Dementia Flashcards
define dementia
syndrome of progressive and global intellectula deteriorartion without impairment of consciousness
what is often the first symptom of dementia
memory loss
what are the symptoms of dementia for the following domains:
-behaviour 5
restless
repititive
purposeless activity
rigid
fixed routines
what are the symptoms of dementia for the following domains:
personality changes 4
sexual disinhibition
social gaffes
shoplifitng
blunting
what are the symptoms of dementia for the following domains:
speech 3
syntax erros
dysphagia
mutism
what are the symptoms of dementia for the following domains:
thinking 4
slow
muddled
poor memory-with confabulation
no insight
what are the symptoms of dementia for the following domains:
perception 2
illusions
hallucinations (often visual)
what are the symptoms of dementia for the following domains:
mood 3
irritable
depressed
emotional incontinence (labile mood and crying)
state the 4 As of alzheimers
amnesia
aphasia
agnosia
apraxia
state irreversible causes of dementia 5
alzeihmers
vascular
mixed
lewy body
fronto-temporal
reversible causes of dementia 3
subdural haematoma
hydrocephalus
hypothyroidism
risk factors for alzheimers 6
increasing age
FHx
inheritied autosomal dominnat trait
-mutation in amyloid precuros protein
apoprotein E allele E4
-encodes cholesterol transport protein
caucasian ehtnicitiy
Downs syndrome
macroscopic patholigcal cahnges in alzheimers 1
widespread cerebral atorphy
-particularuly involving cortex and hippocampus
microscopic patholgical changes in alzeihmers 2
cortical plaques
-deposition of type A-beta-amyloid protein and intraneuronal neurofibrillary tagles
-caused by aggregation of tau protein
hyperphosphorlyation of tau protein has been linked to AD
biochemical changes in alzheimers 1
deficity of acetylcholine form damgaeg to an asceindg forebrain projection
what makes neurofibrillary tangles in alzheimers
paired heliclal filaments
-partially made from tau protein
what is the function of tau and how does it change in alzheimers
interacts with tublin to stablise microtubules and promote tubulin assembly into microtubles
in AD- tau proteins are excessively phosphorylated impairing its function
non-pharmalogical managemnt of alzheimers 3
range of activities to promote wellbeing that are tailored to persons preference
offer group cognitive stimulation for mild/moderate
group reminiscne therapy and cognitive rehabilitation
managemnt for mild to moderate alzheimers (medical) 3
acetylcholinesterases inhibiotrs
-donepizil
-galantamine
-rivastigimine
‘second line’ for alzheimers
memantine
-NMDA receptor antagonist
when is memantine used 3
moderate alzheimers who are intolerant or CI to acetyle choinesterase inhbiotrs
add on drug to `cetylcholinesterase inhibitors for patients with moderate or severe alzheimers
monotherapy in severe alzheimers
use of antidepressants in alzheimers
not recommended
use of antipsychotics for alzheimers 2
only for patients at risk of harming themselves or others
or
when agitations, hallucinations or delusions are causing them severe distress
when is donepizil CI
-what is a significant adverse affect
relatively CI in patients with brady cardia
-adverse affect- insomnia
define vascular dementia
not a single disease but group of syndrome sof cogniti e impairment
-caused by ischaemia or haemorrhage secondary to cerebrovascular disease
incidence of vascular dementia
17% of UK dementias
how does a stroke affect the risk of developing dementia
doubles risk
subtypes of vascular dementia 3
stroke related
-multi-infarct or single infarct dementia
subcortical
-small vessel disease
mixed dementia
-presecnd of both vascular dementia and alzheimers siease
risk factors for vascular dementia 9
Hx of stroke or TIA
atrial fibrillation
hypertension
DM
hyperlipidaemia
smoking
obesity
coronary artery disease
FHx of stroke or cardiovascular disease
what is the most important, characterisitc presentaiotn of vascular dementia
several months or several years of a history of sudden or STEPWISE DETERIORATION of cognitive function
other sympotms of vascular dementia 7
focal neurological abnormlaites
-visual disturbajce, sensory or motor sympomts
difficulty w attention and concentration
sezirues
memory, gait, speech and emotional distrubances
how is diagnosis of vascular dementia made 4
comprehensive history and physical examination
formal screen for cognitive impairment (MMSE, Addenbrookes)
medical review to exclude medication cause of cognitive decline
MRI scan- may show infarcts and extensive white matter changes
how does NICE recommend diagnosis of vascular dementia is made
NINDS-AIREN criteria
what does the NINDS-AIREN criteria for vascular dementia include
presence of cognitive decline
-interferes w daily living and not due to secondary effects of cerebrovascular event
cerebrovascular disease
-neurological signs and/or brain imaging
relationship between the above 2:
-onset of dementia within 3 months following stroke
-abrupt deterioration in cognitive functions
-fluctuating, stepwise progression of cognitive deficits
general managemnt of vascular dementia 2
treatment mainly sympotmatic
-aim to addres indiviual problems
detect and address cardiovascular risk factors
-help slow progression
non-pharmacological managemnt of vascular dementia 3
tailored to individual
-cognitive stimulation programmes
