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Dementia Flashcards

1
Q

Definition (4)

A

Acquired
General
Progressive impairment of cognitive function
Impaired activity of daily living

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2
Q

Cognitive functions impaired

A 
Memory
Recall
Orientation
Language
Abstraction
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3
Q

Prevalence at 60yo and doubling time

A

1% at 60, doubles every 5 years

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4
Q

Prevalence at 85yo

A

30-50%

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5
Q

Categories of dementia (Vitamin D Vest)

A 
Primary degenerative
Vascular
Infectious
Trauma
Rheumatological
Neoplastic
Vitamin, Intracranial tumor, Trauma, Anoxia, Metabolic, Infection, NPH, Degenerative, Huntingtons, Vascular, Endocrine, SOL, Toxic
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6
Q

Reversible causes of dementia

A 
Alcohol (withdrawal, intoxication)
Medications (benzodiazepines, anticholinergics)
Heavy metal toxicity
Hepatic/renal failure
Wilsons
Vit B12
Hypo/hyperglycemia
Cortisol
Thyroid
Normal pressure encephalus
Depression
Intracranial tumor
Subdural hematoma
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7
Q

Common differentials

A 
MCI
Delirium
Depression 
Alzheimers
Vascular dementia
Lewy body dementia
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8
Q

Uncommon differentials

A 
Amnesia
Aphasia
FTD
Parkinsons
Huntingtons
Brain tumors
Cushings
Hypothyroid
\+PTH
SLE
Syphillis
Wilsons
TB
Lyme disease
CJD
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9
Q

Primary neurodegenerative causes (4) with key clinical features

A

Alzheimers- Anterograde amnesia, aphasia, apraxia, agnosia, disturbance in executive function
Dementia with lewy body- visual halluncinations, parkinsonism, fluctuating cognition
Frontotemporal dementia- behavioural / language presentation
Huntingtons disease- chorea

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10
Q

Vascular causes of dementia with key clinical features

A

Multi-infarct dementia->acute onset, stepwise, focal neurological signs, dysexecutive
Vasculitis->systemic S&S of vasculitis

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11
Q

Infectious causes (6) with key clinical features

A

HIV
Syphillis->ataxia, myoclonu, tabes dorsalis
Chronic encephalitis
Chronic meningitis->F,H,N, meningismus, localising neurological defects
Abscess->+ICP, localising neuro signs
CJD->rapidly progressive, myoclonus

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12
Q

Traumatic causes

A

DAI, subdural, epidural hematoma->history, +ICP, papilloedema, localising neuro signs

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13
Q

Neoplastic causes

A

Mass effect, edema, hemorrhage, seizure->+ICP, localising signs, systemic symptoms of cancer

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14
Q

Emergency consideration for suspected dementia

A

Delirium

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15
Q

Initial test to order when delirium not ruled out

A

FBC, UEC, fasting blood glucose, urinalysis MCS, UDS

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16
Q

Importance of herpes simplex

A

Most common cause of sporadic encephalitis

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17
Q

How does HSV encephalitis present

A

Acute febrile illness
Altered mental status
Headache, seizure, focal neurology

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18
Q

What to give in all cases of suspected HSV encephalitis

A

Aciclovir

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19
Q

History

A

Psychiatric evaluation
Premorbid function
Geriatric giants
Changes in cognition, function, personality, language, skills, behaviour
Abrupt, step wise, gradual->vascular
Acute->infection, metabolic, lesion, medication, stroke, hydrocephalus
Rapid decline->delirium
Gait abnormalities, urinary incontinence
Change in ability to manage ADLs, and instrumental activities
Family history
Drug and alcohol
Past medical history
Stroke risk factors->hx, TIA, hypertension, cholesterol, diabetes, CAD, AF
Parkinson’s disease inquiry
Transient neurological->gait, incontinence

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20
Q

What are the activities of daily living (6)

A 
Eating
Bathing
Dressing
Toileting
Transferring
Continence
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21
Q

What are the instrumental activities of daily living (8)

