Dementia Flashcards
Symptoms of dementia?
memory loss
problems with reasoning/communication
Difficulty in making decisions
Dysphasia
Difficulty in coordinating movements e.g. dressing
Disorientation and unawareness of time/place
Difficulty with planning, judgement, loss of initiative and problem solving.
Behavioural and psychological symptoms?
psychosis
agitation and emotional liability
depression and anxiety
Disinhibition
Withdrawal or apathy
motor disturbance
sleep cycle disturbance/ insomnia
Tendency to repeat phrases or Qs
Difficulties with activities of daily living
Assessment for dementia?
Take history (from patient and also from family/friend)
- informant questionnaire on cognitive decline
Timescale of onset of symptoms & deterioration
acute
Physical examination including neurological signs
- coordination/gait problems
-sensory findings
-motor symptoms
Blood tests- assessing cognitive decline
Assess cognitive decline- 10 point cognitive screener
Risk factors for Dementia
Medication history
FH of dementia
Alcohol and drug use
Differential diagnosis
Age related decline
Mild cognitive impairment
depression
delirium
vitamin deficiency- thiamine, B12
Hypothyroidism
Adverse effects of medication
presenting symptoms specifically for Alzheimers
Loss of recent memory first + often difficulty without executive function &/or nominal dysphasia
Loss of episodic memory
Cognitive deficits - aphasia, apraxia and agnosia
presenting symptoms specifically for Vascular dementia
stepwise increase in severity of symptoms- subcortical ischaemic
focal neurological signs
presenting symptoms specifically for Dementia with Lewy bodies
-Core clinical feautures are fluctuating cognition- recurrent visual hallucinations
REM sleep behaviour disorder
1 + symptom of Parkinson’s
- memory impairment may not be apparent in early stages
presenting symptoms specifically for Frontotemporal dementia
Personality change
behavioural disturbance
cognitive function may be relatively preserved
First line treatment of dementia?
Acetylcholinesterase (Ache inhibitors) as mono-therapy mild-moderate Alzheimers
If the patient has severe Alzheimers or is intolerant to general first line what medication should be given?
Memantine
What should be given for Non- Alzheimers Dementia?
Ache/ Memantine - unlicensed but can be used under specialist care
First line treatment for dementia with Lewy bodies and then if 1st line is not tolerated what should be given?
Donepezil or Rivastigamine - 1st line
If Don… or Riv…. not tolerated then Galantamine should be given
Vascular Dementia treatment?
AchE inhibitors or memantine
What drugs should patients with Frontotemporal dementia not be offered?
AchE inhibitors or memantine