dementia Flashcards
treatment of ALZahimar disease
cholinestrase inhibitor as donepezil . rivastgmine
galantamine
memantine [ NMDA RECEPTOR ANATGONIST]
when to give cholinestrase inhibitor
mild to moderate [MMSE LESS THAN 10]
when to give memantine
moderate to severe form of AD
or cannot take cholinestrase drugs
what do you know about donepezil
Once daily (5mg for 4 wks then 10mg)
– MMSE 1 pt better at 24 weeks
– GI symptoms, insomnia/sleep disturbance
–
Syncope -bradycardia – collapses
* Cautions: sick sinus syndrome or other
supraventricular conduction abnormalities…
* Side-effects nausea, vomiting, anorexia, diarrhoea;
fatigue, insomnia, headache, dizziness, syncope,
abnormal dreams, hallucinations, agitation,
aggression; cramps; urinary incontinence; rash,
pruritus;
what is vascular dementia
can occur in small or large vessel
risk factor ; as per all vascular disease
insidious onset of cognitive impairement
often slowing up of cognitive impairement with poor excutive skills
sudden oonset of symptoms followed by stepwise deterioration
by examination; neurological finding prior stroke
investigation for vascular dementia
imaging
eeg
neuropsychology ;Slowing, executive dysfunction +/- other cognitive
domains,
slowing of speed processing, diminished cognitive flexibility,
diminished attention/concentration
Others (e.g. CSF) performed only if suspect unusual (e.g., inflammatory)
cause
parkinsonm with dementia
parkinson disease is at risk 6 times to get dementia than other people
if dementia develop 12 month or befor parkinsonsm diagnsos
dementia with lwey bodies
what id dementia with lewy body
A gradually progressive dementia
Fluctuations in cognitive function
Persistent, well-formed visual
ha”ucinations
Spontaneous motor features o f
* parkinsonis Supportivem features include executive, visuospatial deficits, memory
impairment with progression, repeated falls, syncope, sensitivity to
neuroleptic medications, delusions, hallucinations in non visual
modes, REM sleep behaviour disorders, and depression.
*
*
*
Note memory typically less affected
than AD Onset between 50 and 83years
Mean survival similar to AD
treatment of dementia with lewy body
cholinestrase inhibiotr
why avoiding neuroeplipetic drugs in dementia with lewy body
sedation , worsning confusion
irreversible parkinsonsim
neuroleptic maligant like syndrome
death
prion disease or CJD
Rapid, multifocal dementia with
myoclonus
* Rare (incidence ~1/million/yr worldwide)
* Onset 45 - 75 yrs of age
* Other features
– prominent myoclonus
– cerebellar ataxia
– extra-pyramidal signs
– pyramidal signs
– cortical blindnes
new variant cjd
Young
onset
* Behavioural & psychiatric
disturbance
* Dysaesthesiae in lower
limbs
* Progressive cerebellar syndrome &
dementia
* Longer course than classical
CJD
* Public health implications (BSE epidemic)still
unclear
ct finding CJD
thalamic [ pulvinar] hockey stick sign in new variant of cjd
Gradual deterioration in memory. Now other cognitive domains involved,
affects social functioning?
AD