A 
Housework
Cooking
Cleaning
Shopping
Finances
Telephone
Transport
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22
Q

Cognitive assessment tool and score when indicates an abnormal result

A

MMSE

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23
Q

Components of MMSE

A 
Orientation
Registration
Attention and calculation
Recall
Language
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24
Q

Components of language assessment (6)

A 
Name two objects
Repeat "no ifs, ands, or buts"
Follow a three stage command
Read and obey the following
Write a sentence
Copy the design
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25
Physical examination- what to test and what it may mean
General: vitals, BP, hearing and vision CN->vascular may have visual field defects. Ataxia, nystagmus and lateral gaze palsy may suggest alcohol Motor->vascular and hemiparesis Sensory->peripheral neuropathy may indicate vitamin, toxic metabolic Co-ordination and gait->vitamin B12, NPH, vascular Reflexes-> may have primitive, asymetric in vascular, myoclonus in CJD CV->hypertension, dysrhythmias, PVD, vascular disease, CHF
26
What are the geriatric giants in history
Confusion, incontinence, falls, polypharmacy Memory and safety Behavioural
27
Behaviour issues in dementia
``` Mood Anxiety Psychosis Suicide Personality Aggression ```
28
Safety issues in dementia
Wandering Leaving electrical items on Losing objects Leaving doors unlocked
29
Laboratory investigations
``` UEC, glucose FBC w. differential TSH Vit B12 Folate ESR CRP Urinalysis Urine MCS CXR ```
30
Other tests to consider based on history
``` HIV Urine toxicology Collage vascular Urinalysis for heavy metals Syphyllis serology CSF FDG-PET ```
31
Imaging
CT or MRI
32
Definition of alzheimers
Progressive chronic neurocognitive decline
33
Define aphasia
Language disturbance
34
Define apraxia
Inability to perform motor tasks despite normal motor function
35
Define agnosia
Difficulty recognising objects despite intact sensory modality
36
Epidemiology of AD
60-70% of all dementias 5% of 80 More common in women
37
Gender preference in AD
More common in women
38
How is early onset AD inherited, genes involved and how common
Autosomal dominant->APP, presenilin 1 and 2
39
Pathophysiology of AD- two theories
Amyloid hypothesis->excess interneuronal amyloid (abeta) as overproduction/reduced clearance of beta amyloid->dense amyloid as plaques. Cause inflammation, microglial activation, complement cascade->neuritic plaques leading to cell death. Tau-protein theory->tau protein accumulation as neurofibrillary tangles.
40
Gross pathology of AD
Cortical atrophy +in frontal, parietal, temporal lobes
41
Microscopic pathology of AD
``` Senile plaques Loss of synapses Hyperphosphorylate tau Neurofibrillary tangles Loss of cholinergic neurons ```
42
Biochemical pathology of AD
50-90% reduction in choline acetyltransferase
43
Risk factors for AD (6)
``` Age Family history Down syndrome Genetics Cerebrovascular disease Hyperlipidemia (Weak= brain injury, obesity, low IQ, female, depression, female, DM) ```
44
Clinical presentation catgories (3)
Cognitive Psychiatric Motor
45
Cognitive impairment in AD
Impaired memory, language, abstract, executive
46
Psychiatric manifestations in AD
Mood Psychosis Apathy
47
Motor manifestations in AD
Occurs late-->Parkinsonism
48
Key diagnostic factors in AD (9)
``` Presence of risk factors Memory loss Disorientation Nominal aphasia Misplacing/getting lost Apathy Decline in ADL, IADL Personality change Unremarkable physical examination ```
49
Investigations for AD (9)
``` Bedside cognitive assessment FBC ESR Glucose TSH Vit B12 and folate Metabolic panel UDS CT, MRI ```
50
DSM 5 criteria for AD
Memory impairment + one > aphasia, apraxia, agnosia, disturbed executive function Gradual and progressive Not due to general medical condition, psychiatric illness or other neurological illness or substance use
51
Findings on MRI of AD (3)
Cortical atrophy, +in hipocampua Dilitation of lateral ventricles Widened cortical sulci
52
Management overview of AD
