Dementia Flashcards
Dementia is defined as…
A clinical syndrome characterized by progressive cognitive decline, interfering with individual’s ability to function independently
Cognition encompasses…
All of the mental processes involved in learning, remembering, and using knowledge
DSM details 6 cognitive domains:
Complex, executive, learning + memory, language, perceptual-motor, social
Mild cognitive impairment refers to…
Modest decline in cognition from previous baseline - does NOT interfere with the ability to function independently
May be subjective, or observable on cognitive testing
Can mild cognitive impairment progress to dementia?
May or may not progress - 30% stabilize, 30% progress to dementia, 30% revert to baseline
The link between dementia and delirium is that individuals…
Risk?
Individuals with dementia are particularly vulnerable to developing delirium - and individuals that have experienced delirium are at greater risk of developing dementia
Potentially reverisble contributors to cognitive impairment need to be ruled out before an individual is diagnosed with dementia. This includes…
D-E-M-E-N-T-I-A mnemonic
Drugs
Emotional
Metabolic
Eyes + ears declining
Nutritional
Tumour/other space-occupying lesion
Infection
Anemia
The most common form of dementia is…
Alzheimer’s Disease
Progression of alzheimer’s is…
Slow + progressive: starts with difficulty in short-term memory and gradually impacts all areas of functioning
Alzheimer’s is associated with characteristic…
Beta-amyloid plaques and neurofibrillary tangles
Etiology of alzheimer’s is ____ and is likely…
Unknown - likely a mix of genetic, environmental, and lifestyle factors
Risk factors for developing Alzheimer’s includes…
Aging
Family hx/genetics
Hx of severe head trauma
Mild cognitive impairment
Lifestyle factors
Protective factors against developing Alzheimer’s includes…
Educational attainment
Social engagement
Lifelong learning
Vascular dementia results from…
Interrupted blood flow in parts of the brain
Vascular damage usually visible on MRI, CT, + CV risk factors
CV risk factors for vascular dementia include…
HTN, dyslipidemia, smoking, diabetes, CVD
Symptoms associated with vascular dementia depend on…
The part of the brain that is affected
Compared to Alzheimer’s, these cognitive factors are more common early on in vascular dementia…
What about factors that are more preserved?
Complex thinking + planning
Personality changes
Agitation, moodiness
But insights into deficits may be more preserved compared to Alzheimer’s
Onset of vascular dementia may be…
Abrupt OR gradual (with periods of relative stability and rapid decline)
Frontotemporal dementia has a strong ____, and onset is…
Genetic component - earlier onset (40-50 y.o) and no increased prevalence with age
Damage with frontotemporal dementia is initially limited to…
Name
The frontal and temporal lobes
Symptoms of frontotemporal dementia usually start with…
Changes in speech, language (unusual, choppy, repetitive), and personality (poor judgement, disinhibited behaviour) before memory changes.
Overtime, progresses to global impairment
Parkinson’s dementia is classified as…
Dementia that develops AFTER a clinical diagnosis of parkinson’s disease
Motor sx’s THEN cognitive sx’s
Parkinson’s dementia usually involves disruption in ____ rather than memory processes.
Planning + organizing
Issue with Parkinson’s treatments and dementia is that…
What kinds of treatments do we use for Parkinson’s??
Dopaminergic treatments for PD may exacerbate behavioural + psychological symptoms of dementia
Lewy body dementia is classified as…
Abnormal deposits of alpha-synuclein protein in neurons - cognitive impairment + visual hallucinations manifest FIRST or CONCURRENTLY with PD motor symptoms
“Parkinson disease in reverse”
Distinctive clinical features of lewy body dementia that make it differ from other types include…
Early postural instability and repeated falls
Detailed, recurrent visual hallucinations
Pronounced fluctuations in cognition
Extremely sensitive to antipsychotics
Diagnosing dementia is primarily based on…
A diagnosis of exclusion - ruling out reversible causes of cognitive changes, collecting detailed history (collateral), and conducting cognitive assessment + functional activities questionnaire (FAQ)
One of the commonly used tools to assess cognition is the…
Mini-mental status examination (MMSE)
Pros and cons of the MMSE include…
Pros:
Minimal training
Assesses multiple cognitive domains
Highly sensitive + specific to dementia
Cons:
Not very sensitive to mild cognitive impairment
Scores affected by level of educational attainment
The functional activities questionnaire was developed…
Assess functional impairment (ability to complete ADL’s and IADL’s), correlated with baseline function
Designed to be completed by caregiver/close support
Behavioural and psychological symptoms of dementia (BPSD) encompasses…
Non-cognitive symptoms of disturbed thoughts, perception, mood, or behaviour that may occur with dementia
May be frustrating/distressing to caregivers and pose safety concerns
Examples of behavioural symptoms include…
Agitation, aggression
Disinhibition, wandering
Repetitive behaviours
Hoarding
Vocalizations
Nocturnal restlessness
Examples of psychological symptoms include…
Apathy
Emotional lability
Paranoia
Hallucinations
Delusions
Depression
Triggers for BPSD may include
Psychological (fear, paranoia)
Environmental
Medical (pain!)
Medications
Medications that may trigger BPSD are similar to…
Medications that affect cognition and can trigger delirium
Approach to dementia should consider…
Optimization of co-morbid conditions
Attempt to stop medications contributing to cognitive impairment
Encourage cognitive + social activity, regular exercise, and diet
Caregiver supports
Refer to alzheimer society saskatchewan
2 categories of pharmacological treatment for dementia include…
Treatment to help slow dementia
Management of BPSD
