Dementia Flashcards
What is dementia?
clinical syndrome due to disease of brain
numerous causes
impairment of multiple higher cortical functions (memory, abstract thinking, comprehension, cognitive and non-cognitive sx)
significantly interferes with occupation, ADLs or relationships
at least 6 months duration
Cognitive symptoms of dementia
amnesia: loss of memory
aphasia: difficulty with language
agnosia: inability to recognise objects or people
apraxia: inability to carry out physical tasks
Non-cognitive symptoms of dementia
psychiatric symptoms - delusions, hallucinations, depression, anxiety, misidentification syndrome
behavioural disturbance - agitation, aggression, disinhibition, abnormal vocalisation, wandering, restlessness
personality change: irritability, impulsive behaviour
Types of dementia
Alzheimer’s dementia
Vascular dementia
Dementia with lewy bodies
Frontotemporal dementia
Huntington disease dementia
CJD dementia
Parkinson’s disease dementia
Alcoholic dementia
Dementia pugilistica
When is it more common to get Alzheimer’s disease <65?
family history
Down’s syndrome
Risk factors for Alzheimer’s disease
presenelin 1 + 2, APOE, APP
age, premorbid IQ, female, lower education
hypertension, diabetes, obesity, hypercholesterolaemia, physical inactivity, smoking
head trauma
Presentation of Alzheimer’s disease
insidious onset, slow deterioration
early memory loss
difficulties with language
difficulties with planning or organisation, visuospatial skills, orientation
loss of insight
absence of systemic or brain disease as cause
Neuropathology of Alzheimer’s
temporo-parietal lobe mainly affected, widening of sulci and narrowing of gyri, ventricular enlargement, amyloid plaques, neurofibrillary tangles (tau protein)
Neuroimaging findings in Alzheimer’s
atrophy of medial temporal lobe
How are neurotransmitters affected in Alzheimer’s disease?
decrease acetylcholine, noradrenaline, serotonin
Risk factors for vascular dementia
hypertension
hypercholesterolaemia
diabetes
Clinical features of vascular dementia
abrupt onset
stepwise deterioration
fluctuating course
emotional lability
personality changes
insight maintained until late stages
depression and epileptic fits more frequent
may be signs and symptoms of stroke
How is vascular dementia diagnosed?
NINDS-AIREN criteria based on neuroimaging
multiple large vessel disease-related stroke in critical areas
or massive small vessel disease
or multiple lacunes in the basal ganglia and frontal white matter, or bilateral thalamic lacunes
Core symptoms of dementia with lewy bodies
fluctuating cognition, alertness and attention
parkinsonian motor sx (bradykinesia, limb rigidity, gait and balance disturbance, blank facial expression)
visual hallucinations
REM behaviour sleep disorder
Dementia with lewy bodies pathology
lewy bodies in cerebral cortex/substantia nigra, senile plaques, no neurofibrillary tangles