Dementia Flashcards
Where is Vascular Dementia affects?
Depends on where the insult is.
Can Affects
Gait
Dysarthria, dysphagia
Incontience
Alzheimer’s Treatment?
Symptomatic treatment:
Hallucinations
Brady Cardia
Most common dementia in Australia?
Second most common?
Alzheimer’s
Vascular Disease
Common causes of Dementia?
Alzheimer’s
Vascular
Parkinson’s, Lewy Body
Why get collateral?
Confirm function/previous levels
Ask if it’s sudden
Most common risk factors for dementia?
Age
Education level
Genetics (more for younger onset dementias)
CVD risk factors: DMII, HTN, Obesity
Depression
3 Frontal lobe sections
Inferior: inhibitory
Anterolateral: planning, organization
Interhemispheric fissure: motivator.
What bloods to look for in Dementia?
B12, Renal, UEC, Na+,
Glucose - not well controlled
Heart failure meds taking etc?
TSH
Protective factors for Dementia
Physical activity
Social and cognitive engagement
Education level
Main difference with Delirium?
pathological
Impairment of consciousness (can be subtle)
Hard to pay attention: fluctuating
How to test attention?
Count backwards from 20. Ppl with dementia can do it usually
Dementia, big 3 things to look out for?
Cognitive Impairment
Change in previous level
Functional decline
Do you need memory impairment to have dementia?
Nope
Big feature in Alzheimer’s but not necessary for other dementias
Causes of delirium
Infections
Withdrawal
Alzheimer’s Dx?
2 years between initial symptoms and Dx
Investigations for Dementia?
MMSE
Neurological examination
CT head - prev. Strokes, atrophy
Bloods -
what can Masquerading dementia?
Depression
Language
Educational attainment
Sensory impairement: vision/hearing
MMSE scores cut offs?
28 normal
Cognitive function def’n?
Remembering
Language
Praxis
Internal function of organism to allow it to interface with the environment
Who gets MCI?
Depressed
INtellectual disability
small TIA
Aged 60-90, how does dementia risk change?
Doubles every 5 years
Drugs that can cause dementia?
Anticholinergics
L-dopa
Steroids
DDX for dementia?
Delirium
Depression
DRUGS -
Focal symptoms like speech etc. causes?
Focal Lesions:
Stroke
Head injury
Alzheimer’s NEurological assessment findings?
Quite normal gait, reflexes, tone.
Alzheimer’s Starts where in brain?
How does it present?
Medial hippocampus to the temporal parietal
Memory loss: clues and prompting doesn’t help
Language: word finding
Praxis: coordinating, copying diagram. Dressing apraxia.
Lewy Body Dementia features? 3 important.
Visual and auditory Hallucinations
Parkinsonian Features
Marked Fluctuation - can lose attention.
Other less common dementias?
Alcoholic
FroNto-temporal
Lewy Body
Parkinson’
What drug helps with lewy-body dementia?
Cholinesterase inhibitors
How to differentiate Lewy Body Dementia and delirium?
Chronicity
What does cognitive impairment 4 areas
- memory
- Apraxis
- agnosia
- executive function
Does MMSE examine frontal lobe?
Nope
Mild cognitive impairment (MCI) is?
Between normal
MCI (12-15%)
dementia (8%)
Delirium features?
Often reversible Consciousness - fluctuating alertness Sudden onset Attention: count backwards from 20 Hallucinations
Vascular dementia?
Sudden
Deteriorate step wise
Infarction on imaging
Vascular Dementia presentation?
Stepwise decline with each insult, could be nebulous
CVD risk factors
Difference in MCI?
Still functioning well
But decrease cognition
Onset of dementias?
Acquired Insidious Chronic progressive Generally age related Change from PREVIOUS level. Impact on FUNCTION Collateral
