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dementia Flashcards

1
Q

Define dementia

A

Dementia, also known as major neurocognitive disorder, is a progressive decline in cognitive function affecting multiple domains including language, executive function, memory and social cognition

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2
Q

What are the types of dementia

A
  • alzheimers
  • lewy body
  • vascular
  • frontotemporal
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3
Q

what are some reversible causes of dementia/ differential diagnosis of dementia

A
  • vit b12 deficiency
  • subdural haemorrhage
  • wernickes
  • hypoglycaemia
  • alcohol
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4
Q

What is the most common type of dementia

A
  • Alzheimers
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5
Q

What is the pathology of alzheimers

A
  • deposition of extracellular b- amyloid and intracellular tau protein lead to neurotoxcity and reduced cholinergic transmission
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6
Q

What are the causes of the pathology of Alzheimer?

A
  • Decreased Aβ1–42 together with increased T-tau or P-tau in CSF
  • Increased tracer retention on amyloid PET
  • AD autosomal dominant mutation present (in PSEN1, PSEN2, or APP)
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7
Q

Pathology overlap of the dementias

A
  • 25% of all patients with AD develop parkinsonism.
  • 50% of all cases of PD develop AD-type dementia after 65 years of age (Hansen et al. 1990).
  • 70% of patients with sporadic AD display Parkinson’s pathology
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8
Q

What the risk factors for alzheimers

A
  • FX
  • downs syndrome
  • genetics
  • advanced age
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9
Q

Clinical features of alzheimers

A
  • Characteristic order of language impairment: naming → comprehension → fluency
  • Memory impairment
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10
Q

Brain lesions are marked by … in alzheimers

A
  • neurofibrillary tangles
  • amyloid plaques
  • neuronal loss
  • brain atrophy
  • with defects in acetylcholine synthesis at the cellular level
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11
Q

How would a patient present with alzheimers ?

A
  • agnosia - cant recognise things
  • apraxia - cant do basic motor skills
  • aphasia - cant speak as well as normal
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12
Q

Alzheimer’s diagnosis criteria

A

NINCDS– ADRDA criteria -1984.

(1) the clinical diagnosis of AD could only be designated as “probable” while the patient was alive and could not be made definitively until AD confirmed at PM

(2) the clinical diagnosis of AD could be assigned only when the disease had advanced to the point of causing significant functional disability and met the threshold criterion of dementia.

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13
Q

What happens in the typical amnesic variant for Alzheimers disease?

A

Early degeneration of medial temporal lobe before degeneration spreads to temporal neocortex, frontal and parietal association areas.

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14
Q

What does the temporal lobe do?

A
  • Hearing (superior temporal lobe
  • Language comprehension (superior temporal lobe)
  • Semantic knowledge (anterior temporal lobe)
  • Memory (hippocampus)
  • Emotional/affective behaviour (limbic system)
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15
Q

Features of Amnesic Alzeheimers

A
  • Profound failure to create new memories
  • Can’t find new home
  • Can’t remember new people, names, tasks
  • Events/People since operation
  • Language essentially frozen in 50’s
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16
Q

Timeline for Amnesic variant Alzeheimers

A
  • Selective amnesia. Semantic and language impairments > Complex attention (divided, selective, attention switching) > Visuospatial, sustained attention and executive functioning skills > Global deficits.
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17
Q

What is the congnitive profile of those with AD?

A
  • Episodic memory: frequent intrusions and repetition errors, and high numbers of false positive errors in recall
  • Problem with complex attention/executive function
  • Aphasia
  • Cant remember new things
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18
Q

Visual variant of Alzeheimers

A
  • Posterior occipitoparietal, occipitotemporal or more rarely primary visual cortex
  • Visual deficits, dyspraxia, dysgraphia,simultanagnosia -> global
  • Not common
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19
Q

Linguistic variant of AD

A
  • Lateral temporal region being affected
  • Progressive aphasic syndrome - cant talk
20
Q

What are the psychiatric changes in Alzeheimers?

