Dementia Flashcards
What are the investigations for dementia?
Assessment tools: 10 point cognitive screener or 6-item cognitive impairment test.
Primary care: Bloods to rule out reversible cause including HIV and syphilis
Secondary care: Neuroimaging to exclude reversible cause
What is the pathophysiology of Alzheimers?
Amyloid Plaques,
TAU tangles,
Neuronal loss and brain atrophy
What are the risk factors for Alzheimers?
Age,
Genetic predisposition (APOE E gene),
Family history,
CV disease,
Lifestyle factors,
Traumatic brain injury,
Low education attainment
What is the presentation of Alzheimer’s
Key = Memory loss.
Disorientation,
Nominal Dysphagia,
Misplacing items,
Apathy,
Personality change
What is the pharamacological management of Alzheimer’s?
- Acetylcholinesterase inhibitors (Donepezil, galantamine and rivastigmine) for mild-mod.
- Memantine (second line): Add on drug, or if intolerant to anticholinesterase inhibitors or as monotherapy for severe Alzheimers.
Only give antipsychotics to patients at risk of harm.
What are some factors which indicate depression over dementia?
Short history,
Biological symptoms such as weight loss, sleep disturbence,
Patient being worried about their poor memory,
MMSE - variable results
Global memory loss (dementia tends to affect recent memories)
What are the main subtypes of vascular dementia?
Stroke related VD.
Subcortical VD - Caused by small vessel disease.
Mixed dementia - Both VD and AlzheimersW
What are the risk factors for vascular dementia?
History of stoke/TIA,
Atrial fibrillation,
Hypertension,
Diabetes mellitus,
Hyperlipidaemia,
Smoking,
Obesity,
Coronary heart disease
What are the signs and symptoms of vascular dementia?
Stepwise, progressive deterioration in cognition over months to years.
In comparison to Alzheimers there is less impairment of episodic memory and more in visual skills, semantic memory and executive functioning
What are the investigations for vascular dementia?
Formal cognitive assessment,
Meds rec,
Bloods to look for reversible, organic cause.
Neuroimaging, ideally MRI to identify vascular changes, infarcts or white matter.
What is the NINDS - AIREN criteria?
- cognitive impairment which interferes with AoDL.
- CV disease on imaging/neurological signs.
- Onset of dementia within 3 months of stroke, abrupt deterioration in cognition or stepwise progression of deficits.
What is the management of vascular dementia?
Manage CV risk factors.
Do cognitive stimulation progreammes.
Give drugs if co-existing Alzheimers or parkinson’s dementia.
Advanced care planning
What are the features of lewy body dementia?
Progressive cognitive impairment (comes before parkinsonism)
Cognition may fluctuate.
Parkinsonism.
Visual hallucinations
Explain the diagnosis of Lewy body dementia
Usually clinical but SPECT (single photon emission CT) increasingly used
What is the treatment of Lewy body dementia?
Acholinesterase inhibitors and memantine.
Avoid neuroleptics (antipsychotics)
