Dementia Flashcards
What is the DSM5-TR diagnostic criteria for dementia?
- evidence of significant cognitive decline from a previous level of performance on one or more cognitive domains based on: concern that there has been a decline, substantial impairment of cognitive performance in clinical assessment
- cog defs interfere with independence in everyday activities
- cog defs do not occur exclusively in context of delirium
- cog defs not better explained by another mental disorder
What is the prevalence of dementia?
- 850,000 in UK
- predicted to rise to 1.6 mil by 2040
- 209,600 cases per year
What are the percentages of each dementia type in over 65s?
- 60% Alzheimer’s
- 20% vascular
- 10% mixed
- 6% other
- 4% frontotemporal
How many people have early onset dementia?
42,000 under 65
What extra things must be taken onto consideration for those with early onset dementia?
- working
- dependent children
- financial commitments
- physically fit and behave in a way that people find challenging
- accept and cope with losing skills at young age
- more difficult to access info, support, and services
What are the percentages of each dementia type in early onset dementia?
- 33% Alzheimer’s
- 20% vascular
- 10% Lewy body
- 12% fronto-temporal
- 10% Korsacoffs syndrome
- 15% other types
What are the different dementia classification schemes?
- by disease process
- by primary site of cell damage
- by prognosis
What is DAT?
dementia of Alzheimer’s type
What causes DAT?
- degeneration of neurons
- amyloid beta plaques outside cell - bind to and impair capacity to transmit signals
- tau neurofibrillary tangles - disrupt functioning from inside
- loss of neurotransmitters
What are the triggers of DAT?
unclear but may include:
1. genetics
2. diet
3. lifestyle
4. toxins
How many stages are there of symptom progression in DAT?
3
What are the symptoms of stage 1 DAT?
- WFD
- retrograde and anterograde amnesia
- depression (reactive)
What are the symptoms of stage 2 DAT?
- increased WFD
- vague and generic talk
- comprehension difficulties
- episodic memory impairment which impacts discourse
- WM impairment
- problem solving impairment
- reduced attention span and difficulty switching attention
- misperception/hallucination/delusions
What are the symptoms of stage 3 DAT?
- echolalia
- neologistic speech
- apathy
- aggression
- mute
What causes vascular dementia?
multiple infarcts/strokes
What are the risk factors of vascular dementia?
- high blood pressure
- heart problems
- high cholesterol and diabetes
How does vascular dementia progress?
decline with each new vascular event
How can vascular dementia be treated?
theoretically can stop the decline if you can stop the strokes
What are the symptoms of vascular dementia?
behavioural symptoms and focal neurology signs vary according to site of vascular pathology
What is DLB?
dementia with Lewy bodies
What are Lewy bodies?
spherical protein deposits found in nerve cells in sub-cortex, limbic system, and cortex which interrupt the action of important chemical messengers (e.g. ACh, dopamine)
What are the symptoms of DLB?
- hallucinations
- delusions
- fluctuations in cognitive impairment
- falls/fainting
- disturbed sleep
- hypersensitivity to antipsychotics
What is FTD?
Frontotemporal dementia
What are the statistics for FTD?
- second most common type in under 65s
- 3rd most common neurodegenerative type overall
What causes FTD?
- progressive atrophy of either frontal or temporal lobes
- as disease progresses, all areas are affected
What are the variants of FTD?
- behavioural variant (bvFTD) - frontal lobe variant
- primary progressive aphasia
What is bvFTD?
behavioural variant frontotemporal dementia
What does bvFTD share symptoms with?
- some psychiatric disorders (e.g. SZ, OCD, BPD, bipolar)
- neurodegererative diseases (e.g. MND, corticobasal degeneration)
How does bvFTD progress?
gradual onset with slow progression
What is there an early decline of in bvFTD?
- social interpersonal behaviour
- regulation of personal behaviour
- insight
What are the features of bvFTD?
- emotional blunting
- impulsivity and social disinhibition
- loss of ability to empathise
- detached in relationships
- decline in personal hygiene and grooming
- irritable
- mental rigidity and inflexibility
- overly friendly and trusting
- obsessive compulsive behaviours
- eating tastes can change
- apathy and inertia
What is PPA?
primary progressive aphasia
What are the different types of PPA?
- non-fluent/ aggramatic
- semantic dementia
- lopogenic PPA
What is the diagnostic criteria for non-fluent/aggramatic PPA?
Must have one of:
1. aggramatism in language production
2. apraxia of speech
Must have two of:
1. impaired comprehension of syntaticallly complex sentences
2. spared single word comprehension
3. spared object knowledge
What is the diagnostic criteria for semantic dementia?
Need both:
1. impaired object naming
2. impaired single word comprehension
Need three of:
1. impaired object knowledge, particularly for low frequency items
2. surface dyslexia/dysgraphia
3. spared repetition
4. spared grammaticality and motor aspects of speech
What is the diagnostic criteria for logopenic PPA?
Need both:
1. impaired single word retreival in spontaneous speech and naming
2. impaired repitition of phrases and sentences
Three of:
1. phonological errors in spontaneous speech or naming
2. spared single word comprehension
3. spared motor speech
4. absence of frank aggramatism
