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Geriatrics > Dementia > Flashcards

Dementia Flashcards

1
Q

Dementia is defined as…

A

A clinical syndrome characterized by progressive cognitive decline, interfering with individual’s ability to function independently

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2
Q

Cognition encompasses…

A

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

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3
Q

Mild cognitive impairment refers to…

A

Modest decline in cognition from previous baseline - does NOT interfere with the ability to function independently

May be subjective, or observable on cognitive testing

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4
Q

Can mild cognitive impairment progress to dementia?

A

May or may not progress - 30% stabilize, 30% progress to dementia, 30% revert to baseline

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5
Q

The link between dementia and delirium is that individuals…

Risk?

A

Individuals with dementia are particularly vulnerable to developing delirium - and individuals that have experienced delirium are at greater risk of developing dementia

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6
Q

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

A

Drugs
Emotional
Metabolic
Eyes + ears declining
Nutritional
Tumour/other space-occupying lesion
Infection
Anemia

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7
Q

The most common form of dementia is…

A

Alzheimer’s Disease

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8
Q

Progression of alzheimer’s is…

A

Slow + progressive: starts with difficulty in short-term memory and gradually impacts all areas of functioning

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9
Q

Alzheimer’s is associated with characteristic…

A

Beta-amyloid plaques and neurofibrillary tangles

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10
Q

Etiology of alzheimer’s is ____ and is likely…

A

Unknown - likely a mix of genetic, environmental, and lifestyle factors

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11
Q

Risk factors for developing Alzheimer’s includes…

A

Aging
Family hx/genetics
Hx of severe head trauma
Mild cognitive impairment
Lifestyle factors

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12
Q

Protective factors against developing Alzheimer’s includes…

A

Educational attainment
Social engagement
Lifelong learning

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13
Q

Vascular dementia results from…

A

Interrupted blood flow in parts of the brain

Vascular damage usually visible on MRI, CT, + CV risk factors

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14
Q

CV risk factors for vascular dementia include…

A

HTN, dyslipidemia, smoking, diabetes, CVD

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15
Q

Symptoms associated with vascular dementia depend on…

A

The part of the brain that is affected

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16
Q

Compared to Alzheimer’s, these cognitive factors are more common early on in vascular dementia…

What about factors that are more preserved?

A

Complex thinking + planning
Personality changes
Agitation, moodiness

But insights into deficits may be more preserved compared to Alzheimer’s

17
Q

Onset of vascular dementia may be…

A

Abrupt OR gradual (with periods of relative stability and rapid decline)

18
Q

Frontotemporal dementia has a strong ____, and onset is…

A

Genetic component - earlier onset (40-50 y.o) and no increased prevalence with age

19
Q

Damage with frontotemporal dementia is initially limited to…

Name

A

The frontal and temporal lobes

20
Q

Symptoms of frontotemporal dementia usually start with…

A

Changes in speech, language (unusual, choppy, repetitive), and personality (poor judgement, disinhibited behaviour) before memory changes.

Overtime, progresses to global impairment

21
Q

Parkinson’s dementia is classified as…

A

Dementia that develops AFTER a clinical diagnosis of parkinson’s disease

Motor sx’s THEN cognitive sx’s

22
Q

Parkinson’s dementia usually involves disruption in ____ rather than memory processes.

A

Planning + organizing

23
Q

Issue with Parkinson’s treatments and dementia is that…

What kinds of treatments do we use for Parkinson’s??

A

Dopaminergic treatments for PD may exacerbate behavioural + psychological symptoms of dementia

24
Q

Lewy body dementia is classified as…

A

Abnormal deposits of alpha-synuclein protein in neurons - cognitive impairment + visual hallucinations manifest FIRST or CONCURRENTLY with PD motor symptoms

“Parkinson disease in reverse”

25
Q

Distinctive clinical features of lewy body dementia that make it differ from other types include…

A

Early postural instability and repeated falls
Detailed, recurrent visual hallucinations
Pronounced fluctuations in cognition
Extremely sensitive to antipsychotics

26
Q

Diagnosing dementia is primarily based on…

A

A diagnosis of exclusion - ruling out reversible causes of cognitive changes, collecting detailed history (collateral), and conducting cognitive assessment + functional activities questionnaire (FAQ)

27
Q

One of the commonly used tools to assess cognition is the…

A

Mini-mental status examination (MMSE)

28
Q

Pros and cons of the MMSE include…

A

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

29
Q

The functional activities questionnaire was developed…

A

Assess functional impairment (ability to complete ADL’s and IADL’s), correlated with baseline function

Designed to be completed by caregiver/close support

30
Q

Behavioural and psychological symptoms of dementia (BPSD) encompasses…

A

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

31
Q

Examples of behavioural symptoms include…

A

Agitation, aggression
Disinhibition, wandering
Repetitive behaviours
Hoarding
Vocalizations
Nocturnal restlessness

32
Q

Examples of psychological symptoms include…

A

Apathy
Emotional lability
Paranoia
Hallucinations
Delusions
Depression

33
Q

Triggers for BPSD may include

A

Psychological (fear, paranoia)
Environmental
Medical (pain!)
Medications

34
Q

Medications that may trigger BPSD are similar to…

A

Medications that affect cognition and can trigger delirium

35
Q

Approach to dementia should consider…

A

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

36
Q

2 categories of pharmacological treatment for dementia include…

A

Treatment to help slow dementia
Management of BPSD

Geriatrics (8 decks)

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