Dementia Flashcards
How is Alzheimer’s diagnosis defined? What are the main features?
- Objective (MMSE etc.) memory defect AND another cognitive deficit e.g. aphasia (word-finding difficulties, agrammatism, phonemic and semantic paraphasias, neologisms), agnosia, apraxia, executive dysfunction
- These deficits result in ADL impairment
- Gradual onset and progressive, continuing decline
- From a previous higher level of function
- Features
- Multiple cognitive deficits
- Gradual onset, functional impairment, continuous decline
- Executive function disturbance
- Normal gait and posture
Describe the course of Alzheimer’s disease. What is the average life-expectancy?
- Memory > executive dysfunction > language, behaviour, personality impairment
- 12-15 year average life-expectancy
Which areas of the brain are predominantly affected in Alzheimer’s disease?
- Hippocampal neurons, then neocortical ones
What defines vascular dementia?
- Cognitive decline from higher previous level - memory impairment + one other cognitive domain
- CV disease defined by focal abnormalities on neuro exam AND imaging (CT/MRI)
- Inferred relationship between the first two (onset following recognised stroke, abrupt deterioration, fluctuating, stepwise progression)
What are the clinical features of vascular dementia?
- Early gait disturbance
- Hx of unsteadiness, frequent and unprovoked falls
- Early urinary symptoms
- Pseudobulbar palsy (diffuse UMN lesion - speech and swallowing difficulties)
- Personality/mood changes (lability, abulia)
How is Lewy-body dementia defined?
- Progressive, ADL-interfering cognitive decline
- 2 of: fluctuating cognition with pronounced variations, recurrent detailed visual hallucinations, spontaneous Parkinsonian features (LBs in the brainstem)
- Supportive - repeated falls, syncope, neuroleptic sensitivity, systematised delusions (infidelity, abandonment), hallucinations
What medications should be used which particular care in patients with Lewy body dementia?
- Antipsychotics - people with LBD are typically very sensitive to them
What are the common clinical features of fronto-temporal dementia?
- Early loss of personality and social awareness
- Speech and language disturbance
- Younger onset
- Disinhibition often prominent (frontal)
- Depression and anxiety common
- Progressive and semantic aphasia
- Mental rigidity/inflexibility
What are the cardianl features of normal-pressure hydrocephalus? What is the treatment?
- Ataxia (magnetic gait), cognitive disturbance, urinary incontinence
- Easily treated - CSF shunt (ventriculo-peritoneal)
What are some baseline tests you might consider or order in a person thought to have dementia?
- FBE, UEC, TSH, B12, folic acid, BGL, ESR
- CT/MRI
What are the broad managmenet principles for someone with dementia?
- Early diagnosis
- Rule out other causes
- Plan for future before cognitive impairment
- Advance care directive, POAs
- Relocation to a new house if required
- Easier access to healthcare services and support groups
- Memory clinic referral
- Care for the carer
- Lifestyle changes that may improve overall QOL
- Early drug treatments that may improve QOL and change course of disease
What are some pharmacological treatments for Alzheimer’s disease?
- ACh inhibitors - donepezil, rivastigmine, galantamine
- Anti-glutamate - memantine (late stage disease)
- Folic acid and vitamin B
- Consider antipsychotics (low-dose for agitation) and antidepressants
What pharmacological treatments are available for Lewy-body dementia? Frontotemporal dementia?
- LB dementia
- ACh inhibitors
- FTD
- SSRI
- Atypical antipsychotic
