Dementia Flashcards
What is the definition of dementia?
Evidence of substantial cognitive decline from a previous level of performance in one or more of the cognitive domains
What are the cognitive domains?
Language
Visuospatial awareness/perceptual motor function
Memory learning
Social cognition
Complex attention
Executive function
How can you describe dementia?
Slowly progressive neurodegenerative disease leading to cognitive decline
How can you test for executive dysfunction?
Category fluency (assess working memory, “name 5 animals”)
Tap test (tap when hear a letter said)
Attention (say months backwards)
Clock drawing test (good for diagnosing vascular dementia)
What test is good for testing visuospatial and perceptual dysfunction?
Clock drawing test (hemi neglect)
What is a cognitive assessment tool used when assessing dementia?
Montreal cognitive assessment
What are the main 4 types of dementia?
What is another type of dementia?
Alzheimer’s
Vascular
Levy body
Frontotemporal
Alcohol induced dementia
What is the most common dementia to least common dementia?
Alzheimer’s = most common
Vascular
Lewy body
Frontotemporal
What type of disease can cause rapidly progressives neurodegenerative dementia/cognitive decline?
Prion diseases
What is a prion disease?
Fatal accumulation of prion proteins within the brain leading to neuronal damage
What are the risk factors for developing dementia?
Old age
Inactive
Smoking
Alcohol
Air pollution
Social isolation
Obesity
Hearing impairment
Depression
Diabetes
HTN
Less educated
Head injury
What are the 2 methods of pathophysiology for Alzheimer’s dementia?
Insoluble B amyloid plaques aggregate inducing inflammation and neuronal death
Tau protein neurofibrillary tangles (hyperphosphorylation)
What is the normal function of Tau proteins?
Stabilise microtubules in neuronal cytoskeleton
What macroscopic changes occur with Alzheimer’s?
What part of the brain is affected first?
General brain atrophy
Hippocampus affected first (memory)
Narrowing of gyri
Widening of suckling
Ventricular enlargement
What medications are often used to manage Alzheimer’s dementia and why?
Acetylcholine esterase inhibitors
Levels of Ach are low in Alzheimer’s and are needed to form memories in the hippocampus
What are some examples of Acetylcholinesterase inhibitors used to manage Alzheimer’s dementia?
Donepazil
Rivastigmine
Galantanine
How does Alzheimer’s dementia present?
Slow progressive decline
Short term memory loss
Motor and language decline
Long term memory loss
Disorientation
Immobilisation
What are some differentials that need to be ruled out when considering Alzheimer’s dementia?
Hypothyroidism
Hypercalcaemia
B12 deficiency
Delirium
What type of medication is given in very advanced Alzheimer dementia and why?
Memantine
Glutamate receptor antagonist
Lots of glutamate released by dying neurones, memantine protect neurones against these high levels
What causes vascular dementia?
Small vessel damage to the brain (mini strokes)
What are the risk factors for developing vascular dementia?
HTN
Smoking
Previous stroke/MI
Diabetes
AFib
Hypercholesterolaemia
How does vascular dementia present?
Depends on the area of the brain that suffered the vascular damage:
-focal neurological deficit
-speech deficit
-motor paresis
-gait impairment
-emotional changes
-fluctuations in state
How do you treat vascular dementia?
Treat the risk factors and the symptoms
What is lewy-body dementia?
Rapid onset dementia caused by the formation of Lewy bodies which eventually causes Parkinsonism
What makes up Lewy bodies?
Misfolded alpha synuclein proteins
Where do the Lewy bodies form to cause the dementia symptoms?
Where do the Lewy bodies form to cause the Parkinsonism symptoms?
Dementia = cortex
Parkinsonism = substantia nigra pars compacta
What is a characteristic feature of Lewy body dementia?
Visual hallucinations
Parkinsonism
What are the characteristic features of Parkinsonism?
Bradykinesia
Hypertonia
Pil rolling Tremor
Lead pipe rigidity
Instability
What pathway is damaged in Parkinson’s and Lewy body dementia?
Nigrostriatal pathway specifically substantia nigra pars compacta
How do you manage Lewy body dementia?
Acetylcholine esterase inhibitors like donepazil or rivastigmine
L-dopa with carbidopa for the reduced dopamine in the Parkinsonism
What medication is given to patients with Lewy body dementia if they are acting due too the hallucinations?
Antipsychotics like haloperidol
How does a patient with Frontotemporal dementia present?
Changes in social behaviour
Lack of behavioural inhibition / behavioural disinhibition
Loss of empathy
Lack of insight
What are the other 2 types of Frontotemporal dementia?
Semantic dementia
Progressive non fluent aphasia
What is semantic dementia?
Type of Frontotemporal dementia
Has fluent speech but lacks semantic knowledge
What is progressive non fluent aphasia?
Type of Frontotemporal dementia
Have apraxia and effortful speech
