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GP/GERIS > DEMENTIA > Flashcards

DEMENTIA Flashcards

0
Q

What are the major domains of cognition?

A

Declarative episodic memory
Executive cognitive functioning
Visuospatial function
Language

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1
Q

What is dementia?

A

Deterioration in cognition that impairs ADLs

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2
Q

What are the differences between dementia and delirium?

A

Delirium is acute onset, has in attention, can also get hallucinations mood disturbances involuntary movements and irrational flight of ideas.

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3
Q

What are the key pathological changes in AD?

A

Cerebral atrophy
Neuronal loss
Amyloid plaques and neurofibrollary tangles.

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4
Q

What are RFs for alzheimers?

A

Age
FHx
Low cognitive reserve (reduced brain function)
Low physical activity, smoking, alcohol

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5
Q

Protective factors against AD?

A

Higher level of education
Mentally active
Socially active
Reg exercise and diet

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6
Q

What are the types of dementia?

A 
Alzheimers 
Lewy body 
Vascular 
Frontotemporal - 
Parkinson's
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7
Q

How do you differentiate Lewy body with Parkinson’s?

A

Parkinson’s disease dementia will have long standing PD

DLB has visual hallucinations, falls, fluctuating alertness.

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8
Q

What is the clinical presentation of AD?

A

Early - atrophy of medial temp lobes -> benign forgetfulness, diff with ADLs but 20% present with language (first word diff), executive (organisational diff), visuospatial (navigational difficulty)

Middle - unable to work, easily confused, language impairment from atrophy of LATERAL POSTERIOR TEMPORAL CORTEX

Late - atrophy of FRONTAL LOBE -> loss of judgement and reasoning

End stage - rigid, mute, incontinent and bedridden.

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9
Q

What changes would you expect on MMSE of AD?

A

Yearly decline in 3-3.5 points.

Will be affected by level of education and language.

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10
Q

What test should you use for fronto-temporal?

A

Frontal assessment battery not MMSE

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11
Q

What are the key clinical features of alzheimers dementia?

A 
Chronic progressiveness 
Atleast two areas of cognition
- agnosia
- amnesia
- ataxia
- aphasia
- executive dysfunction
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12
Q

Ix?

A

LAB
CBE EUC LFT CRP BGL urinalysis
TFT B12/FOLATE
HIV/SYPHILLIS if expected

RAD
CT/MRI head

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13
Q

What are the complications of AD?

A 
Aspiration (most common)
SEPSIS
PE
HEART DISEASE
MALNUTRITION
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14
Q

Management of dementia?

A

Non pharm
Nutrition - if poor associate with morbidity and mortality -> nutritional supplements, risk of aspiration
Exercise
Psychosocial - counselling support (respite), driving ability, consider Advance Directives

Pharm (limited use)
Anticholinesterases (MMSE 10-24), mild MMSE improvement of 1-2 points, contraindicated
Memantine for mod to severe
Only PBS if given prior to anti-chol I.e 1st line.

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15
Q

Why use Anticholinesterases?

A

Prevents break down of acetylcholine.

Hence increases level and duration

16
Q

What is ADVANCED DIRECTIVE??

A

‘Advance directive’ is a general term describing
• Enduring power of attorney for financial matters
• Enduring power of guardianship for lifestyle (e.g. nursing home) and health care
• Medical power of attorney for medical treatment
• Advance health care directive: written statement stating sort of medical treatment the individual may or may not want after he/she is no longer able to make these decisions

17
Q

What are features of LBD?

A

Visual hallucinations
Parkinsonism
Fluctuating course

18
Q

Features of frontotemporal?

A

Executive so dysinhibition and disorganisation

Personality changes

19
Q

What drug shouldn’t be given in LBD?

A

Typical Antipsychotic.

Risk of NEURO malignant syndrome (reduced dopamine levels). Therefore give quitepine.

20
Q

What are reversible dementia causes?

A

Infectious/inflammatory
- HIV, SYPHILLIS, pneumonia, UTI

IATROGENIC, intoxication

  • alcohol
  • Anticholinergics, benzodiazepines

Endocrine/metabolic

  • hypothyroidism
  • glucose
  • organ failure
  • electrolyte
  • b12/folate

Neurological

  • SOL
  • TBI
21
Q

Limits of MMSE?

A 
Does not distinguish DDD
Language/cultural 
Education level 
Doesn't test all cognitive - executive 
Sensory and motor deficits - tremor, arthritis, visual impairment
22
Q

What tests after MMSE?

A

RUDAS
CLOCK DRAWING
FAB
GDS

23
Q

What is Memantine?

A

NMDA RECEPTOR ANTAGONIST.
For moderate to severe AD.
Benefit greatest with cholinesterase inhibitor but is not PBS when coupled.

24
Q

Management of VD?

A

Reduce vascular risks, diabetes smoking

25
Q

LBD MANAGEMEBT?

A

ACI

LEVODOPA

26
Q

What are risks to caregivers?

A

More like to report to gp

Be hospitalized

27
Q

What are the precautions of donepezil? Or side effects?

A

Anorexia, wt loss
GI effects
Vagotonic effect - causing bradycardia and/or heart block.
Also severe depression (mohda), treat depression first then donepezil

GP/GERIS (9 decks)

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