Dementia Flashcards
What are the Types of Dementia and their respective prevalences?
Alzheimers disease 60-70%
Vascular dementia(s) 18-32%
Frontotemporal dementia 10-20%
Lewys Body dementia 5%
What are the types of vascular dementia?
Multi-infarct dementia
Subcortical vascular dementia
Which symptoms are required for diagnosis of dementia?
Reduced cognitive functioning in at least two domains:
Social cognition
Attention
Memory
Psychomotor speed
Language
Executive functioning
Social judgment
Visuospatial functioning
ICD-11
How long does the impairment in ADL have to be to qualify for dementia?
6 months
What does ADL stand for?
Activities of Daily Living
How are learning and IQ related in the context of dementia?
IQ is affected much later than learning in the development of dementia.
Because learning and IQ are related, can a high IQ but low learning be an early sign of dementia.
Which tests are used for screening dementia?
MMSE (Mini Mental State Examination)
ACE (Addenbrooke’s Cognitive Examination)
VFT (Verbal Fluency Test)
What does the MMSE test for?
it is 30 items, that test for:
- cognition
- orientation in space-time
- memory
- attention
- following instructions
What is the scoring of the MMSE?
mild: 20-26 points
moderate: 10-19 points
serious: <10 points
Functioning+Points of MMSE scoring: Mild
20-26 Points
Person can live at home, with some help.
Driving should be evaluated
Functioning+Points of MMSE scoring: Moderate
10-19 Points
Person needs help for living at home
Misunderstandings can happen pga communication/reasoning problems
3A: Aphasia, Agnosia, Apraxia
Functioning+Points of MMSE scoring: Serious
<10 Points
Person needs help 24/7
Decision making, conversation strongly impaired
Cognitive issues lead to agresive behaviour, unrest, anxiousness, screaming,…
Many issues cannot be communicated anymore (bedsores, infections,…)
Very late: Motor issues
On which dimensions does the ACE test for?
Addenbrooke’s Cognitive Examination test for:
Attention
Memory (episodic, semantic, learning, free/cued recall)
Wordflow
Language
Visual Spacial Orientation (Clock/3D Cube)
For which types of dementia does the VFT test for?
Frontotemporal dementia:
- Semantic Issues -
Alzheimers disease:
- Phonemic Issues -
Some reasearch says that it is not enough to disdinguish between them
How does the VFT work?
The person has 60 seconds for naming items according to a rule.
Right, wrong, repeating words, subcategories and closeness of words are evaluated.
Less than 14/17 items is a problem
In context of the VFT what are indicators for which dementias?
Problems with phonemic similar words -> Frontotemporal dementia
Problems with semantic similar words -> Alzheimers disease
But research shows, that this is not super reliable
How can dementia be postponed?
Using cognitive activities
How can ADL of Dementia be improved?
Clear structure of the day
Precise and clear communication
Error-Free-Learning (learning from errors cannot happen, because they are not recognized)
Habitualization+Priming
Stabilizing circadian rhythm
Which other issues can increase dementia symptoms?
Urinary infection
Dehydration
Metabolism issues
vitamin deficiencies
What are medicines used for treating dementia?
Acetylcholinesterase inhibitors (ACE-H)
Which medication should be avoided with dementia?
Antidepressiva+Antispychotics, because they can decrease cognitive and motor functioning and increase the chance of accidents
What are the prevalences of dementia with age?
< 69 - 0,9%
70-74 2,3%
75-79 6,1%
80-84 17,6%
85-89 31,7%
90+ 40,7%
What is the comorbidity of dementia with depression?
40%
How can multi-infarct dementia be treated?
Multi-infarct dementia could be caused by high blood pressure, which could be treated
What is a sign of subcortical dementia?
Slowed processing and attention, usually before memory issues.
Memory can be retrieved with a cue. -> It is not gone like in other dementias
Problems with the myelination of the axons (derfor SUBcortical)
What are signs of multi-infarct dementia?
The person often has issues with tasks/skills that are related to the areas affected. They loose more and more specific skills.
Memory issues usually happen later and are often weaker
What are risk factors for vascular dementia?
Smoking, High blood pressure, Arteriosclerosis, irregular heart beat
(nearly) NO genetic predispositions
Prognosis of Vascular dementias
usually worse than Alzheimers
How can vascular dementias be diagnosed?
Through looking for changes in the brain tissue with an MRI
What is the prognosis of Vascular dementia?
It is worse than Alzheimers.
Around 5 years.
The person is most likely to die of a strike/heart attack
When does frontotemporal dementia often start?
It starts early, between 45-65
(2/3 of cases)
Which brain areas are usually most affected by frontotemporal dementia and what does that lead to?
It affects mostly the frontal and temporal areas of the brain
That leads to problems with inhibition and language
How is Huntington’s disease connected to dementia?
It can lead to symptoms such as dementia
What causes Huntington’s disease?
Too many CAG repeats in Chromosome 4 lead to a protein becoming toxic.
How many CAG repeats are needed for Huntingtons’s disease?
> 40 disease will develop
27-40 increased risk
At which age does Dementia with Lewy bodies develop?
Usually between 60-80 years
What are characteristics for Dementia with Lewy bodies?
REM sleep behaviour disorder
Visual hallucinations (People/Animals)
-> Do NOT use antipsychotics
Paranoia
Motor problems
It usually starts earlier (50 vs 65)
It progresses faster than other dementias
Short life expectancy (4 years after diagnosis)
Fast fluctuating cognitive functioning
How should Dementia with Lewy bodies NOT be treated?
With Antipsychotics, that makes the symptoms worse
How is Dementia with Lewy bodies and Parkinsons related?
Both have problems with the Basal ganglia and people with Parkinsons almost always have high counts of Lewy bodies
How many people with Alzheimers have Dementia with Lewy bodies?
50%
With Alzheimers, which parts of Memory are affected?
At first storing in Episodic Memory (Anterograde Amnesia)
Semantic memory in such that connections between facts are lost, not the facts themselves
Procedural memory is not affected
How can people with Alzheimers be influenced?
By Priming, they activate things that they see directly in their environment
What are protective/risk factors for Dementia/Alzheimers?
High education
Active work life
Meaningful activities
Hobbies
High IQ
Physical activity in middle age
Emotionally taxing events (moving, loss, trauma)
-> They can give cognitive resources to draw from
-> They delay onset, but can make it worsen faster
What are the prevalences of Alzheimers over the ages? What about gender differences?
65 years 2%
Doubles every 5 years.
People 80-85 years 16%
85-90 years 33%
> 100 years 66%
Women have a higher chance than men
What is the cause of Alzheimers?
Senile plaque collects in the dendrites
Tau proteins build up in the nerve cells
-> This kills nervecells -> Atrophy
Which area is first affected with Alzheimers?
The Hippocampus
What determins deadlyness with Alzheimers?
Earlier lifestyle choices (smoking, training, learning)
Condition
Depression
Urinary infections
How to test for Alzheimers?
Testing Cerebral spinal fluid for Tau proteins (that can be done before symptoms start)
Testing for memory problems (recall + recognition)
It can only be diagnosed 100% after death via autopsy
Is Dementia mainly genetic?
Yes, especially early dementia. In later phases lifestyle has also an effect
What are common comorbidities of Dementia?
That one often has multiple types of Dementia at the same time
Depression 50%
What is usually the cause of death for patients with Alzheimers?
Pneumonia (lung infection)
What is the Dementia mantra?
Use it or loose it!
How long is the average lifetime of a person after they are diagnosed with Alzheimers?
~ 6 years
