Dementia Flashcards
What is dementia
Progressive and chronic detiroration
Decline across mutiple cognitive domains
Memory most commonly affected
What the functional impairments of dementia
Agnosia
Anosognosia
Apraxia
Apathy
What are some RFs of Dementia?
Age Genetics Cog reserve Cardiovascular RFs Hearing loss Depression
What leads to a lesser cognitive reserve?
Leaving education early
Less job complexity
Social isolation
What are the stage of dementia?
Early
Middle
Late
What are the feature of early stage dementia?
Gradual onset
Forgetfulness
Losing track of time
Becoming lost in familiar places
What are the main features of vascular
Presumed vascular cause:
Atherosclerosis
Small vessel disease
Ischamia
What causes Alzheimers?
Most common form
Extracellular accumulation of amyloid plaques
Intracellular accumulation of neurofibrillary tangles
What is the difference between normal brain and a brain in someone with dementia?
Atrophy
Temporal lobes and hippocampus particualry affected
Can be seen on MRI
What are the main features of vascular dementia?
Presumed vascular cause:
Atherosclerosis
Small vessel disease
Ischeamia
Stepwise decline ‘plataeus’ then next insult causes decline again
Stroke is a major RF
What is the difference between normal brain and Alzheimers?
Atrophy
Temporal lobes and hippocampus particualry affected
Can be seen on MRI
What does Vascular dementia look like on a MRI?
White dots - areas of small vessel disease
What are the main features of LB dementia?
Deposition of alpha-synuclein
Age is biggest RF
Cog. signs:
Visual hallucination
Changes in alertness, concentration
Parkinsonian symptoms:
Movement disorders
What are the main features of Frontotemporal dementia?
Group of disorders when nerves are lost in frontal and temporal lobes causing them to shrink
Can affect behaviour, personality, language and movement
What is the treatment for dementia?
Medication
Mind-stimulating activities
Therapy
Lifestyle changes
What are some medications used in the treatment of Dementia?
Acetylcholinesterase inhibitors
e.g. donepezil, rivastigmine
What are some medications used in the treatment of Dementia?
Acetylcholinesterase inhibitors
e.g. donepezil, rivastigmine
Meds to treat vascular RFs e.g. statins
Anti-psychotics e.g. haloperiodol and risperidone
Anti-depressants
What are some non-pharmacolgical treatments for dementia?
Cognitive stimulation therapy
Cognitive rehabilitation
Remince on life
What is delirium?
Common clinical syndrome that involves disturbed consciousness, cognitive function or perception which has an acute onset and fluctutating course
What are the consequences of delirium?
Longer hospital stay Increased incidence of dementia More HAIs Increased chance of long term care e.g. nursing homes More likely to die
What are some RFs for Delirium?
Age Dementia Low eduational level Frailty Depression Poor nutrition Surgery
What are some signs of delirium?
Distractible Inattentive Drowsy/Hyperalert Picking at clothes/sheets Not getting out of bed Generally unwell
How do you diagnose delirium?
2 screening tools
4AT
CAM
What is involved in the management in delirium
Treat underlying cause
Supportive care
Orientation (told the time, where they are, familiar items etc.)
Appropriate environment
Stop medicines that make it worse e.g. Anticholinergics like warfarin and furoesmide
What medications are used in the treatment of delirium?
Not routinely used
Used to manage symptoms short-term
e.g. Anti-psychotics
Benzodiazepines (Lorazepam)
What is the leading cause of disability worldwide?
Depression
What is the core symptom of depression?
Feeling down/depressed/hopeless
What is pseudo-dementia?
Depression related cognitive dysfunction
What are the symptoms of pseudo-dementia?
Memory issues
Deficits in executive functions
Deficits in speech and language
How do you recognise depression in the elderly?
Geriatric depression scale
15 point questionnaire
CORNELL Score if they cannot answer questions
What is the mangement of depresision
Talking therapies Exercise and social prgrammes Good sleep hygeine Improved nutrition Treat pain/co-morbidities Review medication
What is the pharmacological management of depression?
SSRIs e.g. citalopram or sertraline
SNRIs e.g. venlafaxine
Atypical e.g. mirtazapine (helps with sleep and appetite)
Avoid TCAs as they have anticholinergic effects
