dementia Flashcards
most common causes
Alzheimer’s
vascular
Lewy body
blood screen
FBC, U+E, LFT, Calcium, glucose, ESR,CRP, TFT’s vitamin B12 and folate
when is neuroimaging performed
secondary care to assess for reversible causes like subdural haematomas, normal pressure hydrocephalus
vascular dementia
group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease.
Patients with VD typically presents with
Several months or several years of a history of a sudden or stepwise deterioration of cognitive function
MRI scan - vascular dementia
infarcts and extensive white matter changes
when are AChe inhibitors used in the management of vascular dementia
suspected comorbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.
Factors suggesting diagnosis of depression over dementia
short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
patient worried about poor memory
reluctant to take tests, disappointed with results
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)
levy body - pathological feature
alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas.
features - Lewy body
progressive cognitive impairment
with cognition loss before Parkinson’s signs
visual hallucinations
diagnosis of lewy-body dementia
usually clinical
single-photon emission computed tomography (SPECT) is increasingly used.
medical mx of lewy body dementia
acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine
features of fronto-temporal dementia
<65
insidious onset
preserved memory and visuospatial skills
personality change and social conduct problems
picks disease
most common form of fronto-temporal dementia
Macroscopic changes seen in Pick’s disease include:-
Atrophy of the frontal and temporal lobes
Microscopic changes include:-
Pick bodies - spherical aggregations of tau protein (silver-staining)
Gliosis
Neurofibrillary tangles
Senile plaques
semantic dementia
progressive aphasia
CPA
non fluent speech
Alzheimer’s pathological changes
widespread cerebral atrophy, particularly involving the cortex and hippocampus
cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
medications for management
the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease
memantine (an NMDA receptor antagonist) is in simple terms the ‘second-line’
donepezil s/e
c/i in bradycardia
adverse effects : insomnia
reversible causes
B12, thiamine def, normal pressure hydrocephalus, uraemia, hypothyroidism , hypoglycaemia
Duloxetine is an SNRI, so inhibits the reuptake of noradrenaline
(NA) at the synapse, meaning there is increased NA available, and
this increases the tone of the internal urethral sphincter.
