dementia Flashcards
what are some risk factors for alzheimer’s disease ?
increasing age
family history
caucasian ethnicity
down’s sydnrome
what are some pathological changes in Alzheimer’s disease ?
macroscopic - widespread cerebral atrophy
microscopic - cortical plaques due to deposition of amyloid protein
biochemical - deficit of ach from damage
what is the non-pharmacological management of alzheimer’s disease ?
activities to promote wellbeing
cognitive stimulation therapy
what are some pharmacological management options of Alzheimer’s disease ?
- 3 acetylcholinesterase inhibitors - donepezil, galantamine and rivastigmine
- memantine
what can be given to manage non-cognitive symptoms in Alzheimer’s disease ?
antidepressants for mild to moderate depression
anti-psychotics if risk of harming self
what is donepezil contra-indicated in ?
bradycardia
what are some factors that favour delirium over dementia ?
acute onset
impairment of consciousness
fluctuation of symptoms
abnormal perception
agitation
delusions
what is the most common cause of dementia in the UK ?
alzheimer’s disease
what are the causes of dementia ?
alzheimer’s disease
cerebrovascular disease
lewy body disease
rare -
huntington’s
CJD
HIV
what are some potentially treatable differentials of dementia ?
hypothyroidism
B12 / folate / thiamine deficiency
syphilis
brain tumour
normal pressure hydrocephalus
depression
what are some investigations of dementia ?
a blood screen - exclude reversible causes - FBC, U&E’s, LFTs, calcium, glucose, ESR/CRP, TFT’s, vitamin b12
neuroimaging
what are the common features of frontotemporal lobar dementia ?
onset 65
insidious onset
personality change
impaired social conduct
disinhibition
increased appetite
perseveration behaviours
what are the macroscopic changes of frontotemporal dementia ?
atrophy of frontal and temporal lobes
what are the microscopic changes of frontotemporal dementia ?
pick bodies
gliosis
neurofibrillary tangles
senile plaques
what is lewy body dementia ?
characteristic feature is alpha-synuclein cytoplasmic inclusions in the substantia nigra, paralimbic and neocortical areas.
what are the features of lewy body dementia ?
progressive cognitive impairment
parkinsonism
visual hallucinations
what condition is associated with lewy body dementia ?
parkinsons disease
how is a diagnosis of lewy body dementia made ?
clinical
single-photon emission computed tomography
what is the management of lewy body dementia ?
ach inhibitors and memantine
what medications should be avoided in lewy body dementia ?
neuroleptics should be avoided
what is vascular dementia ?
not a single disease but a group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease
what are some risk factors for vascular dementia ?
history of stroke or TIA
AF
DM
hyperlipidaemia
smoking
obesity
coronary heart disease
what are some symptoms of vascular dementia ?
focal neurological abnormalities - visual disturbance
difficulty with attention and concentration
memory disturbance
gait disturbance
speech disturbance
emotional disturbance
how is a diagnosis of vascular dementia made ?
comprehensive history and physical examination
formal screen for cognitive impairment
medical review
MRI scan
what are the guidelines that NICE recommend for diagnosing someone with vascular dementia ?
- presence of cognitive decline that interferes with daily lifestyle
- cerebrovascular disease
relationship between the 2
what is the non-pharmacological management of vascular dementia ?
tailored to the individual
cognitive simulation programmes
music and art therapy
managing challenging behaviours
what is the pharmacological management of vascular dementia ?
no specific
only consider AChE inhibitors or memantine for people with co-morbid dementia
what are some predisposing factors for delirium ?
over 65 years old
background of dementia
significant injury
frailty or comorbidity
polypharmacy
what are some predisposing events for delirium ?
infection -UTI
metabolic - hypercalcaemia, hypoglycaemia, dehydration
change of environment
severe pain
alcohol withdrawal
constipation
what are some features of delirium ?
memory disturbance
agitated
disorientation
mood change
visual hallucinations
disturbed sleep cycle
poor attention
what is the management of delirium ?
treat underlying cause
modify environment
first line sedative - haloperidol 0.5mg
in what condition are anti-psychotics challenging in ?
parkinson’s disease
what drugs can cause delirium ?
anti-depressants
anti-psychotics
benzodiazepines
anti-parkinsonian drugs
anticholinergic drugs
opiates
diuretics
recreational drug intoxication and withdrawal
what are some causes of delirium ?
trauma
hypoxia
increasing age/frailty
NOF fracture
smoker
drugs
change in environment
lack of sleep
imbalance of electrolytes
urinary retention
infection
uncontrolled pain
medical conditions - dementia, parkinsons disease
