Dementia Flashcards
What is dementia?
Loss of memory, language, problem-solving and other thinking abilities severe enough to interfere with daily life.
What are the most common types of dementia?
- Alzheimer’s Disease (60-80%)
- Vascular Dementia
- Lewy Body Dementia
- Frontotemporal dementia
What are some rarer types of dementia?
- Huntington’s
- Pick’s disease
- HIV
- Creutzfeldt–Jakob disease (CJD)
What are non-specialist assessment tools for dementia?
- 10-point cognitive screener (10-CS)
- 6-item cognitive impairment test (6CIT)
What initial investigations should be done to exclude reversible causes of dementia?
Confusion Screen:
* Blood tests: FBC, U&Es, LFTs, Calcium, glucose, ESR/CRP, TFTs, Vitamin B12, folate
What type of imaging is essential for dementia diagnosis?
Neuro-imaging
What are some differentials to rule out that are potentially treatable?
- Hypothyroidism
- Addison’s disease
- B12/folate/thiamine deficiency
- Syphilis
- Brain tumour
- Normal pressure hydrocephalus
- Subdural haematoma
- Depression
- Chronic drug use
What characterizes Alzheimer’s Disease (AD)?
Complex neurodegenerative disorder with a gradual decline.
What are genetic risk factors for Alzheimer’s Disease?
Apolipoprotein E (APOE) increases risk of AD.
What are some non-genetic risk factors for Alzheimer’s Disease?
- Age 65+
- Female gender
- Lower educational attainment
- Hypertension/Diabetes/Obesity/Smoking
- Head injury
What are the pathophysiological features of Alzheimer’s Disease?
- Beta-amyloid plaques
- Neurofibrillary tangles
- Widespread cerebral atrophy, mainly involving the cortex and hippocampus
What symptoms are associated with Alzheimer’s Disease?
- Memory loss
- Problems reasoning/communication
- Difficulty making decisions
- Dysphagia
- Behavioral changes: depression, agitation, psychosis
What further investigations are specific for Alzheimer’s Disease?
- Cerebrospinal fluid analysis: decreased beta-amyloid 42, increased total tau or phosphorylated tau
- Amyloid PET Imaging
What are the first-line pharmacological treatments for cognitive management in Alzheimer’s Disease?
1st = Acetylcholinesterase inhibitors (Donepezil, Galantamine, Rivastigmine)
2nd =** Memantine** (NMDA receptor antagonist)
What non-cognitive management options are available for Alzheimer’s Disease?
- Antidepressants
- Antipsychotics (only if patient is at risk to themselves or others)
What defines Vascular Dementia (VD)?
Group of syndromes of cognitive impairment caused by different mechanisms.
What are the risk factors for Vascular Dementia?
- History of stroke or TIA
- Atrial Fibrillation, Hypertension, Diabetes
- Smoking and obesity
- Coronary heart disease
- Family history of cardiovascular disease
What are the sub-types of Vascular Dementia?
- Stroke-related VD
- Subcortical VD
- Mixed dementia
What symptoms are associated with Vascular Dementia?
- Sudden or stepwise deterioration of cognitive function
- Seizures
- Focal neurological abnormalities
What is the management approach for Vascular Dementia?
- Address individual problems
- Non-pharmacological: cognitive stimulation, multi-sensory stimulation
- Pharmacological: No specific medication advised, AChE inhibitors or memantine for VD + 1 other dementia
What is the pathophysiology of Dementia with Lewy Bodies?
Alpha-synuclein cytoplasmic inclusions in the substantia nigra, paralimbic and neocortical areas.
What are the two types of Dementia with Lewy Bodies?
- Dementia with Lewy Bodies - dementia before Parkinsonian symptoms
- Parkinson’s disease dementia - tremor, bradykinesia, and rigidity before dementia
What are the fluctuating symptoms of Dementia with Lewy Bodies?
- Parkinsonism
* Hallucinations - Cognitive impairment
- REM sleep disorders
- Attention and executive function issues
What is the diagnosis method for Dementia with Lewy Bodies?
- Clinical
- Imaging: SPECT scan
