Dementia Flashcards
what is CFAS
cognitive function and ageing study
what did the CFAS show
comparison of dementia cases from 1989 - 2011
prevalence increasing rapidly but people in 70s are now at lower risk than 30yrs ago
level of education rising and changes in way CVD has been treated (improving brain health) means cases should drop but its not outweighed by no. of people living older
what is the diagnostic criteria for dementia cognitive/behavioural symptoms?
intefere with ability to function
represent decline from previous functioning
impariment in memory, visuospatial function, language, personality, behaviour
not explained by delirium psychiatric disorder
how should you assess dementia when asking patients family
ask about things they have noticed such as ability to do normal tasks like washing, dressing, housework, finances
what is a way of measuring executive function
the instrumental activities of daily living scale (IADL)
assesses ability to use telephone, shopping, food prep, housekeeping, laundry, transport, medication and finances
what is cognition
the localisation of function
important for rather than responsible for
what type of memory is affected in alzheimers
episodic memory
hippocampal tissue shrinkage
e.g what you had for breakfast in the morning or what you did last summer - long term memory
what are some frontal lobe functions
sequencing and planning e.g putting on shoes before socks
personality
decision making
temporal-order judgments
planing
problem solving
abstract conception
what is the dorsolateral streams function
executive abilities and adaptive behaviours like anticipating, planning, evaluating
what are the functions of the orbitomesial stream
social and emotional behaviours
what is a test that shows frontal lobe and executive function
dot to dot of numbers randomly scattered on paper in order
people who have dysfunction do this slowly or make errors e.g forget there is numbers there
what are some non-cognitive symptoms of dementia
can be a cause of disability by causing physical and motor symptoms, autonomic symptoms
personality/behaviour changes
occur later in alzheimers
what can the non-cognitive symptoms of dementia help identify
the type of dementia for diagnosis
what are some autonomic and motor symptoms of dementia
incontinence
constipation
postural hypotension
falls
parkinsonism
what are some neuropsychiatric symptoms of dementia
apathy (lack of interest/drive)
depression
sleep disturbance
agitation
aggression
psychosis
what 4 criteria can help diagnose the sub-type of dementia
pattern of onset and progression of decline
pattern of cognitive impairment
pattern of symptoms
imaging and biomarker findings
outline alzheimer symptoms that could aid diagnoses
- insidious onset and gradual progression
- anterograde memory (ability to remember/learn new info)
-initially deficit in memory language visuospatial executive function, not behaviour or personality
how can we assess amyloid and tau deposition in patients now
extraction of CSF from spine
sample taken when alive but categorised based on postmortem finding
how would a PET scan show alzheimers
purple colour = low signal
warm colours = high signal
so would be warm colours which show tau deposition
outline the symptoms of dementia with lewy bodies which could aid diagnoses
insidious onset and gradual progression with episodes of delirium and fluctuation
predominant executive and visuospatial deficits
cognitive fluctuation
visual hallucinations, parkinsonism, REM sleep disorder
loss of sense of smell and autonomic symptoms
what is different about dementia with lewy bodies aetiology
alpha synuclein deposition instead of amyloid beta
what are indicative biomarkers of dementia with lewy bodies
look at nerve cells associated with movement (SPECT)
PSG (polysomnography) - electrode on skull and muscle which measure REM sleep - muscles in sleep should be paralysed but for dementia patients they move
outline symptoms which could aid in frontotemporal dementia diagnoses
gradual progressive decline
frontal executive cognition impaired
apathy, loss of sympathy/empathy
repetitive, obsessive behaviours
hyperorality/dietary changes
using a PET scan and administering sugar can aid in diagnoses of frontotemporal dementia - what would the scan look like?
low uptake if brain is not functioning, so less warmer colours in the brain - more purple
outline the symptoms which could aid in the diagnoses of vascular dementia
abrupt/step-wise decline - following a stroke
focal neurological signs, early gait disturbance and falls
early incontinence
use imaging to find decrease in blood flow to brain
what are biological treatments for dementia
drugs
optimising physical health
what are psychological treatments for dementia
cognitive stimulation therapy
carer support
what are social treatments for dementia
housing and care needs - activities
what receptor is associated with cognitive symptoms for alzheimers and dementia with lewy bodies?
what treatment can be used to help this?
acetylcholine deficit
implicated in attention, memory function
cholinesterase inhibitors - boost ACH in brian by inhibiting acetylcholine esterase to keep more ACH in synapse - helps cognitive function and activities of daily living
what is an example of a cholinesterase inhibitor
donepezil
rivastigmine
what drug is memantine and why does it help alleviate the symptoms of alzheimers disease
blocks NMDA receptors which decreases excitation - as it is thought glutaminergic excitotoxicity occurs in alzheimers
moderate improvement in cognitive function
what is the future of dementia treatment
disease modifying treatments
newest - lecanemab and donanemab
work with immune system to clear amyloid in brain to slow progression
but side effects like oedema and need intravenous infusion
what is the most promising alzheimers biomarker
p-tau