-multisensory stimulation
-music and art
-animal assisted therapy
managing challenging behaviours
-address pain
-avoid overcrowding
-clear communication
pharmacolgical managemnt of vascular dementia
no specific pharmacoligical treatment approved
no evidece of aspirn or statin effectiveness
when would AChE inhibitors or memantine be considered for patients with vascular dementia 3
suspected comorbid Alzheimers disease
parkinsons disease dementia
dementia with lewy bodies
incidence of lewy body dementia
20% of dementia cases
characteritisc pathophys of lewy body dementia
alpha-synnuclein cytoplasmic inclusions (lewy bodies) in the substantial nigra, paralimbic and neocortical areas
what is lewy body dementia related to
parkinsons disease (although ocmplicated)
*_also 40% of alzheimers ptx have lewy bodies
featutes of lewy body dementia 4
progressive cognivtive impairement
-typically before parkinsonism
-but usually both occur within a year of each other
cognition can FLUCTUATE in contrast to other dementias
parkinsonism
visual hallucinations (other delusions/hallucinations may be seen)
how do sympotms of lewy body dementia differ to parkinsons
in lewy bodies parkinsonism and cognitive impariment typically occur WITHIN A YEAR of each other
in parkinsons -motor symptoms typically present AT LEAST one year before cognitive symptoms
how does lewy body dementia contrast to alzheimers
lewy body dementia- early attention and executive function loss
alzheimers- early memory loss
diagnosis of lewy body dementia 2
usually clinical
SPECT-single-photon emission computed tomography
-increasingly used
-radioisotope is used to detect lewy bodies
-V effective
managemtn of lewy body dementia
AChE inbhiotrs and memantine as used in alzheimers
what should be avoided in lewy body dementia
neuroleptics should be avoided as patients are extremely sensitive and may develop irreversible parkinsonism
subtypes of frontotemporal lobar degeneration 3
frontotemporal dementia (picks disease)
progressive non fluent aphasia (chornic progressive aphasia CPA)
semantic dementia
common features of frontotemporal dementias 4
onset before 65
insidious onset
relatively preserved memory and visuospatial skills
personality change and social conduct problems
most common type of frontotemporal dementia
Picks disease (frontotemporal dementia)
what is picks disease characterised by 2
personality changes and impaired sociaal conduct
other common featutes of picks disease 4
hyperorality (compulsive need ot place both edilbe and inedible objects in ones mouth)
disinhibition
increased appetite
perseveration behaviours
what is characterisitc of picks disease on imaging
focal gyral atrophy with kinfe-blade. appearance
macrosocpic changes of picks disease 1
atophy of frontal and temporal lobes
microscopic changes of picks diseae
pick bodies
-spherical aggregatiosn of tau proteins (silver-staining)
gliosis
neurofibrillary tangles
senile plaques
managemnt of picks disease
AChE inhibotrs or memantine not recommneded with frontotemporal dementia
chief factor of chronic progressive aphasia
non fluent speech
-short utterances that are agrammatic
comprehension relatively preserved
characteriscs of semantic dementia
fluent progressive aphasia
speech is fluent but empty and conveys little meaning
memory is better for recent rather than remote events (unlike Alzheimers)
cognitive function tests 4
TYM test (test your memory)
MMSE
Montreal cognitive assessment (MOCA)
Addenbrookes
frontal lobe funciton test
frontal assessment battery
-beside test help discriminate frontotemporal type dementia from others
key princiopels of teh mental capcity act 5
A person must be assumed to have capacity unless it is established that he lacks capacity
A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
A person is not to be treated as unable to make a
decision merely because he makes an unwise decision
An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests
Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action
assessment of capacity
He or she has an ‘impairment of, or disturbance in, the functioning of the mind or
brain’ whether permanent or temporary AND
- He or she is unable to undertake any of the following
a. understand the information relevant to the decision
b. retain that information
c. use or weigh that information as part of the process of making the decision
d. communicate the decision made by talking, sign language or other means
what should be considered when assessing someones best interests 4
- Whether the person is likely to regain capacity and can the decision wait.
- How to encourage and optimise the participation of the person in the decision.
- The past and present wishes, feelings, beliefs, values of the person and any other relevant factors
- Views of other relevant people
what does a lasting power of attorney do
allows a person to act on the patients behalf
and
-proprery andfinancial affairs
-health and welfare decisions
only has otherity to make decision about life-sustaing treatment
define advance decisoins
Advance decisions can be drawn up by anybody with capacity to specify treatments they would not want if they lost capacity. They may be made verbally unless they specify refusing life-sustaining treatment (e.g. Ventilation) in which case they need to be written, signed and witnessed to be valid. Advance decisions cannot demand treatment
