Dementia Flashcards
What is Dementia?
Neurodegenerative syndrome w progressive decline in several cognitive domains
(Memory / Concentration / Language / Learning etc)
How is a diagnosis of dementia made? (4 things)
- History
- Cognitive testing
- Examination
- Medication review
What are the Key Features of the History needed for diagnosing Dementia? (5 things)
- Patient History
- Collateral History
- Timeline of decline
- Cognitive domains affected
- Non-cognitive symptoms
What Non-Cognitive symptoms suggest LATE disease dementia? (3 things)
- Agitation
- Aggression
- Apathy (lack of interest / enthusiasm)
What Cognitive Testing should you do for sus Dementia pt? (3 things)
- AMTS (Dementia screen test)
- Function and language tests
- Mental State Examination (to identify anxiety / depression / hallucinations)
What does Examination help identify in sus Dementia? (3 things)
- Physical causes
- Risk factors (e.g for Vascular dementia)
- Parkinsonism
What is the use of Medication Review in sus Dementia?
To exclude drug-induced cognitive impairment
What investigations should you do for sus Dementia? (4 things)
- Look for Reversible / Organic causes
- PET / SPECT
- EEG
What investigation can you do for other causes of Dementia? (8 things)
- FBC - anaemia
- ESR & CRP - infection / vasculitis
- T4 and TSH - hypothyroidism
- U&Es - renal failure / electrolyte disturbances (high / low Ca)
- B12 / B9 (folate) - vitamin deficiencies
- LFT – alcohol related / encephalopathy
- Coagulation screen + Albumin - assess liver function
- Glucose
What will an MRI show you in sus Dementia? (3 things)
- Underlying vascular damage
- Structural pathology
- Identifies other reveresible pathologies:
- Subdural haematomas
- Normal-pressure Hydrocephalus
What scan should you do when Dementia diagnosis is unclear / to confirm subtype?
PET / SPECT
When should you do a EEG for sus Dementia? (4 things)
When sus:
- Delirium
- Frontotemporal Dementia
- CJD (degenerative brain disorder that leads to dementia)
- Seizure disorder
What are the Subtypes of Dementia? (4 things)
- Alzheimer’s disease (AD)
- Vascular dementia
- Lewy body dementia
- Fronto-temporal dementia
What are the causes of Dementia? (8 things)
Diabetes
Ethanol
Medication
Environment (CO poisoning)
Nutritional
Trauma
Infection
Alzheimer’s (most common cause)
DEMENTIA
What are the CF of Dementia? (7 things)
- Memory loss / can’t retain new info
- Language impairment
- Concentration loss
- Poor judgment
- Apraxia (inabilty to perform an action)
- Behavioural disturbance
- Personality change
What is the pathophysiological steps of Alzheimer’s? (2 + 5 things)
- Amyloid Precusor Protein (APP) degrades into –> Beta-Amyloid Peptide
- Beta-Amyloid Peptide accum results in:
- Progressive neuronal damage (cortex + hippocampus)
- Neurofibrillary tangles
- Beh Amyloid plaques
- Loss of ACh
- Vascular Fx
What are the parts of the brain most vulnerable to neuronal loss in Alzheimer’s? (4 things)
- Hippocampus
- Amygdala
- Temporal neocortex
- Subcortical nuclei
What are the Risk Factors for Alzheimer’s? (5 things)
- Age (60+, risk doubles every 5 yrs)
- FHx
- Down’s syndrome (inevitable) (40 yrs old +)
- Apolipoprotein-E e4 alleles
- ApoE usually breaks down B-amyloid, but the ApoE-e4 allele version is less effective
1. Vascular (HTN / Diabetes / AF)
What are the MACROSCOPIC pathological changes in Alzheimer’s?
Widespread cerebral atrophy (esp cortex + hippocampus)
What are the MIROSCOPIC pathological changes in Alzheimer’s? (2 things)
- Amyloid plaques
- Neurofibrillary tangles (bc abn aggregation of Tau prot)
What investigations should you do for sus Alzheimer’s?
- CT / MRI
- MMSE
- Neuropsychological testing (to confirm cogn imp)
What’s the use of a CT / MRI in sus Alzheimer’s? (2 things)
- To check for Cerebral atrophy (esp Cortex + Atrophy) = AD
- To exclude other dementia causes