Dementia Flashcards
risk factors for alzheimer’s ?
5% of cases are inherited as an autosomal dominant trait
mutations in the amyloid precursor protein (chromosome 21)
Down’s syndrome
increasing age
what are the pathological macroscopic changes seen alzheimer’s ?
cerebral atrophy, particularly involving the cortex and hippocampus
what are the pathological microscopic changes seen alzheimer’s ?
cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles
caused by abnormal aggregation of the tau protein
hyperphosphorylation of the tau protein has been linked to AD
biochemical changes ?
deficit of acetylcholine from damage to an ascending forebrain projection
Diagnosis of dementia
10-point cognitive screener (10-CS), 6-Item cognitive impairment test (6CIT)
assessment tools not recommended by NICE
in primary care, a blood screen is usually sent to exclude reversible causes
in secondary care, neuroimaging is performed* to exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus) and help provide information on aetiology to guide prognosis and management
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first line management of Alzheimer’s disease mild to moderate
Patients with Alzheimer disease have reduced production of choline acetyl transferase
three acetylcholinesterase inhibitors donepezil, galantamine and rivastigmine
second line managemnet of Alzheimer’s disease in mild to moderate
or who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors?
memantine- NMDA receptors
mono therapy in severe Alzheimer’s?
memantine (an NMDA receptor antagonist)
side effects and contra of donepezil?
insomnia
contra : in bradycardia, AV block (sick sinus syndrome)
cholinesterase inhibitors helps in what way ?
improve some cognitive function and improvement in activities of daily living. There is no role for cholinesterase inhibitors in advanced Alzheimer’s disease.
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What is LEWY BODY DEMENTIA
abnormal deposits of a protein called alpha-synuclein in the brain
clinical features of lewy body dementia
contrast to Parkinson’s disease, where the motor symptoms typically present at least one year before cognitive symptoms
parkinsonism - slow movement s , Reduced facial expression, Shuffling walk , tremor in arms and legs at rest
in contrast to Alzheimer’s, early impairments in attention and executive function
visual hallucinations / delusions
diagnosis of lewy body dementia ?
Montreal Cognitive Assessment score low due to cognitive impairment
usually clinical
single-photon emission computed tomography (SPECT)
what should be avoided in levy body dementia ?
neuroleptics - extremely sensitive and may develop irreversible parkinsonism.
Mx of lewy body dementia ?
both acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine
Cause of VD ?
causing ischaemia or haemorrhage secondary to cerebrovascular disease.
stroke doubles the risk of developing dementia.
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Vascular risk factors : Hypertension
Diabetes mellitus
Hyperlipidaemia
Smoking
Obesity
Coronary heart disease
A family history of stroke or cardiovascula
What are the 3 main subtypes of vascular dementia ?
Stroke-related VD – multi-infarct or single-infarct dementia
Subcortical VD – caused by small vessel disease
Mixed dementia – the presence of both VD and Alzheimer’s disease
VD has what kind of deterioration ?
sudden or stepwise deterioration of cognitive function.
Symptoms and the speed of progression vary but may include VD
Focal neurological abnormalities e.g. visual disturbance, sensory or motor symptoms
The difficulty with attention and concentration
Seizures
Memory disturbance
Gait disturbance
Speech disturbance
Emotional disturbance
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Non-pharmacological management ?
Tight control of vascular risk factors
Include: cognitive stimulation programmes, multisensory stimulation, music and art therapy, animal-assisted therapy
Managing challenging behaviours e.g. address pain, avoid overcrowding, clear communication