Supportive Environmental control Cholinesterase inhibitors Symptomatic management
53
Supportive management of AD
``` Carer support Home safety evaluation OT assessment Driving, shopping, finances Self care Written instructions and explanations for carers Calenders, clocks, charts for orientation Lighting Exercise AHD ```
54
Environmental control measures for AD
Identification bracelets | Tagging devices with GPS
55
Cholinesterase inhibitor goals, when to start, first line
To slow the decline Begin when mild AD diagnosed Donepezil 5mg OD or rivastigmine OR Galantaine
56
Symptomatic management AD- mood, psychosis, insomnia, behavioural
Antidepressant->sertraline, citalopram, escitalopram Agitation, wandering, psychosis->risperidone, olanzepine, quetiapine, aripiprazole Insomnia->sleep hygeine Behavioural->environmental and behavioural modification
57
When should you consider mirtazepine
If poor appetite and insomnia
58
When antipsychotics not to be used in dementia
Evidence of vascular dementia
59
When antipsychottic treatment should be stopped
Evidence of worsening neurology
60
What environmental factors should you consider with exacerbation of psychosis and confusion
Poor lighting Disorientation Isolation
61
MOA of donepezil
Decrease breakdown of ACh- alleviating the relative deficiency
62
Donepezil CI and cautions, pregnancy and breastfeeding
CI in active peptic ulcer and GI/ureteric obstruction | Caution in hx peptic ulcer, heart block/bradyA, parkinsons, asthma, COPD
63
Common side effects of donepezil (10)
Nausea, abdominal pain Urinary frequency, diarrhea Insomnia, fatigue, depression, drowsy Sweating, hypertension
64
Counselling use of donepezil
Initial dose 5mg May cause dizzy/drowsy, if it does do not use heavy machinery Omit one or more if adverse effects If interrupted treatment, start back at low dose to minimise risk of severe vomiting
65
Key diagnostic factors in Lewy body dementia
``` Presence of risk factors (old age, male) Cognitive impariment Fluctuations in mental state Visual hallucinations Depression EPS REM sleep disturbance Severe antipsychotic sensitivity Others- auditory, falls and syncope, delusions ```
66
Etiology and pathogenesis of LBD
protein alpha-synuclein, a cytoplasmic protein associated with synaptic vesicles
67
Epidemiology of LBD
15-25% of all dementias
68
Treatment of lewy body dementia
Donepezil
69
Prognosis of lewy body dementia
3-5 years
70
Key diagnostic factors in FTD
Coarsening of personality, social behaviour and habits Progressive loss of language fluency/comprehension Memory impairment, disorientation, apraxias Self neglect, abandonment of work, activity and social contacts
71
Two variants of FTD
Behavioural | Language
72
Which FTD variant is more common
Bahavioural
73
Language variants of FTD
Progressive non fluent aphasia | Semantic dementia
74
Features of progressive non-fluent aphasia
non fluent, laboured speech, anomia, preserved single word comprehentions, word finding deficit, impaired repetition
75
Features of semantic dementia
fluent, normal rate, impaired single word comprehension, intact repetition, use of words of generalisation (things) or supraordinate categories (animal for dog)
76
What are supraordinate categories
Use of animal for dog
77
Two histology types of FTD
Frontal lobe degeneration with microvacuolar change | Pick type with astrocytic gliosis +/- ballooned cells and inclusion bodies
78
Epidemiology of FTD
10% of all dementias
79
Core features in FTD
Insidious decline and gradual Early decline in social interpersonal conduct Early impairment of regulation of personal conduct Early emotional blunting Early loss of insight
80
Supportive features in FTD
Behavioural Language Motor
81
Motor features of FTD
``` Primitive reflexes Incontinence Akinesia Rigid Tremor Low and labile blood pressure ```
82
Management of FTD
``` Supportive care Treat irritability with benzodiazepine Treat any concurrent illness Home assistance, respite Treat mania etc with valproate Organise and manage end of life care ```

MI Internal Medicine (67 decks)

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