A
  • Subtle behaviour changes: inattentiveness, mild cognitive dulling, social withdrawal, emotional withdrawal and agitation
  • Apathy (most freq change), disengagement
  • Psychotic symptoms: delusions (delusions of theft) or hallucinations
  • Agitation, anxiety.
21
Q

Secondary care:
Specialised diagnostic tests for Alzheimers

A
  • Structural MRI
  • Pathology- amyloid imaging
  • Brain Function: FDG PET, functional MRI
22
Q

Pathology of vascular dementia

A

Reduced blood flow to the brain, secondary to small or large vessel disease

Present with stepwise detroriation of cognitive function

23
Q

Clinical features of vascular dementia

A
  • Evidence of previous stroke
  • Depression and delusions
  • Emotional lability
  • Memory impairment
  • Gait disturbance and incontinence are sometimes seen
  • Attention difficulties
  • visuo-spatial difficulties
24
Q

Pathology of lewy body dementia

A

Cortical and subcortical deposition of Lewy-Bodies (intracellular aggregates of ɑ-synuclein)

25
Clinical features of lewy body dementia
- Cognitive symptoms precede motor symptoms unlike in - Parkinson’s related dementia - Visual hallucinations and delusions - important and early - REM sleep disorder - Memory and attention impairment - Parkinsonism
26
Pathology of frontotemporal dementia
Progressive degeneration of the frontal and/or temporal lobes associated with Pick bodies, with a number of subtypes such as Pick’s disease Rapidly progressing and in younger people
27
clinical features of frontotemporal dementia
- Behavioural and personality changes, e.g. impulsivity - Memory impairment - Language impairment e.g. reduced fluency or comprehension - Emotional lability
28
Rf for dementia
-age - High BMI - Smoking -T2DM -Depression -hearing loss - FH - biggest - hypercholesteraemia
29
How does the DSM-V diagnostic criteria work
- Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains: - The cognitive deficits interfere with independence in everyday activities, - The cognitive deficits do not occur exclusively in the context of delirium - The cognitive deficits are not better explained by another mental disorder, e.g. major depressive disorder, schizophrenia
30
what are the cognitive domains
- Learning and memory - Language - Executive function - Complex attention - Perceptual - motor - Social cognition
31
How is the diagnosis of dementia made
- bedside cognitive testing - fbx - metabolic panel - serum tsh
32
What cognitive tests can you do ?
mini mental state exam >25-- normal > 18-25 impaired < 17 severely impaired
33
General management of dementia
- conservative - social stimulation - exercise
34
management for alzheimers
- AchE inhibitor - donepzil, galantamine, memantine, are first line for mild to moderate - Prevention - Support - Carers- courses - Advice
35
How can we manage alzeheimers and dementia?
Engaging in more than six leisure activities had 38% lower risk of developing dementia. 22 cohort studies of the effects of education, occupation, premorbid IQ, and mental activities calculated decreased the risk of developing dementia by 46%
36
Tx for severe alzheimers
memantine in combination with AchE inhibitor
37
First line management for lewy body dementia
- AchE donepezil or rivastigmine Rivastigimine - PD dementia or Lewy body dementia 1st line
38
for what types of dementia is donepzil given as first line
- alzheimers - lewy body - NO ITS RIVASTIGMINE - Parkinsons
39
Management of vascular dementia
- optimise CV risk factors - AchE inhibitor
40
Complications of dementia
- disability, dependancy and morbidity - behavior and psychological changes - abuse
41
What is the 6CIT test
What year is it? What month is it? Give an address with 5 parts (John, Smith, 42, High, St, Bedford) Count 20-1 Say months of year in reverse Repeat address
42
What would distinguish depression from dementia
DEPRESSION - onset and decline often rapid - subjective complaints of memory loss - patient is distressed / unhappy Dementia Vague, insidious onset Unaware or attempt to hide problems (symptoms may go unnoticed). Confusion in evening. Mood might be labile. Cognitive performance consistent. Attempts all questions.
43
what is the first cognitive marker for AD
- Memory impairment
44
would mri show atrophy or hypertrophy for dementia
- atrophy
45
What are the contraindications of donepezil
in patients with bradycardia cause insomnia

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