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Psych + gero -3-K > Dementia > Flashcards

Dementia Flashcards

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1
Q

What could be confused for dementia,

A

Depression- may also cause personality change, memory disturbance & intellectual decline.

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2
Q

What should be excluded?!

A

Delirium

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3
Q

Define delirium

A

Acute confusional state caused by infection, drug intoxication/ or withdrawal, metabolic disturbance or systemic illness.
Cause of altered cerebral function.

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4
Q

How many people are affected by dementia?

A

5-10% over the age of 65, 20% over 80s.

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5
Q

What makes up dementia?

A

Alzheimers disease
Vascular dementia
Dementia woth Lewy bodies

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6
Q

Whats Alzheimers?

A 
⬆️ with age
B- amyloid peptide plaques accumulation in around neurons wth neurofibrillaty tangles in cerebral cortex. 
Rare under 50
20% in those over 85
10-15% familial

65% of dementias

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7
Q

What are the main featurs of alzheimers?

A

Earliest: memory loss,
Dominenst: progressive loss of ability to retain and recall new info.

Apathy: may appear depressed.
Advanced disease: dysphasia, apraxia, (diff using tools and implements. Visuospatial difficulties often develop.

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8
Q

What is Vascular dementia?

A

May occur in isolation, may coexist with alzheimers
(Mixed dementia)
In pts with signfcnt vascular RFs.
(20% of dementias)
Stepwise deterioration in cognitive function
Neuropsychological assesment- reveals patchy cognitive impairment.
Hx of stroke, O/E, cerbral imaging.

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9
Q

Define demetia with Lewy bodies

A

Characterised by Lewy bodies( aggregates of protein within nerve cells) in cerebrum.
Overlap with PD, cz pts experiencing parkinsonian motor features.

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10
Q

What can Lewy bodies dementia be mimicked with?

A

Delirium
Cz the main feature is fluctuating cognitive impairment with visual hallucinations.
10% of dementias
3d commonest cause of dementia.

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11
Q

Other causes of dementia

A 
Huntingtons disease
Wilsons disease
1/3 of PD
Advanced MS
And may be a feature of HIV/AIDS
Long Hx of chronic alcohol abuse- alcohol related dementia.
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12
Q

Invx

A

🔶Largely clinical
Extensive invg not required, apart from exclusion.
Young or atypical presentation :
🔹Vit B12
🔸syphils
🔹thyroid function
🔸calcium & glucose
🔹Cerebral Imaging (CT or MRI) to exclude a space- occupying lesion or hydrocephalus, –> indicating cerebral atrophy in dementia. (Diagnostic? Maybe ischaemic changes in vascular dementia)
🔹Neuropsychology assesment to document the pattern of cognitive impairment.
EEG
Lumbarpuncture: evidence of raised intracranial pressure in inflammation, infx.

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13
Q

Mx of dementia

A

Largely supportive
Cholinestarease inhibitors - rivastigmine and galantamine, modestly deruce cognitive deterioration in Alzheimers D.
Tx of vascular RFs in vascular dementia reduces progssion.
Mostly, long term care required.

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14
Q

Whats huntigtons,

A

Progressive neurodegenerative disease inherited in an autosomal dominent fashion.(50%) of kid to get it. Present :30-50s

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15
Q

Wilsons

A

Rare autosomal recessive disorder of copper metabolism
Accumulation of Cu in liver, brain esp basal ganglia.
Cu deposits rings in cornea.

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16
Q

Define Dementia

A 
Aquired global ( impairamanet)neuroprogressive deterioration of intellect, behaviour & personality
Sufficient severity to interaupt ocupational & social function.
Often associated with deterioration in emotional control, social control & motivation.
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17
Q

Whats pre-senile dementia?

A

65Y

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18
Q

Degenerative Causes of dementia

A

Alzheimers,
Lewy body
Fronto-temporal dementia.

19
Q

Vascular causes of dementia & what percentage do they occupy?
& metabolic causes?

A

25%
Cerebrovascular disease
Cranial arteritis

Metabolic: uraemia, liver failure.

20
Q

Traumatic causes of dementia

& other.

A

Post-head injury
Punch-drunk (boxers)

Other: 
Alcohol/drug abuse
Vit B12 & thiamine deficiency
Subdural haemoatoma
Cardiac arrest
Resp failure, CO poisoning, encephalitis e.g. Werinckes in cirrhosis.. (Thats why liver F)
CJD, HIV/AIDS, syphillis, hypothyroidism (T4 levels) 
Hypocalcaemia, 
Huntingtons, PD.
21
Q

Signs & symptoms of Alzheimers

A

No stx Hx. AD- impaired abilit to learn or recall new info, ⬇️ language funtion, diff w/ names & understanding whats being said.–> nominal & comprehensive dysphasia
Agnosia- F to recognise objects.
Dysbraxia
Behavioural changes- aggression, wandering,agitation, delusions, impairment at planning.

22
Q

What are the SS of vascular dementia?

A

Multi- infractions usually. Distinguish from Hx from Alzheimers, CFs & cause. Hx of TIA w/ brief impairment of consciousness, pareses, visual loss.
Dementia may follow succession of acute CV events, or single major stroke.
Vawcular occlusions = Vascular dementia.m

23
Q

SS of Lewy bodies

A

Neuronal, inclusion bodies (markers of neural loss)
Similar to delerium (acute deterioration of mental state usually underlined by physical illness)
Confusion, tension, hallucinations.
Falls: common symptom.

