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OPM, Oncology, Palliative + Breast > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia?

A

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

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2
Q

Cognitive symptoms of dementia

A

amnesia: loss of memory
aphasia: difficulty with language
agnosia: inability to recognise objects or people
apraxia: inability to carry out physical tasks

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3
Q

Non-cognitive symptoms of dementia

A

psychiatric symptoms - delusions, hallucinations, depression, anxiety, misidentification syndrome

behavioural disturbance - agitation, aggression, disinhibition, abnormal vocalisation, wandering, restlessness

personality change: irritability, impulsive behaviour

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4
Q

Types of dementia

A

Alzheimer’s dementia
Vascular dementia
Dementia with lewy bodies
Frontotemporal dementia
Huntington disease dementia
CJD dementia
Parkinson’s disease dementia
Alcoholic dementia
Dementia pugilistica

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5
Q

When is it more common to get Alzheimer’s disease <65?

A

family history
Down’s syndrome

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6
Q

Risk factors for Alzheimer’s disease

A

presenelin 1 + 2, APOE, APP
age, premorbid IQ, female, lower education
hypertension, diabetes, obesity, hypercholesterolaemia, physical inactivity, smoking
head trauma

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7
Q

Presentation of Alzheimer’s disease

A

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

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8
Q

Neuropathology of Alzheimer’s

A

temporo-parietal lobe mainly affected, widening of sulci and narrowing of gyri, ventricular enlargement, amyloid plaques, neurofibrillary tangles (tau protein)

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9
Q

Neuroimaging findings in Alzheimer’s

A

atrophy of medial temporal lobe

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10
Q

How are neurotransmitters affected in Alzheimer’s disease?

A

decrease acetylcholine, noradrenaline, serotonin

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11
Q

Risk factors for vascular dementia

A

hypertension
hypercholesterolaemia
diabetes

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12
Q

Clinical features of vascular dementia

A

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

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13
Q

How is vascular dementia diagnosed?

A

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

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14
Q

Core symptoms of dementia with lewy bodies

A

fluctuating cognition, alertness and attention
parkinsonian motor sx (bradykinesia, limb rigidity, gait and balance disturbance, blank facial expression)
visual hallucinations
REM behaviour sleep disorder

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15
Q

Dementia with lewy bodies pathology

A

lewy bodies in cerebral cortex/substantia nigra, senile plaques, no neurofibrillary tangles

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16
Q

Dementia with lewy bodies biomarker

A

reduced dopamine transporter uptake in the basal ganglia on SPECT/PET scan

17
Q

What CT/MRI findings are present in dementia with lewy bodies?

A

generalised atrophy with more preservation in the medial temporal lobe compared with Alzheimer’s

ventricular enlargement

18
Q

What is the other name for frontotemporal dementia?

A

Pick’s disease

19
Q

Frontotemporal dementia variants

A

behavioural:
early changes in personality, behaviour and judgement
socially inappropriate behaviour
disinhibition
apathy
perseveration
hyperorality/dietary changes
loss of empathy

primary progressive aphasia:
- semantic dementia (loss of meaning of words)
- progressive non-fluent aphasia (impaired speech production)

20
Q

Frontotemporal dementia pathology

A

gross atrophy of frontal and anterior temporal lobe

21
Q

Frontotemporal dementia pathology

A

tau protein present in frontal and temporal lobes

22
Q

Name some cognitive screening tools

A

abbreviated mental test score
mini mental state examination
montreal cognitive assessment
general practitioner assessment of cognition
addenbrookes cognitive examination
cambridge cognition examination

23
Q

AMTS components

A

1) age
2) time to nearest hour
3) an address to be repeated
4) year
5) name of hospital/home address
6) recognition of 2 persons
7) date of birth
8) date WW1 started
9) name of present monarch
10) count backwards from 20-1

<7 suggests impairment

24
Q

Dementia investigations

A

dementia bloods screen: FBC, U&E, TFT, LFT, blood glucose, folate, vitamin B12, calcium

urine MC&S

neuroimaging: CT, MRI, DAT scan, SPECT
neuropsychological testing
gold standard is autopsy

25
Q

Dementia differentials

A

metabolic: hypothyroidism, hyperparathyroidism, hypoglycaemia

nutritional

inflammatory: MS, sarcoidosis, SLE

structural: normal pressure hydrocephalus, space-occupying lesion, subdural haematoma

infections: neurosyphilis, encephalitis, Lyme disease

inherited: Wilson’s disease

depression/pseudodementia

medications

delirium

26
Q

Driving with dementia guidelines

A

DVLA must be informed
most are unfit to drive
in early dementia, a licence may be issued subject to annual review
formal driving assessment may be necessary
group 2 licence must be revoked

27
Q

Dementia pharmacological treatment

A

cholinesterase inhibitors:
- donepezil
- rivastigmine
- galantamine

NMDA antagonist:
- memantine

antipsychotics:
- risperidone
- haloperidol

benzodiazepines
anticonvulsants, antidepressants etc

28
Q

How do cholinesterase inhibitors work in dementia?

A

stop the breakdown of acetylcholine (an important neurotransmitter in memory and cognition)
do not prevent progression of disease

29
Q

Cholinesterase inhibitors side effects

A

nausea
vomiting
diarrhoea
dizziness
headache
muscle cramps

30
Q

Who should cholinesterase inhibitors be used in caution with?

A

gastric ulcer
heart disease
COPD

31
Q

How does memantine work in dementia?

A

blocks pathological effects of glutamate release
allows better function of impaired brain
slows cognitive decline and functional decline
decreases agitation

32
Q

Side effects of memantine

A

headaches
dizziness

33
Q

Who should memantine be avoided in?

A

kidney disease
seizure disorders

34
Q

Risks of antipsychotics in dementia

A

accelerated cognitive decline
cerebrovascular events
mortality

OPM, Oncology, Palliative + Breast (21 decks)

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