Dementia Flashcards
How prevalent is Dementia?
> 85 y/o - 1 in 5
75 y/o - 1 in 10
65 y/o - 1 in 20
More than half have Alzheimer’s disease
What are some of the common types of Dementia?
Alzheimer’s disease - Global + progressive
Vascular - Patchy
Lewy body - Parkinsonian
Creutzfeldt-Jakob disease (Prion disease)
Fronto-temporal dementia (Pick’s disease)
AIDS dementia
What are some of the reversible types of Dementia?
Chronic alcohol abuse
Deficiencies eg B12, Thiamine, T4
Infection eg Syphillis
Neoplastic - Frontal lobe tumours
What are some of the risk factors for Dementia?
Genetic - Apolipoprotein E (APOE)
Vascular
Psychsocial - Nutritional (Diet high in sat fats + Cholesterol), Lower education, Poor social network/Lack of social engagement
What is the vascular hypothesis for Dementia?
Smoking Alcohol Being overweight High total cholesterol DM Cardiovascular/Cerebrovascular disease
What are some of the protective factors for Dementia?
Diet - Antioxidants eg Vit E + C, fish, veg, fruit, poly unsaturated fats
Physical activity
Mental activity eg reading, socialising
More complex work - high level of complex mental activity across lifespan correlated with reduced hippocampal atrophy
What is the pathophysiology of Vascular dementia?
Arteriosclerosis of blood vessels Occlusive neuronal death Involves large + small blood vessels Emboli Vasculitis Haemorrhages
What are some of the features of Vascular dementia?
Memory + cognitive impairment
Emotional + behavioural disturbances
Uneven distribution of deficits
O/E - Plantar reflex extension, Unilateral limb UMN deficit - Focal neurological deficits*
What are the features of Lewy body dementia?
Visual hallucinations
Parkinsonism
Fluctuating memory + cognitive impairment
What is the pathophysiology of Lewy body dementia?
Lewy bodies (Protein) accumulate in the brain
Alpha synuclein + ubiquitin
Cerebral + Substantia Nigra
What other neurological disease are Lewy bodies present in?
Parkinson’s disease
What are the requirements to have a diagnosis of Dementia?
6 months or more of; Decline in cognitive function Decline in memory Preserved awareness of the environment Decline in emotional control/motivation or changes in social behaviour
How can you assess Dementia in a patient?
Speak to relatives/carers
Personal history + family history
Medical history + medications
Substance use history
Social history - living conditions, finances
Functional history - mobility, ADL, continence
MSE!
What investigations should be done in a patient with Dementia?
FBC TFTs B12 + folate U+Es LFTs CRP CT/MRI of brain EEG Syphilis serology HIV test Heavy metals testing *Dependent on history, may do CXR*
What is the Primary prevention for Dementia?
Vascular and lifestyle factors are modifiable
Focus on maintain an active and social lifestyle
Define Dementia
A group of neurodegenerative diseases that result in a progressive decline in global cognition with no impairment in consciousness
What is Pick’s dementia?
Fronto-temporal atrophy causing change in personality, loss of inhibition, progressive non fluent aphasia, somantic dementia (Loss of meaning)
Earlier onset than other dementias
What is the treatment for dementia?
Acetylcholinesterase inhibitors eg Rivistigmine, Donepezil, Galantamine
NMDA receptor antagonists eg Memantine
What is BPSD?
Behavioural psychiatric symptoms in dementia
Occurs in majority of dementia patients
Treat by keeping patients in a calm environment, engaging with them, having familiar surroundings/people. Try to avoid sedation, can use antipsychotic short term
