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3a Geriatrics > Dementia > Flashcards

Dementia Flashcards

1
Q

What are the 4 main types of dementia from most - least common

A
  • Alzheimer’s disease
  • Vascular dementia
  • Lewy body dementia
  • Frontotemporal dementia
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2
Q

How is dementia generally investigated

A
  • Primary care: blood screen to exclude reversible cause - FBC, U&Es, LFTs, Calcium, glucose, ESR/CRP, TFTs, vitamin B12 and folate levels
  • Secondary care: neuroimaging
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3
Q

What cognitive assessments may be done in the assessment of dementia

A
  • mini mental state exam
  • 6-Item cognitive impairment test (6CIT)
  • Montreal cognitive assessment scale
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4
Q

Give some differentials to dementia

A
  • hypothyroidism
  • B12/folate/thiamine deficiency
  • syphilis
  • brain tumour
  • normal pressure hydrocephalus
  • subdural haematoma
  • depression
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5
Q

What is Alzheimer’s disease

A

a progressive degenerative disease of the brain accounting for the majority of dementia seen in the UK

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6
Q

Give 5 RFs for alzheimer’s disease

A
  • increasing age
  • FHx
  • Genetics
  • Down’s syndrome
  • apoprotein E allele E4
  • Cerebrovascular disease
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7
Q

What mutations are thought to cause the inherited form of Alzheimer’s disease

A
  • amyloid precursor protein (chromosome 21)
  • presenilin 1 (chromosome 14) genes
  • presenilin 2 (chromosome 1) genes
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8
Q

Describe the pathological changes that occur in Alzheimer’s disease

A
  • macroscopic: widespread cerebral atrophy, particularly involving the cortex and hippocampus
    microscopic:
  • cortical plaques due to deposition of type A-Beta-amyloid protein (extracellular)
  • intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein (intracellular)
  • hyperphosphorylation of the tau protein has been linked to AD
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9
Q

Describe the features of Alzheimer’s disease

A
  • insidious onset and progressive but slow decline
  • cognitive impairment: poor memory, receptive/ expressive dysphasia, disorientation
  • behavioural and psychological changes: agitation, depression, sleep cycle disturbance, disinhibition, wandering
  • activities of daily living: loss of independence, problems with finances, problems with basic personal care
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10
Q

Describe the non-pharmacological management of Alzheimer’s disease

A
  • range of activities to promote wellbeing that are tailored to the person’s preference
  • group cognitive stimulation therapy for patients with mild and moderate dementia
  • exercise
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11
Q

Describe the pharmacological management of Alzheimer’s disease

A
  • mild to moderate: acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
  • moderate-severe: NMDA receptor antagonist (memantine) +/- acetylcholinesterase inhibitors
  • memantine monotherapy if severe AD or intolerant/ CI to Achesterase inhibitors
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12
Q

Which acetylcholinesterase inhibitor is best for hallucinations

A

rivastigmine

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13
Q

How are psychiatric symptoms managed in dementia

A
  • antidepressants aren’t recommended for mild to moderate depression in patients with dementia
  • antipsychotics should only be used for patients at risk of harming themselves or others or when symptoms are causing severe distress
  • antipsychotics are associated with a significant increase in mortality in dementia patients
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14
Q

What is vascular dementia

A

a group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease

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15
Q

What are the three main subtypes of vascular dementia

A
  • 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
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16
Q

Describe the presentation of vascular dementia

A
  • symptoms of dementia appear suddenly and there’s a stepwise deterioration pf cognitive function
  • focal neurological abnormalities - depending on region of brain
  • difficulty with attention and concentration
  • Seizures
  • Memory disturbance
  • Gait disturbance
  • Speech disturbance
  • Emotional disturbance
17
Q

How is vascular dementia investigated

A
  • Blood screen
  • neuropsychological tests
  • CT/MRI - may show infarcts and extensive white matter changes
18
Q

State and describe the criteria used to diagnose probable vascular dementia

A

NINDS-AIREN criteria
1. Presence of cognitive decline that interferes with ADLs, not due to secondary effects of the CVA: established using clinical examination and neuropsychological testing
2. CVD: defined by neurological signs and/or brain imaging
3. A relationship between the above two inferred by:
* the onset of dementia within three months following a recognised stroke
* an abrupt deterioration in cognitive functions
* fluctuating, stepwise progression of cognitive deficits

19
Q

Describe the non-pharmacological management of vascular dementia

A

Tailored to the individual
* Include: cognitive stimulation programmes, multisensory stimulation, music and art therapy, animal-assisted therapy
* Managing challenging behaviours e.g. address pain, avoid overcrowding, clear communication

20
Q

Describe the pharmacological management of vascular dementia

A
  • only consider AChE inhibitors or memantine if there’s mixed dementia
  • no specific pharmacological treatment approved for cognitive symptoms
  • detect and address cardiovascular risk factors
21
Q

Describe the pathological changes that occur in Lewy body dementia

A
  • misfolded alpha synuclein aggregates to form Lewy bodies that deposit inside neurones, particularly in the neocortex and basal ganglia
  • Lewy bodies lead to reduced levels of ACh and dopamine in the brain
22
Q

Describe the features of Lewy body dementia

A
  • Early: progressive cognitive impairment
  • fluctuating cognition
  • visual hallucinations
  • Later: parkinsonism - typically occur within a year of onset of cognitive impairment
23
Q

How is Lewy body dementia diagnosed

A
  • usually clinical
  • blood screen - exclude other causes
  • single-photon emission computed tomography (SPECT)
24
Q

How is Lewy body dementia managed

A
  • AChE inhibitors and memantine
  • avoid neuroleptics - can cause irreversible parkinsonism
25
Q

What are the common features of frontotemporal dementias

A
  • onset before 65
  • insidious onset
  • Relatively preserved memory and visuospatial skills
  • Personality change and social conduct problems (compulsive behaviour, abnormal eating etc)
26
Q

Describe the pathological changes seen in frontotemporal dementia

A
  • Macroscopic: Atrophy of the frontal and temporal lobes
  • Microscopic: Pick bodies - spherical aggregations of tau protein
27
Q

How is frontotemporal dementia managed

A
  • no cure or way to slow down progression
  • non-pharmacological: exercise, SALT
  • pharmacological: SSRIs -decrease disinhibition and impulsivity
    (AChE inhibitors/ memantine not recommend)
28
Q

Give 5 factors that would suggest a diagnosis of depression over dementia

A
  • short history, rapid onset
  • biological symptoms: weight loss, sleep disturbance
  • relatively normal mini mental state test
  • will answer ‘I don’t know’ as opposed to trying to give an answer
  • global memory loss
29
Q
A

3a Geriatrics (5 decks)

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