Dementia 2.0 Flashcards
When is diagnosed with Dementia?
- evidence of cognitive decline (in at least 1 cognitive domain)
- deficits INTERFERE with independence in everyday activities
- no ddx(esp. delirium)
How is the course of Dementia?
- progressive and worse with time
- a/w neurodegeneration
Name acute cognitive disorders of the brain. (3)
- viral encephalitis
- head injury
- stroke
How does viral encephalitis bring about cognitive impairment?
-fronto-temporal problems
>memory, behavioural changes, language
DIstinguish Antegrade from Retrograde amnesia
- Antegrade: inability to make new memories
- retrograde: the inability to recall old memories
In which condition may both these amnesia present together?
Transient Global Amnesia
What may trigger transient global amnesia and who is it often seen in?
- seen in >50 y.o
- triggers: emotions and changes in temperatures
Which anatomical site in the brain is said to be closely linked to TGA?
- the hippocampus
How often may TGA occur and how long does an episode take?
- this is a transient condition lasting 4-6hrs (always <24hrs)
- only 6% recurs
How is TGA different from Transient Epileptic Amnesia?
- more short lived (lasts 20-30 mins)
- a/w temporal lobe seizures (30% not witnessed)
- response to ANTI-EPILEPTIC medication
What metabolic factors cause sub-acute cognitive d.o?
- B12, calcium levels
- thyroid factors
Inflammatory cause of sub-acute cognitive d.o?
-limbic encephalitis
What is Subjective Cognitive Impairment?
How does subjective cognitive impairment present as?
Pt complains of worsening of thinking abilities, but standard test can’t proove decline….
- everyday forgetfulness
- reduced concentration/ attention/ reaction time and memory d.o
What causes Creuztfeldt-Jakob Disease? (CJD)
-causes by highly infective prion protein, which ACCUMULATES at high levels in the brain
>irreversible nerve damage —RARE CONDITION
What is the most common type of CJD and how does it come about?
- the SPORADIC type
- occurs in the 60s
- said to be caused by the “misfolding” of a normal brain protein forming a prion
Which CJD arises from eating beef?
- variant CJD d.t contamination by BSE
- seen in 20s
- —<1% of cases
How may Iatrogenic CJD occur?
- by poor sterility of surgical instruments used between brain surgeries
- (Past); CJD arose from the use of human pituitary GH from deceased individuals. infected with GJD
Which CJD presents with cerebellar dysfxn or visual onset of symptoms?
What is this CJD type’s age of onset?
- iatrogenic
- 30s
Which CJD causes painful SENSORY disturbance?
How long does this CJD last?
Variant
14months
Which CJD type causes RAPID onset of dementia, myoclonus, neuro deficits?
How long does this CJD type last?
Sporadic
4 months
What are the other symptoms of Prion disease?
- difficulty in gait
- hallucinations
- muscle stiffness
- confusion and Fatigue
- hard to speak
Major cause of dementia in the UK
AD
What are the initial symptoms of AD and why?
FORGETFULNESS
-d/t the degeneration of the MEDIAL hippocampus and lateral parietal lobes ->APRAXIA and visuospatial difficulties
What causes the neurodegeneration in AD?
d/t to the accumulation of the A-Beta amyloid proteins in the form of extracellular amyloid plaques -> APOPTOSIS
- formation of the neurofibrillary tangles
- also said to cause synaptic loss
What occurs with posterior cortical atrophy ?
-visuospatial disturbance
What forms of PRIMARY PROGRESSIVE aphasia is seen in AD?
- SEMANTIC
- Staccato speech (effortful)
- Logopenic Aphasia
What ivx may prove the presence of AD?
- MRI: focal atrophy of TEMPORAL and PARIETAL lobes
- SPECT: reduced metabolism at the temporoparietal region
- CSF: reduced amyloid and increase in TAU
What rx for AD?
- MEMANTINE (NMDA-r blocker); gold standard
- ACh boosting rx > Cholinesterase inhibitors (rivastigmine/ galantamine)
Who is usually seen to have FTD?
