Dementia Flashcards
What is dementia?
Progressive impairment of multiple domains of cognitive function in alert patients leading to loss of acquired skills and interference in occupational and social roles
What is meant by late onset of dementia?
Developing dementia after the age of 65
What is meant by a young onset of dementia?
Developing dementia before the age of 65
What is the most common type of dementia?
Alzheimer’s
Which genetic condition may lead to early onset of dementia?
Huntington’s
Which infections can lead to early onset of dementia?
HIV
CJD (Creutzfeldt-Jakob disease)
Which inflammatory disorder can lead to early onset of dementia?
MS
Which toxin can lead to early onset of dementia?
Alcohol
There re some causes of dementia which are treatable. Which vitamin deficiency can be treated to also treat dementia?
Vitamin B12
What are some endocrine causes of dementia which can be treated?
Thyroid disease
What are some infections which can cause dementia but can be treated?
HIV
Syphilis
What are some issues which can mimic dementia?
Hydrocephalus
Tumour
Depression
Why may depression get confused with dementia?
Sometimes depression can lead to problems with alertness, concentration and attention and may be difficult to retain information.
In examination of those with dementia, which examinations would be carried out?
Cognitive function
Neurological
Vascular- some types of dementia are of vascular causes
Which investigations are routinely carried out in those with suspected dementia?
Bloods
CT/MRI
Other tests can be done to rule out other mimics/causes of dementia. Which investigation would be done if you suspected CJD was the cause of the dementia?
ECG
In Alzheimer’s, in which lobe of the brain would there hypometabolism?
Temporal lobe
During an examination of cognitive functions, which domains are tested?
Memory, attention, language, visuospatial, behaviour, emotion, executive function, apraxia. agnosias
Apraxia?
Difficulty to perform learned tasks
Agosias?
Difficulty with interpreting sensory information e.g. difficulty recognising faces
What are some of the screening tests used in the examination of cognitive function?
Mini Mental Exam (MMSE)
Montreal (MOCA)
How is the type of dementia diagnosed?
Cannot get during life, only upon post-mortem examination of the brain
If there was a rapid speed in the development of dementia, what do you think would be the cause?
CJD
If there was a stepwise speed in the development of dementia, what do you think would be the cause?
Vascular dementia
If there were abnormal movements or a movement disorder with the dementia, what could be the cause of the dementia?
Huntington’s
If dementia presented with symptoms of Parkinsonism, what could be the type of dementia?
Lewys body dementia
If dementia also presented with myoclonus, what could be the cause of the dementia?
CJD
What is the pathophysiology behind alzheimer’s?
Beta-amyloid plaque deposition and neurofibrillary tangles
What are some of the risk factors of Alzheimer’s?
Genetics
Environmental- smoking, obesity, hypertension, diabetes.
Which factors would decrease risks of Alzheimer’s?
Better cognitive reserve
Good diet (especially Mediterranean diet!!! just for interest)
Plenty of exercise
Which lobes does Alzheimer’s affect?
Temporal and parietal lobes
What does the involvement of the temporal lobe in Alzheimer’s lead to?
Early memory disturbance
What happens in frontotemporal dementia?
Early change in personality / behaviour, which is often a late symptom of dementia.
Which aspects are preserved in those with frontotemporal dementia?
Memory
Visuospatial
As the frontal lobes are affected in frontotemporal dementia, what can this lead to?
Changes in eating habits
What is the pathology behind dementia with Lewy bodies?
Accumulation of abnormal alpha synuclein
Which functions of the brain are disrupted in early stages of dementia with Lewy bodies?
Visuospatial
Executive dysfunction
What are some other symptoms of dementia with Lewy bodies?
Prominent fluctuation
Parkinsonism
Treatment of dementia is symptomatic treatment. What are some of the pharmacological treatments used to treat?
Insomnia
Behaviour- care with antipyschotics
Depression
What are some of the non-pharmacological treatments for those with dementia?
Information and support from dementia services
OT
Social work
What are some treatments specific for Alzheimer’s dementia?
Cholinesterase inhibitors as there is cholinergic deficit
-> donepezil, rivastigmine, galantamine
NMDA antagonist
-> mematine
In which type of dementia may there be hallucinations?
Dementia with Lewy bodies
A 70 year old man presents with progressive short-term memory impairment and is unable to recall when to take his medications and had unable to mange his financial affairs. On cognitive testing he has deficits in memory, visuospatial function and language abilities. What is the most likely diagnosis?
Alzheimer’s dementia
A 75-year-old woman presents with progressive deterioration in cognitive function. Her husband says that some days are much worse than others. She sees small animals or children in her house which aren’t there. Cognitive assessment reveals deficits in all cognitive domains, particularly in executive function and visuospatial functioning. Neurological examination reveals mild rigidity and bradykinesia with a shuffling gait. What is the most likely diagnosis?
Dementia with Lewy bodies
