initially (later ↓LTM) Gradual decline over several years Depression common early on Suspicion, persecutory accusations Personality changes or entrenches May require prompts/assistance
Describe the gross neuropathology in severe Alzheimer’s disease
Extreme shrinkage of cerebral cortex
Several enlarged ventricles
Extreme shrinkage of entorhinal cortex
Extreme shrinkage of hippocampus
What is the consequences of neuronal loss in Alzheimer’s disease?
Loss of synaptic connectivity
Degeneration
What are the plaques and neurofibrillary tangles that form in Alzheimer’s disease
Plaques: abnormal clusters of chemically “sticky” proteins called beta-amyloid that build up between nerve cells.
Neurofibrillary Tangles: form inside dying cells, comprise twisted fibres of a protein called tau.
Risk factors of Alzheimer’s disease
Age Family history of AD Down’s syndrome / FH Head injury (in males) FH Parkinson's Depression Epilepsy Encephalitis / meningitis Herpes zoster/simplex
Describe the assessment of dementia
History - Including collateral Examination - Mental state exam, Mini-mental state exam - Physical examination - MoCA
Special investigations (depend on findings) - TSH, VDRL, FBC, Renal & Hepatic function, Ca2+. Phos, B12, Folate, CXR, PSA, HIV, EEG, CT scan
Early management of dementia
Discuss dx Rx other illness esp. depression Eliminate non-essential drugs Advise on will-making Monitor driving and household safety AD support group Discuss referral to specialised clinic Medication options
Medication that could be given in early stages of dementia
Cholinesterase inhibitors
Donepezil (Aricept)
Galantamine
Rivastigmine
May provide limited benefits for people with:
• Mild to moderately severe Alzheimer’s disease
• Dementia with Lewy bodies
• Vascular dementia, or,
• Mixed dementia.
Later management of dementia
Help carers optimise preserved pt. functions Monitor / Rx neuropsychiatric symptoms Arrange support / respite Monitor health of carers Plan transition to nursing home
Features of vascular dementia
Features:
Personality often preserved
May have step-wise deterioration
