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Geriatrics > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia?

A

An acquired impairment of higher mental functioning (intellect, memory personality) occurring in an alert patient. Usu progressive, very few cases are reversible.

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2
Q

Main features of dementia?

A
  • Development of multiple cognitive deficits
  • Condition sufficiently severe to cause impairment in function
  • Chronic, progressive
  • Cannot be diagnosed during delirium or depression
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3
Q

What are examples of the cognitive deficits of dementia?

A

Short term memory + one or more of:

  • Aphasia (language disturbance)
  • Apraxia
  • Agnosia (object recognition)
  • Executive function
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4
Q

Population diagnosed with dementia?

A

~8%

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5
Q

How does the prevalence and incidence of dementia change with ageing?

A

Prevalence and incidence double every 5 years after 60y. 20% over the age of 80 have dementia.

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6
Q

What conditions can resemble dementia?

A
  1. Normal changes with ageing
  2. MCI
  3. Delirium
  4. Depression
  5. Mild-mod intellectual disability
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7
Q

How does memory change in the elderly?

A

Normal decline in speed of processing, some decrease in recent memory.
Ax: stress, Rx, mood, pain, bereavement

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8
Q

What is MCI?

A

Memory and other cognitive complaints noted subjectively and objectively without apparent impact on general function.

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9
Q

What is the progression for individuals presenting with amnestic MCI?

A

Of pts p/w with prominent memory loss , over 50% will develop dementia in 5y

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10
Q

What are the common causes of dementia?

A

-Alzheimer’s (50-70%)
-Vascular (10-20%)
-Frontal lobe
-Lewy Body
=90% dementias

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11
Q

What are less common causes of dementia?

A
  • Alcohol related
  • Huntington’s
  • Hydrocephalus
  • Hypothyroidism
  • B12 deficiency
  • Neurosyphilis
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12
Q

What are the major proven RFx for AD?

A
  • Age
  • Down syndrome
  • Genetic predisposition (APOE)
  • Ethinicity
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13
Q

Which gene is associated with AD?

A

APO E4

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14
Q

What are the other RFx for AD?

A
  • HTN
  • DM
  • Hyperlipidemia
  • Smoking
  • Obesity
  • Significant head injury
  • Nutritional (on top of vascular RF modification effect): ?fish, ?mediterranena diet ?fruti and vegie
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15
Q

What are AD protective factors?

A
  • Education
  • Physical activity
  • Social engagement
  • Cognitive activity
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16
Q

Time course of AD?

A

Insidiously progressive

  • gradual onset
  • steady worsening
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17
Q

Main features affected AD?

A
  • New learning (amnestic features)
  • Praxis
  • Language
18
Q

Neuro exam AD?

A

Normal until late stages

19
Q

Structural imaging AD?

A

Often normal;

-may have some degree of atrophy esp hippocampus and adjacent

20
Q

What pharm can be used in AD?

A

Cholinesterase inhibitors e.g. donepezil, galantamine, rivastigmine

21
Q

Success of AD pharm Rx?

A

Benefits modest, 30-60% show clinical benefit.

Aim to delay progress and improve function.

22
Q

Major features of vascular dementia?

A
  • focal neuro signs
  • attention, exec fun affected
  • insight preserved
  • radiol shows infarction
  • Sudden onset, stepwise progression
  • Overactive bladder and disturbance of gait common early signs
23
Q

What affects VD presentation?

A

Location of lesions i.e. subcortical changes produce executive function changes often a/w gait disturbance and incontinence

24
Q

How does fronto temporal dementia present?

A
  • Early: behavioural changes
  • Executive dysfunction
  • Language disturbance (poor verbal fluency)
25
Q

Why are cognitive assessments different in frontotemporal dementia?

A

New learning is preserved until later so MMSE etc may be normal as no frontal functions tested

26
Q

Imaging in fronto temporal dementia?

A
  • FT brain atrophy

- Functional: decreased frontal perfusion

27
Q

What characterises Lewy body dementia?

A
  • fluctuating attention and concentration
  • detailed visual hallucinations
  • parkinsonism within 1y of cognitive onset
28
Q

What should be covered in dementia clinical assessment?

A
  • General medical (inc RFx and CV assessment)
  • Neuro Hx and PEx
  • Meds (esp anticholinergics, sedatives)
  • FHx, esp in those with younger onset dementias
  • Neuropsychiatric Hx inc behavioural disturbances
  • A careful description of onset and progression of disease. (Supplemented by carer or informant)
  • Functional status inc driving, at home safety, medications
  • legal: ACP, EPOA, finances
29
Q

Disadvantages MMSE?

A
  • lack of testing of executive function (i.e. frontal lobe)
  • education, language and cultural bias
  • high ceiling effect
  • requires copyright
30
Q

What are the Ix of dementia workup?

A

-FBE/LFT/UEC/ESR
-CMP
-TFTs
-B12 / folate
-MRI/PET
Other as required e.g. syphilis, EEG, UA.

31
Q

Referrals in new dementia diagnosis?

A
  • ACAS

- Alzheimer’s Australia (for carers and families)

32
Q

Which areas are affected by AD?

A
  • Temporoparitetal CORTICAL areas

- Hippocampal and mesial temporal areas

33
Q

AD average survival?

A

8-10y

34
Q

Why are people with Down Syndrome at risk of AD?

A

Amyloid Precursor Protein gene on Chr21 (therefore get 3x copies)

35
Q

Pathophysiology of AD?

A
  • Neuritic Plaques
  • Neurofibrillary Tangles
  • Neurotransmitter defects (lost 90% ACh in adv AD)
36
Q

What are neuritic plaques?

A

Form outside neurons; spherical bodies composed of Beta amyloid

37
Q

What are neurofibrillary tangles?

A

Form inside neurons from hyperphosphorylated tau

38
Q

Pathophysiology of Lewy Body Dementia?

A
  • Loss of cholinergic function: cognitive issues
  • Loss of dopiminergic function: parkinsonism
  • Lewy Bodies: proteinaceous (alpha-synuclein) cytoplasmic inclusions(stain for ubiquitin)- in the brainstem, subcortex and cortex. Sparing of medial temporal lobes.
  • Has amyloid protein, but much fewer neurofibrillary tangles
39
Q

What other conditions are a/w FT dementia?

A
  • MND
  • Corticobasal degeneration
  • Progressive supranuclear palsy
40
Q

What is the aim of CTB in dementia work up?

A
  • Exclude mass lesions
  • Subdural haematomas
  • NPH
  • Large vascular lesions
41
Q

What is the mainstay of dementia Mx?

A

Non drug Rx i.e. planning, risk modification, education.

42
Q

What are the risks that should be addressed in dementia management?

A

-Medication compliance
-Adequate nutrition
-Home modifications- change stove/ car keys etc
Identity cards/ bracelets
-Driving assessment
-Awareness of abuse/ neglect

Geriatrics (15 decks)

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