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YR5 Psychiatry > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia?

A

Acquired, chronic + progressive cognitive impairment which results in impairment of ADLs

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2
Q

What are the primary and secondary dementia?

A

Primary: Alzheimers, Lewy body, Frontotemporal, Vascular

Secondary: Deficiencies (B12, Thiamine), Dehydration, Infection (Syphilis)

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3
Q

What are 8 risk factors for Alzheimers dementia?

A

Age

Female

FH

Vascular RFs

Low IQ/ education

Head injury

Previous depression

Down syndrome

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4
Q

Summarise the epidemiology of dementia.

A

5% of >65s

20% of > 80s.

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5
Q

What are the signs and symptoms of dementia?

A

Most commonly affected areas inc. memory, visual-spatial, language, attention + problem solving.

Most types of dementia are slow + progressive.

  • Memory impairment
  • Anxiety/ Depression
  • Mood changes: Agitation/ Irritability
  • Speech abnormalities
  • Disinhibition + impulsivity
  • Delusions (often believing people are stealing from them) or hallucinations
  • Changes in sleep or appetite.
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6
Q

What investigations would you do for dementia?

A

Bloods: r/o other causes
FBC + B12 + folate
U+Es: uraemia, renal failure
Alcohol hx + LFTs
Syphilis + HIV testing
TFTs

Refer to memory clinic
Hx + collateral
Cognitive testing
Brain MRI/ CT: shows degeneration

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7
Q

What are the main types of dementia?

A

Alzheimer’s: 50-80%

Vascular: 20-30%

Lewy Body: 10-25%

Frontotemporal: 10-15%

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8
Q

How does Alzheimer’s Dementia present?

A

Amnesia: Memory loss, esp. recent events

Aphasia: Language deficits

Agnosia: difficulty recognising things/ faces

Apraxia: Impaired visuospatial skills

Gradual progressive onset

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9
Q

How does Alzheimer’s Dementia present on imaging?

A

Cortical atrophy (esp. medial temporal + parietal)

Beta amyloid plaques

Neurofibrillary tangles

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10
Q

How does vascular dementia present?

A

Abrupt or gradual onset

Patchy cognitive impairment

Focal neurological signs

Signs of vascular disease

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11
Q

How does vascular dementia present on imaging?

A

Multiple white matter lucencies

Atrophy

Strokes

Lacunar infarcts

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12
Q

How does Lewy Body dementia present?

A

Fluctuating cognition + consciousness

Visual hallucinations

Parkinsonism

Neuroleptic sensitivity

Autonomic instability (syncope)

Recurrent Falls

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13
Q

How does Lewy Body dementia present on imaging?

A

Generalised atrophy

Lewy bodies in cortex + midbrain

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14
Q

How does frontotemporal dementia present?

A
  • Insidious onset, typically in 50-60s, rapid progression
  • Disinhibition
  • Socially inappropriate behaviour
  • Poor judgement
  • Apathy, decreased motivation
  • Poor executive function
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15
Q

How does frontotemporal dementia present on imaging?

A
  • Frontal + temporal atrophy
  • Pick cells + pick bodies in cortex
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16
Q

What causes the cognitive symptoms seen in Alzheimers?

A

Reduced levels of Acetylcholine

17
Q

What is the pharmacological treatment for Alzheimers dementia?

A

Cholinesterase inhibitor: Donepezil, Rivastigmine
NMDA antagonists: Memantine (severe)

18
Q

What is the pharmacological treatment for Vascular dementia?

A

Aspirin
(to prevent further ischaemic damage)

19
Q

What is the pharmacological management for frontotemporal dementia?

A

SSRIs help with behavioural Sx
Supportive Tx
Atypical antipsychotics

20
Q

What is the management for Lewy body dementia?

A

Cholinesterase inhibitor: Donepezil, Rivastigmine

Clonazepam for REM sleep disturbance

Parkinson’s medication could relieve tremors but worsen psychosis
Antipsychotics are DANGEROUS, can cause confusion, Parkinsonism + death

21
Q

What are the complications of dementia?

A

Pneumonia

Institutionalisation

UTI

Falls + their complications

Weight loss

Elder abuse

Depression

Agitation

22
Q

Which genes are associated with early and late onset Alzheimers dementia?

A

Early: APP mutations (Chr21), Presenilin 1 + 2 mutations

Late: APOE E4 allele

23
Q

List 7 risk factors for vascular dementia

A

Age

Male

Smoking

HTN

Diabetes

Hypercholesterolaemia

Atrial fibrillation

24
Q

Which gene is associated with increased risk of Lewy body dementia?

A

APOE E4 allele

25
Q

List 4 features contributing to pathophysiology of Alzheimers Dementia

A

Plaques

Neurofibrillary tangles

Cortical atrophy

Cholinergic pathway loss

26
Q

How should Parkinsons disease dementia be treated?

A

Levodopa +/- MAO-B inhibitor or COMT inhibitors

27
Q

How do plaques form in AD?

A

In neuronal cell membranes, APP influences cell growth + survival

When broken-down abnormally, forms insoluble extracellular plaques of B amyloid

Disrupts signalling between neurones, triggers immune mediated inflammation + damages blood vessels

28
Q

How do neurofibrillary tangles form?

A

Plaques trigger abnormal phosphorylation of Tau

Tau usually stabilises microtubules

Phosphorylated Tau collapses into twisted strands

Disrupts cell transport + causes neuronal death

29
Q

How does cortical atrophy arise in AD?

A

Follows neuronal loss

Hippocampus (essential for short term memory + visuospatial skills) affected early before temporal + parietal lobes

Enlarged sulk + ventricles on imaging

30
Q

Which pathways are thought to be mostly affected in AD?

A

Cholinergic pathways

31
Q

What patholophysiology is found in vascular dementia?

A

Arteriosclerosis

Cortical ischaemia

Cortical infarcts

32
Q

How are dementia with Lewy bodies and Parkinsons disease related?

A

2 expressions of a shared problem in metabolising alpha-synuclein protein

Causes deposition of Lew bodies

33
Q

What are Lewy bodies?

A

Abnormal eosinophilic intracytoplasmic neuronal structures composed of alpha synuclein with ubiquitin

34
Q

How does DLB differ to PD?

A

PD: Lewy bodies in brainstem. Movement disorder predates cognitive Sx >,1y

DLB: Lewy bodies in cingulate gyrus + neocortex. Cognitive impairment precedes movement Sx/ occurs within 1y of their onset

35
Q

Describe the presentation of variant CJF

A

Initially psychiatric Sx: depression, anxiety + insomnia
Later: Amnesia, ataxia + sensory neuropathy

36
Q

Describe the presentation of sporadic CJD

A

Age of onset commonly 6-+
Presents with neurological Sx

YR5 Psychiatry (33 decks)

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