Dementia Flashcards
What is Dementia?
Syndrome- condition with multiple features
-> progressive and chronic
Involves deterioration in cognitive function beyond what is expected from normal ageing
What are some of the general functions affected by dementia?
Memory- difficulty with recent events
Thinking/Concentrating- difficulty making decisions/completing tasks
Orientation- losing track of day/date, being confused about where they are
Comprehension
Calculation
Learning capacity- impact on learning new skills
Language- use and understanding
Judgement
Visuospatial skills- judging distance and seeing in 3D (falls)
What is the deterioration of cognitive function in dementia often preceded by?
Deterioration in:
Emotional control
Social Behaviour- anxiety, withdrawal, inappropriateness.
Motivation- Lethargy
What is the most common type of dementia?
Alzheimers
What causes damaging effects in Alzheimers?
- Reduction in size of cortex- severe in hippocampus
- Plaques of beta amyloid
- Tangles
How does build up of beta amyloid plaques cause damage in Alzheimers?
APP undergoes mutation affecting cleaving, so toxic beta form is made, this causes degradation of neurons (impairs pathways)
-> Plaques may cause inflammatory response and granulation formation
What are tangles and their effect in Alzheimers?
Made of TAU protein (normally found in microtubules giving structure)
-> abnormal fold in this protein causes a tangle to form affecting structure of microtubule structure (can stick to other TAU proteins)
-> DAMAGE and DEGENERATION to neurones and synapse
What are the distinctive features in Alzheimers?
STML
Aphasia
Communication difficulty
Mood swings
Withdrawal
Loss of confidence
Difficulty with everyday activities
What causes vascular dementia?
Reduced blood flow to the brain- damage and death of brain cells
Which conditions can vascular dementia occur as a result of?
Small vessel disease- narrowing and blocking of these within the brain
Stroke
TIAs- tiny widespread damage to brain
What underlying issues can be linked to small vessel disease involved in vascular dementia?
Hypertension
Smoking
Obesity
-> modifiable risk factors
What are the distinctive features of vascular dementia?
Memory issues of sudden onset
Visuospatial difficulties
Stroke symptoms
Anxiety
Delusions
Seizures
What causes dementia with lewy bodies?
Build up of abnormal Lewy body protein in brain cells (same protein that causes damage in Parkinson’s) in areas responsible for memory or muscle movement
What are the distinctive features of Dementia w Lewy bodies?
Fluctuating cognitive ability
Visuospatial difficulties
Attentional difficulties
Overlapping motor disorders
Speech and swallowing issues- affects dentistry
Sleep disorders
Delusions
What is the function of the frontal lobe?
Behaviour/emotional control
Problem solving
Planning
What proteins are associated with Frontotemporal dementia?
TDP-43
Ubiquitin associated clumps
What is different about onset of FT dementia?
Occurs in younger patients
What are the distinctive features of FT dementia?
STML- variable
Uncontrollable repetition of (other’s) words
Mutism
Personality change
Decline in social/personal conduct
What are some examples of rarer forms of dementia?
- HIV – related genitive impairment
- Parkinson’s disease
- Corticobasal degeneration
- Multiple Sclerosis
- Niemann-Pick disease
- Creutzfeldt-Jakob disease
What are the common effects of dementia on behaviour?
- Depression
- Apathy / Emotional Blunting
- Anxiety
- Irritability/ Disinhibition
What percentage of patients with dementia suffer from depression?
40%- may precede diagnosis
What are the features of emotional blunting?
Not smiling
Laughing inappropriately
Not showing or reciprocating affection
What medications can help patients with emotional blunting and apathy in dementia?
Drugs that can increase availability of Noradrenaline and Dopamine in brain
Why are stimulants used less often in patient with dementia?
Side effects
What are the features of anxiety in dementia?
Can be situational or generalised
Awareness of deficits can be heightened when patient fails to complete previously simple task or has to complete complex task
Patients do not wish to leave their home
Feeling of unease
Rumination on anxiety laden topics- physical/money issues
What can be used to treat anxiety in dementia?
Non-stimulating anti-depressants
Why are sedatives not generally used to treat dementia patients with anxiety?
Due to increased risk of:
Confusion
solemnness
Falls
- May make dental treatment safer
How does irritability present in dementia?
Snappiness
Patient is on edge
Short fuse
What can happen as a result of disinhibition in dementia?
Hateful speech- race, gender etc
-> may be out of character
Which non-pharmalogical intervention can help against behavioural effects of dementia?
Increasing social and physical activity
Which features of psychosis may affect patients with dementia?
Hallucinations
Delusions
Paranoia
What are hallucinations?
Abnormal perception of stimulus which isn’t really there
What are the common types of hallucinations in dementia?
Visual
Auditory
Tactile
For which form of dementia are hallucinations a diagnostic criterion?
Dementia w Lewy bodies
What are delusions?
Fixed false belief that is resistance to reason or confrontation
-> may involve paranoia- patient mistakenly believes that others are trying to in inflict harm in some way
What are the strategies for managing patients with dementia who are experiencing psychosis?
- Avoid explanations- be general but assertive
- Avoid lengthy conversations
- Avoid confrontation- consider not correcting or contradicting
- Try and distract patient
- Change topic, activity or venue
- Use humour
What are the issues with using anti-psychotic medications in patients with dementia?
No drugs are approved
Increased risk of death
Metabolic risks
-> Increased blood sugar and cholesterol
-> lowering BP when standing
Sedation
What should be considered/completed in terms of oral health in patients with early stage dementia?
- Oral assessment is good at this time to plan for future- remember dementia is progressive
- High quality restorations- more insult as caries is increased (poor diet, poor OH, dry mouth)
- Pragmatic treatment rather than complex restorative work may be wise
- Preventive regime- F supplements
What are key teeth and their significance?
- Occluding teeth- functional, help mastication
- Anteriors- incisional function and aesthetics
-> Better nutrition goes with this- more likely to engage with healthy harder to eat foods
-> Social aspects- more likely to engage and easier speech
What must be considered when treatment planning for patients with mid stage dementia?
Consider location where the consultation/treatment would be best for patient as access may be more challenging
Are lower risk treatments available?
-> prevention and maintenance
Consider medical status
What is the focus of treatment for late stage dementia?
Comfort- hygiene, moisture
-> Non-invasive- ART, prevention
If emergency management- what is least likely to fail?
What aspects of behaviour management are useful in a dental setting for patients with dementia?
Touch and reassurance- ask for consent for every part of examination
-> Can be valuable to help people with dementia feel comfortable and safe
Treat at best time of day for them
Find out about patient likes- can go back to this if patient becomes distressed
What is the issue with IS and dementia patients?
May be unlikely to understand or be able to remember to follow nose breathing instructions
-> limited effectiveness
What are the differences with IV sedation in dementia patients?
- Slower drug metabolism- smaller quantity of drug will have to be titrated really slowly
- Bigger risk of respiratory depression
- Access issues for canulation- frailty
- Patients may not have escort- lack of 1-1 care in care homes
What is the mean IV dose of patients over 70 to achieve sedation compared to those under 70?
Over- 2.8mg
Under- 5.7mg
Which complications of GA are patients with dementia at an increased risk of?
Death
Thromboembolic events
Dehydration
Insufficient nutrition intake
Insufficient pain treatment
Post operative delirium
Post operative cognitive function loss – affects 1 in 3 of those >80
*Avoid at all costs unless only option
How does music therapy work in patients with dementia?
Can help reorientate patients with dementia as music is relevant to patient (Playlist for life- important songs that can trigger memory)
-> Reduces stress and provides distraction
