Dementia Flashcards
Why is it hard to diagnose dementia?
It follows a heterogenous course.
In old age it presents with multiple comorbidities.
Diagnostic overshadowing
What is the most common cause of dementia.
Alzheimer’s disease
Is there a cure to dementia
No
What is the difference in prevalence of causes of dementia in Young onset dementia vs Late onset dementia.
YOD- Slightly more prevalence of familial autosomal dominant (fAD) Alzheimer’s
Alzheimer’s disease is most common cause in both but bigger proportion in LOD.
Lewy body dementia and other causes of dementia are more common in YOD.
What are the most common causes of dementia?
-Alzheimer’s
-Vascular disease
-Frontotemporal dementia
-Lewy body dementia
What is the most important thing for doctors to do in clinic with dementia patients.
1.Get a patient history
2.See how well the patient is doing
3.How they change
(30 score assessment, mini mental state examination)
What is the path a dementia patient takes through the NHS.
1-Referral
2-History
3-Examination
4-Investigations
5-Diagnosis
6-Management
Define dementia
Severe loss of memory and other cognitive abilities, which lead to impaired daily function.
What examinations happen after the interview?
-CN test, upper limb and lower limb nerve test.
-Mental state e.g. speech, mood, behaviour, perception.
MINI MENTAL STATE EXAMINATION/ MONTREAL STATE
What investigations are done after the examination?
-Neuropsychology
-MRI
-PET
-Bloods
What blood tests are done as part of the investigations
-FBC
-Inflammatory markers
-Thyroid function
-Biochemistry and renal function
-Glucose
-B12 and folate
-Clotting
-HIV
-Syphilis
-Caeruloplasmin
(probably don’t need to know)
What do you see in brain imaging as the disease progresses?
-Narrowed gyri
-Widened sulci
-Dilated & enlarged ventricles
What do you see on MRI at the stage of Alzheimer’s
-Medial temporal volume loss
-Bilateral hippocampal volume loss
-Shrunken structures replaced by CSF, therefore appearing black.
What do PET scans involve
PET scans involve cannulating patient, injecting them with contrast. This will light up amyloid in the brain.
What is amyloid.
Proteins that build up in artery walls of the brain.
What PET scan signs are pathognomic of Alzheimer’s?
Amyloid along with Tau proteins.
What are the common potential diagnoses that can be made.
-Alzheimer’s
-Vascular
-Lewy body
-Frontotemporal
-Depression
-Delirium
What are the potential management strategies for dementia?
-Acetylcholinesterase inhibitors
-Watch and wait
-Specialist therapies
What signs could you use to differentiate Alzheimer’s from different types of dementia.
-Subtle
-Insidious amnesia
-Non insidious amnesia
What signs could you use to differentiate Vascular dementia from different types of dementia.
-Related to cerebrovascular diseases with step-wise deterioration
-Multiple infarcts i.e. strokes.
What signs could you use to differentiate Lewy bodies dementia from different types of dementia.
-Cognitive impairment before/ within 1 year of parkinsonian symptoms
-Visual hallucinations and fluctuating cognition
What signs could you use to differentiate frontotemporal dementia from different types of dementia.
-Behavioural variant FTD
-Semantic dementia
-Progressive non-fluent aphasia
