DEMENTIA Flashcards
What is dementia?
A syndrome associated with global deterioration of intellect, behaviour and personality, often with a focus of loss of memory.
What are the two most common causes of dementia?
Alzheimer’s disease
Vascular dementia
What is the prevalence of dementia in persons aged between 50 and 70?
1%
What is the prevalence of dementia in those ages 90?
50%
What is the earliest symptom of dementia?
Loss of episodic memory for recent events
Subsequent to loss of memory, what are the symptoms associated with dementia?
Abnormal behaviour - Loss of inhibition Loss of intellect Mood changes Difficulty coping with ordinary routines Disorientation in place, time and person Loss of self-care Double incontinence Paranoia
When taking a history of dementia, what must you always do?
Take a collateral history as patient often loses insight. The collateral history should be taken away from the patient as things such as personality change are hard to discuss in front of the patient.
What are the key things to determine when taking a history from someone with suspected dementia?
Rate of intellectual decline
Specificities of decline
Activities of daily living and social interaction
Nutritional status
Drug history
General health and relevant disorders (eg stroke)
Family history of dementia
What makes up your differential diagnosis for someone presenting with progressive loss of memory and intellect?
Primary neurodegenerative disease
Metabolic disorders: Hypothyroidism, Vit B12 and folate deficiency Mitochondrial cytopathies Wilson's disease
Infection:
HIV
Prion - Creutzfeldt-Jakob disease
Syphilis
Vasculitis
Space occupying lesions
Pseudodementia (depression)
Normal pressure hydrocephalus
What routine blood tests would you do to rule out potentially treatable causes of dementia?
Thyroid function tests
Vit B12 and folate levels
WCC indicating infection
Blood cultures:
Syphilis
What specific blood tests might you perform to rule out potentially treatable causes of dementia?
Caeruplasmin - Wilson’s disease
HIV - AIDS dementia
Autoantibodies - Vasculitis and inflammatory diseases
What would CT or MRI rule out as a treatable cause of dementia?
Space-occupying lesions
Normal pressure hydrocephalus
You would also see the widespread cortical atrophy
What is normal pressure hydrocephalus?
A type of brain malfunction caused by decreased absorption of cerebrospinal fluid (CSF). Its typical symptoms are gait disturbance, urinary incontinence, and dementia or mental decline.
How is normal pressure hydrocephalus diagnosed?
CT or MRI - Enlarged ventricles without cortical atrophy
Lumbar puncture with removal of 50ml gives some symptomatic relief.
What is the most common EEG change in a dementia patient?
Widespread delta waves
What investigations should be performed if symptoms of dementia are suggestive of mitochondrial disease?
Muscle biopsy