Dementia Flashcards
What is pseudodementia and what is its main distinguishing feature?
Severe depression mimicking dementia - key differentiator is global memory loss rather than short-term memory loss
What are the factors suggesting depression over dementia?
Short history, rapid onset
Biological symptoms (weight loss, sleep disturbance)
Patient worried about poor memory
Global memory loss (instead of recent memory loss)
Reluctant to take tests and disappointed with results
Mini-mental test score can be variable but often normal
What are the 6 cognitive domains that decline is seen in dementia?
Learning and Memory Language Executive function Complex attention Perceptual-motor Social cognition
What are the 3 conditions for cognitive impairment to be specifically dementia?
Cognitive deficits interfere with independent everyday activities
Cognitive deficits do not occur in the context of delirium
Cognitive deficits are not better explained by another mental disorder (e.g. depression, psychosis)
What are the 5 types of dementia?
(most common to least common) Alzheimers Lewy body Vascular Frontotemporal Others (Parkinson's, Huntington's) or mixed dementia
What are the 4 key sections of a dementia history?
Timeline (gradual, progressive vs stepwise vs acute)
Ability to do ADLs/finances/manage house
Language skills
Visuospatial
What are the 5 cognitive tests you can do at the bedside for dementia
AMTS (abbreviated mental test score)
MMSE (mini mental state exam)
MOCA (montreal cognitive assessment)
ACE (addenbrooke’s cognitive examination)
RUDAS (rowland universal dementia assessment scale)
What is the maximum score for the AMTS and what threshold indicates cognitive impairment?
10
below 7
What differentials would you have in a potential case of dementia?
Delirium
What are the distinguishing features of delirium vs dementia?
Rapid onset Acute medical cause Clouding of consciousness Visual perceptual disturbances Risk factors - age >65, cognitive impairment, current hip fracture, severe illness
What are the features of vascular dementia?
Acute onset/stepwise progressive (can be insidious)
Cardiovascular risk factors (TIA/CVA/hypertension/diabetes/hypercholesterolaemia)
Cognitive symptoms - impaired attention and frontal features
Fluctuations in performance
Night time confusion
Personality and insight relatively preserved
Potential focal neurological signs
Emotional lability, pseudobulbar palsy, gait disturbance, incontinence
What are the features of Lewy-body dementia?
Lewy bodies present Visual hallucinations REM behavioural sleep disorder Autonomic dysfunction (postural hypotension) Neuroleptic sensitivity
What is the difference in Lewy body distribution between lewy-body dementia and parkinson’s?
LBD - more widespread and involve cortical regions
Parkinson’s - confined to substantia nigra
What are the features of fronto-temporal dementia?
Personality change Loss of social awareness and insight Disinhibition, impulsivity Apathy, inertia, apontaneity Mental rigidity, inflexibility Personal neglect and declining self-care Stereotypic behaviours and rituals Change in eating habits and food preference Loss of empathy and mentalising ability
What other differentials that can be dementia?
Creutzfelt-Jakob Disease Alcoholic dementia Neurosyphilis Normal pressure hydrocephalus HIV Vitamin deficiencies Tumours Huntington's
What is the aim of investigations when suspecting dementia?
Main aim is to rule out reversible/acute causes
Potentially assess progression too (neuroimaging)
Memory clinic for MDT approach
What does the memory clinic do for patients with dementia?
Assessment and diagnosis of dementia
Management of anti-dementia medication and BPSD (behavioural and psychiatric disorders in dementia)
Post-diagnostic support
Research for trials
What is the main medication for Alzheimer’s dementia?
Cholinesterase inhibitors (AChEi) (donepezil, galantamine, rivastigmine)
Memantine (second-line) - non-competitive glutamate receptor antagonist
What are the treatment guidelines for 3 main dementias?
Alzheimer’s - AChEi +/- memantine (mild to moderate), memantine (intolerant/refractory to AChEi) or severe disease
LBD
Frontotemporal - AChEi
Vascular - none, only start AChEi if co-morbid Alzheimer’s or LBD
Don’t stop treatment because of disease severity alone
What is mild cognitive impairment?
Dementia-like syndrome but not severe enough to be classified as dementia
What are the features of mild cognitive impairment syndrome?
Cognitively impaired but not having a significant effect on their daily life
Still able to function independently
Dementia-esque
What are the 4 things a patient needs to do in able to demonstrate capacity?
Understand
Retain
Use/weigh
Communicate decision
