Dementia Flashcards
What is ‘Dementia” in DSM-5?
Called ‘Neurocognitive disorder’
>Major
>Mild (not ‘minor’)
Decline in at least one neurocognitive domain
For Alzheimer diagnosis decline in two or more neurocognitive domains.
What neurocognitive domains are effected in Dementia?
CALM PLES:
Complex Attention: doing an activity and not getting easily distracted.
Learning and Memory:
Perceptual-motor function:
Language: could be broca’s or wernicke’s aphasia.
Executive function
Social cognition
In Dementia there is cognitive decline. What are the effects of this?
One or more cognitive domains (“Calm ples”)
The cognitive deficits:
>Interfere with independence in everyday activities
>Not exclusively in the context of a delirium
>Not better explained by another mental disorder (e.g., major depressive disorder, schizophrenia).
Compare mild vs major neurocognitive disorder.
Mild neurocognitive disorder:
1. Evidence of modest cognitive decline from a previous level of performance.
2. The cognitive deficits are insufficient to interfere with independence but greater effort, compensatory strategies, or accommodation may be required to maintain independence.
3. Cognitive deficits do not occur exclusively in the context of delirium.
4. Cognitive deficits are not primarily attributable to another mental disorder.g major depressive disorder, schizophrenia).
Major neurocognitive disorder:
1. There is evidence of substantial cognitive decline from a previous level of performance.
2. Cognitive deficits are sufficient to interfere with independence.
3. Same as mild.
4. Same as mild.
Neurocognitive disorder is a syndrome(cluster of symptoms) rather than a diagnosis. What are the types of neurocognitive disorders?
Specify whether due to:
>Alzheimer’s disease
>Vascular disease
>Traumatic brain injury
>HIV infection
>Substance/medication use
>Frontotemporal lobar degeneration
>Lewy body disease
> Prion disease
Parkinson’s disease
Huntington’s disease
Another medical condition
Multiple aetiologies
Unspecified
What is Alzherimer’s disease?
60-70% of dementia over age 60.
Characteristics
> Reduced short-term memory initially (later reduced LTM)
>Gradual decline over several years
>Depression common early on
>Suspicion, persecutory accusations
>Personality changes or entrenches
>May require prompts/assistance.
Gross neuropathology in Alzheimer’s disease(AD).
Neuronal loss Leads to:
>Loss of synaptic connectivity
>Degeneration of cortical architecture.
In severe gross neuropathy:
>Extreme shrinkage of the cerebral cortex.
>Severely enlarged ventricles.
>Extreme shrinkage of the hippocampus.
In Alzheimer’s disease, what happens at the Neuronal level?
- Plaques: Beta-amyloid proteins that build up Between nerve cells.
- Neurofibrillary Tangles: Twisted fibers of Tau protein form inside dying nerve cells.
What are the risk factors of Alzheimer’s disease?
> Age
Family history of AD
Down’s syndrome / FH
Head injury (in males)
FH Parkinson’s
Depression.
Epilepsy.
Encephalitis/meningitis
Herpes zoster/simplex
How do you assess dementia?
History
>Including collateral
Examination
>Mental state exam, Mini-mental state exam
>Physical examination
Special investigations (depend on findings)
>TSH, VDRL, FBC, Renal & Hepatic function, Ca2+. Phos, B12, Folate, CXR, PSA, HIV, EEG, CT scan
The Montreal cognitive assessment(MoCA) is used to assess cognitive function. What does it look at?
- Visuospatial/executive function.
- Naming objects/animals.
- Memory.
- Attention.
- Language.
- Abstraction.
- Delayed recall.
Which cognitive domain is being tested by the MoCA?
- Complex attention: Attention.
- Learning & Memory: Memory& attention.
- Perceptual motor function: Visuospatial/executive.
Condition affecting this function-Apraxia: loss of the ability to carry out learned purposeful movements. - Language: Language & Naming.
Disease affecting this function: Aphasia. - Executive function: Visuospatial/executive.
Dementia Management(Early).
> Discuss dx
Rx other illness esp. depression
Eliminate non-essential drugs
Advise on will-making
Monitor driving and household safety
AD support group
Discuss referral to specialised clinic
Medication options
Medicines to treat NCD(neurocognitive disease).
Cholinesterase Inhibitors
>Donepezil (Aricept)
>Galantamine
>Rivastigmine
NMDA receptor antagonist
>Memantine
Medication may provide limited benefits for people with:
>Mild to moderately severe >Alzheimer’s disease
>Dementia with Lewy bodies
>Vascular dementia, or,
>Mixed dementia.
Dementia Management (Later)
> Help carers optimise preserved pt. functions
Monitor / Rx neuropsychiatric symptoms
Arrange support / respite
Monitor health of carers
Plan transition to nursing home.