24
Q

How do you diagnose dementia?

A

Based on Hx & examination
Esp cognitive testing- Mini Mental State test.
Can be confirmed by psychometric testing.
Hx must also be taken from someone that has known the patient for a long time.

25
Q

What could be a differential diagnosis to dementia?

A 
Pseudo-dementia
(Depressive disorder, prev Hx of depression for FHx of mood disorder) 
Anxiety disorders (GAD, phobias, stess) 
Mania
Depression
26
Q

How would you investigate Dementia?

A 
Exclude 2o causes:
FBC- anaemic? 
ESR/CRP, 
U&Es, baseline, renal F? 
Glucose- hypoglycaemic? Confused? 
LFTs-- cirrhosis? Werinkes encephalopathy.
Serum Ca
Vit B12
Folate
TFTs (T4 levels) 
Syphillis serology
HIV antibodies. 
Radiology: CXR, CT/MRI to confirm cortical atrophy & exclude tumours etc. 
EEG- Lewy bodies identified.
27
Q

How would you treat dementia?

A 
DONEPEZIL
 ACh-ase Inhibitor
NICE/ mild- moderate Alzheimers. 
NSAIDs & HRT are prebpventative of developing Alzheimers.
Treat reversible cause. 
GPs especially- care management  plan.
Neuropsych referral.
28
Q

What happens in delirium?

A

Toxic confusional state
Acute or subacute condition
1. Impaired of consciousness 4. FLUCTUATES
2. Abn in perception + 3. Mood

Conf 🌙✨ Worse at night.
-/+ hallucinations, delusions, restelness + aggression.
Infx + drugs Commonest

29
Q

What are some causes of delirium?

A

Systemic infection
Drugs
Drug/alcohol withdrawal
Metabolic disturbance - Hepatic failure, renal F, Electrolyte imbalance, hypoxia, Hypoglycaemia, Vitamin B12 + B1( Weeinkes-Korsakoff syndrome)

Brain damage- tumours, trauma, SAH, abscess,

30
Q

What drugs can cause delirium?

A

TCA
Benzodiazepines
Opiates
Anticonvulsants

31
Q

How do we treat delirium?

A 
Invx + tx of underlying disease.
1. Withdraw drugs possible
2. Rehydrate
3. Pain relief
4. Sedation if aggressive or for management
Quiet area.

Benzos usually given.
Severe delirium though: haloperidol 2.5mg -5mg IM.

32
Q

Is consciousness affected in Dementia?

Who is affectd?

A

No

10% 80s

33
Q

What are the clinical features of Alzheimers?

A 
1o degenerative cerebral disease
CFs:
Steady progression over years
1. Short memory loss prominent
2. Slow disibtegration of personality and intelelct
34
Q

Whats dementia?

A

Progressive decline of cognitive function ie loss of mind,

Cerebral cortex, all or patches.

35
Q

Patho features of Alzheimers?

A
  1. Neuronal reduction in several areas
  2. Neurofibrillary tangles
  3. Argentophile plaques–> amyloid-b + granulovacuolar bodies
36
Q

Investigations of Alzheimers?

A

Simple mental state assesment: abbreviated Hodgkinsons one (10)
Age, time, year, address recall, place, recognition of 2 ppl(dr, nurse)
DOB, 1st world war, name of present president, count backwards 20

Healthy >8
Exclude other causes of dementia ie vascular, Huntingtons, lewy bodies
Bloods: LFTs (HepF), TFTs(hypo), FBC, vitB12, folate.
Imaging: CT in young presenile.

37
Q

Mx of Alzheimers?

A

Anxiety + depression need tx.

  1. Impaired cortical cholinergic fx due to reduced cerebral production of choline acetyl transferase +
  2. ⬇️ in acetylcholine synthesis.

Acetyl cholinesterase inhibitors ⬆️ cholinergic submission by inhibitting cholinesterase at the synaptic cleft.
Modest benefit
1. Intellectual deterioration is slower in MILD-MODERATE
2. Community managed ! Home care, day care, –> eventually care home

38
Q

What are some examples of Acetyl cholinesterase inhibitors?

A

Donepezil

Rivastigmine

Galantamine

39
Q

Prognosis of dementia?

A

8-10years

40
Q

What happens in vascular D?

A

Multi infract.
Stepwise deterioration with declines followed by periods of stability.
Hx of TIAs, stroke, HTN, CVs rfs, smoker?

41
Q

What should not be used in Lewy body dementia?

A

Neuroepileptic drugs

42
Q

What characterises Lewy body dementia?

A

Fluctuating cognition + pronounced variation in attention + alertness .
⭐️ prominent or persistent memory loss may NOT happen at the early stages.

Prominent: impairment in attention, visuospacial ability,
Visual hallucinations : strange faces, frightening creatures Common
⭐️Parkinsonism: slowing, rigidity w/ repeated falls.

Delusions + transient loss of consciousness occur.
Autopsy: cortical Lewy bodies

Could be confused with delirium.

43
Q

Some causes of Dementia

A

Alzh
Vasc D
Xs alcohol- Werinkes -Korsakoff syndrome- Vit B1
Hypothyroidism
Intracranial mass: subdural haematoma, hydrocephalus
Chronic traumatic encephalopathy: punch drunkeness
Syphillis
Huntingtons
Creutzfeld-Jakob disease
Late Parkinsons

Psych + gero -3-K (14 decks)

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