-MOST <65Y.O; Early onset dementia
What pathogenic proteins are involved in the pathogenesis of FTD?
tau protein
TDP-43
Ubiquitin
—-aggregation of these proteins cause cell damage -> NEURODEGEN.
What are the 3 variants of FTD?
- Behavioural Variant (most common)
- Semantic Dementia
- Progressive Non-fluent aphasia
What are some frontal features seen in FTD?
- DISINHIBITION
- apathy
- loss of empathy
- hyperorality
- compulsive behaviours
What is found with IVX of FTD?
- MRI- atrophy of FT lobes
- SPECT - reduced FT metabolism
- csf: NORMAL amyloid; incr. TAU
How to treat FT dementia?
- with antipsychotics
- safety management of finances, food and internet
- Power of attorney
Give 2 examples of Late-Onset dementia.
- Lewy body dementia
2. Vascular dementia
How does Vascular dementia occur and how does it present as?
-d/t subcortical SMALL VESSEL DISEASE…co-existent amyloid pathology
>reduced attention, executive dysfxn, slow processing
What pathways are disrupted in Lewy Body Dementia?
cholinergic and dopaminergic d/t cell damage by alpha-synuclein aggregates in cells
What forms the CORE criteria of Lewy body dementia?
- fluctuating cognition
- recurrent well-formed VISUAL hallucinations
+/- extrapryamidal fts.
What are the physical symptoms of extrapyramidal fts?
- slurred speech, paranoia, anxiety
- dystonia, AKATHISIA, BRADYKINESIA, TARDIVE DYSKINESIA
- tremor
What ivx could be done for LBD?
- DaT imaging
- alpha-synuclein ligand imaging
What rx for LBD?
- small dose LEVODOPA to reduce ACh
- trial cholinesterase inhibitors
How is Parkinson’s D. DEMENTIA different from Lewy Body Dementia?
If Body or Brain came first!
- PDD: cogntive decline occurs >1 YEAR of motor symptoms
- LBD: cognitive may occur in <1 year of Motor presentation (or they occur TOGETHER/ cognitive decline comes first)
—though both dementias are pathologically and clinically similar
What additional symptoms are seen in Huntington’s Disease?
- in addition to dementia:
- —chorea with LATER psychosis
- changes in mood and personality (APATHY)
- SLURRED speech
What IVX for Huntington’s disease?
- genetic testing (>35 repeats of CAG repeats)
- MRI (loss of caudate heads)
What rx could be given?
mood stabilizers
chorea rx
HD nurse specialist
Why check for Vit B12 and Calcium levels for dementia screening?
- Vit B12 def. predisposes one to DEMENTIA
- Hypercalcemia is said to cause memory loss, irritability and depression
Name the disorders of cognitions that kicks in with AD.
- Posterior Cortical Atrophy
2. Progressive primary aphsia
What is in the core criteria to make the dx of Vascular Dementia?
- Presence of Cerebrovascular disease
2. Clear temporal relationship between ONSET of dementia and cerebrovascular dementia
How does vascular dementia present as >
- reduced attention
- reduced executive dysfxn
- slowed processing
Is post-stroke dementia a thing?
YES
- 25% develop Vascular dementia usually in less than 3 months of the stroke
How to manage VaD?
- vascular risk factors +/- Cholinesterase inhibitor
2. Community Psyciatry Nurse
What are the fts of FTD?
- early FRONTAL fts (apathy/ loss of empathy/ disinhibition/ hyperorality)
- early loss of insight
How is FTD managed?
- Safety management= controlled access of FOOD/ MONEY/ INTERNET
- Power of Attorney
- MND nurse specialist if co-existent MND
How is FTD treated?
- trial of TRAZADONE/ anti-psychotics to help behavioural fts
What support could be given to a LB pt?
PD nurse specialist
Name 2 early onset dementia.
- FTD
2. Huntington’s Dementia
What is involved in the dementia screen and when is it performed?
- B12
- TFTS
- syphilis
- HIV
- Ca2+
- –screen is done when pt is YOUNG or there is family hx
