Dementia Flashcards
Dementia
Syndrome (collection of signs and symptoms)
Decline in cognitive abilities ; changes in behaviour ; decline in day to day functional ability
Impairment in:
- learning and memory
- complex attention
- language
- executive function
- perceptual motor function
Loss of memory no longer necessary
Must be acquired and represent significant decline from prev level of functioning —> rule out intellectual disability
Not occurring exclusively during delirium
Not accounted for by another mental disorder
Learning and Memory
Recent memory: difficulty recalling recent events — forget to turn off lights, stove
Long term: memory affected as it progresses — start to get past events mixed up
Explicit learning — learning to go new places, use new appliances
Complex attention
Sustained attention —> maintenance of attention over time — follow tv show
Selective attention —> maintenance of attention despite distractions — distracted, forget what to do
Divided —> multitasking — making coffee while talking on phone
Language
Expressive —> word finding difficulties ; difficulty naming objects
Receptive —> cannot understand others ; others need to simplify sentences ; difficulty following instructions
Perceptual motor function
Visual perception/Gnosis —> recognition of objects, faces
Perceptual motor/Praxis —> to do with hands ; driving, opening door, chopsticks , hand eye coordination assembly
Social cognition
Behaviour out of acceptable social range
Insensitive to modesty in dress / political, religious or sexual topics
Without regard to family or friends
Without regard to safety
Executive function
Difficulty with complex projects, decision making
Instrumental Activities of Daily Living (ADLs)
Alzheimer’s
> 62%
Gradual progression
- Early onset (rare < 10%)
- Late onset
- Familial (rare <5%)
Extracellular amyloid plaques —> aggregates of misfolded proteins btw nerve cells
Lewy body Dementia
> 5%
Gradual progression
Fluctuating cognition
Vascular Dementia
> 17%
Step wise progression
Multiple strokes
Frontal lobe dementia
> 2%
Gradual progression
Rare, younger onset
Tau
Stabilised microtubule network
Hyper phosphorylation —> inhibits assembly and disrupts microtubules
Combined insults from B-amyloid and tau drive decline in dementia
Risk factors
- Age
- Family history/genetics
- familial forms rare
- increase risk for AD (APOE) and frontal lobe (FTDP-17) - Gender
- AD: more females
- Vascular: more males - Diabetes and depression (stress)
- Head injury and anaesthesia
- Lifestyle choices — education, smoking, physical inactivity
Dementia caregivers in SG
Women
Above 50
Below secondary education
Older adults in their care have at least 1 BPSD (Behavioural and psychological symptoms of dementia)
Assistance in ADLs
Receive assistance from family/friends
Have paid helper
Gave up or cut back on work
Psychological morbidity
Behavioural and psychological symptoms related distress
Care burden
Early diagnosis
Understand their condition (psycho education)
relieve symptoms
Access / carer support
Legal — power of attorney, wills
Financial planning — assets, house
Life planning
Drug intervention
- Curative (NA)
- Disease modifying (in progress)
- Symptomatic : minimising impact of illness
Cholinesterase inhibitors
prevent breakdown of acetylcholine (neurotransmitter), symptomatic relief
Donepezil (Aricept) , Rivastigmine (Exelon) , Galantamine (Reminyl) ,
High potential for side effects
NNT = 14:1 —> treat 14 ppl to see benefit in 1
Aducanumab (Aduhelm)
Monoclonal antibody stick to amyloid molecule that forms plaques in brains of ppl with Alzheimers
Immune system removes plaque
Intravenous fusion every 4 weeks forever
Nonpharmacologic treatment
Cognitive enhancement
Indiv and grp therapy
Regular appts
Communication with family , caregivers
Env modification — e.g. hot day, person more agitated
Attention to safety
Physical Activity
Daily tasks
At least 2 and a half hrs per week
Nutrition
Avoid saturated fats, processed meats, simply carbs, salt
Fruits, veggies, complex carbs, grains and nuts, oily fish and omega 3 fatty acids
Anti-oxidants —> vitamins E and C
Mental stimulation
Education
Puzzles, games, reading
Adapt to changing abilities
Socialisation
Trust in and inform others to help
Lowers blood pressure —> lower risk of stroke
Keep mind active
Improve immune function
Creativity, attitude and spirit
Manage stress —> antidepressants , aromatherapy, diet and exercise , meditation
Be creative —> music, art, dancing
