Dementia Flashcards
Alpha-synuclein cytoplasmic inclusions
Lewy body dementia shows alpha-synuclein cytoplasmic inclusions (Lewy Bodies) on post mortem.
Epidemiology Lewy Body dementia
third most common type of dementia
Core features of Lewy Body dementia
fluctuating cognition, parkinsonism and visual hallucinations
Ix Lewy body dementia
clinical
single-photon emission computed tomography (SPECT)/DaTscan
Mx Lewy body dementia
acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine)
memantine
Epidemiollogy Alzheimer
most common dementia
Beta-amyloid plaques and neurofibrillary tangles with hyperphosphorylated TAU proteins
Acetylcholine deficiency
Alzheimer’s
Clinical presentation of Alzheimer (5 AS)
Amnesia (recent memories lost first)
Aphasia ( problem with speech/words)
Agnosia ( problems with recognition of something )
Apraxia (difficulty with movement/tasks)
Associated behaviours e.g. apathy, irritability
Ix Alzeihmer
Imaging: Cortical atrophy or ventricular enlargement, temporal lobe, paraphippocampus and hippocampus affected
Cognitive testing: ACE III,MOCA, Neurophysiology
Mx Alzeihmer disease
Mild moderate disease
Acetylcholinesterase inhibitors
Donepezil
Rivastigmine ( comes in patch form)
Galantamine
Severe disease
NMDA receptor antagonist memantine
Epidemiology Vascular dementia
second most common form of dementia
Clinical presentation vascular dementia
Several months or several years of a history of a sudden or stepwise deterioration of cognitive function
Focal neurological abnormalities
difficulty with attention and concentration
Seizures
Memory disturbance
Gait disturbance
Speech disturbance
Emotional disturbance
Mx Vascular dementia
Treatment is mainly symptomatic
address cardiovascular risk factors
Non-pharmacological management like cognitive stimulation programmes, music and art therapy
no specific pharmacological treatment
3 types of Frontotemporal lobar degeneration/dementia
Frontotemporal dementia (Pick’s disease)
Progressive non fluent aphasia (chronic progressive aphasia, CPA)
Semantic dementia
Behavioural variant (picks disease)
*most common type and is characterised by personality change and impaired social conduct.
*Stereotypical, repetitive and compulsive behaviour
*Relative preservation of memory, visuo spatial functioning in early stages.
*Early Language problems
Ix Pick’s disease
Focal gyral atrophy with a knife-blade appearance is characteristic in MRI
Macroscopic changes include:-
Atrophy of the frontal and temporal lobes
Microscopic changes include:-
Pick bodies - spherical aggregations of tau protein (silver-staining)
Gliosis
Neurofibrillary tangles
Senile plaques
Progressive non fluent aphasia (chronic progressive aphasia, CPA)
*Reduced speech fluency
*Articulation problems
*Phonological ( organisation of sounds) and syntactical ( sentence structure) errors
*Preservation of comprehension , understanding of speech
Semantic dementia
*Semantic = interpretation of meaning
*Preservation of fluency
*Normally phonology and syntax
*Difficulty with naming and comprehension
*Unlike in Alzheimer’s memory is better for recent rather than remote events.
Definition delirium
Acute, fluctuating syndrome
Disturbance of consciousness, cognitive function, perception and affect
Distinguishing Delirium from Dementia
Dementia
*Longer history, insidious onset occurring over months and years
*fluctuation is Less likely (except DLB lewy body)
*Psychotic symptoms much less likely, if they do appear they are less prominent, more simple (except DLB)
*Disturbance in motor activity is less likely (although sun dowing is where people with dementia might become more restless and confused in late afternoon/early evening)
*Emotional changes are less likely
Causes of delirium-
CHIMPS PHONED
Constipation
Hypoxia
Infection
Metabolic disturbance
Pain
Sleeplessness
Prescriptions
Hypothermia/pyrexia
Organ dysfunction (hepatic or renal impairment inc retention)
Nutrition
Environmental changes
Drugs (over the counter, illicit, alcohol and smoking)
Clinical presentation of delirum
Fluctuating cognition/cognitive impairment
Inattention
Altered conscious level
Disorientation
Disorientated thinking
Hallucinations, illusions, delusions
Memory problems
Change in emotion mood or personality
Disturbed sleep wake cycles
Acute onset- Onset usually 1- 2days
Usually triggered by underlying medical condition
Ix Delirium
Confusion screen
Concentration tests
Urinalysis
Blood tests:
FBC (e.g. infection, anaemia, malignancy)
U&Es (e.g. hyponatraemia, hypernatraemia)
LFTs (e.g. liver failure with secondary encephalopathy)
Coagulation/INR (e.g. intracranial bleeding)
TFTs (e.g. hypothyroidism)
Calcium (e.g. hypercalcaemia)
B12 + folate/haematinics (e.g. B12/folate deficiency)
Glucose (e.g. hypoglycaemia/hyperglycaemia)
Blood cultures (e.g. sepsis)
Imaging:CT head/CXR
4A’s Test
*Alertness - state name and address
*AMT4 - Age, date of birth, place (name of the hospital or building), current year
*Attention- Instruct patient to list months in reverse order, starting at December
*Acute change or fluctuating course
*Maximum score of 12
*Score of 4 and above indicates possible delirium
