Dementia Flashcards
What are 5 conditions that may resemble dementia?
Normal cognitive changes with age; Mild Cognitive Impairment; Delirium; Depression; Intellectual disability.
What are 4 things to look for when diagnosing dementia?
A decline in ability/change from baseline; No ongoing delirium or depression; impairment severe enough to affect function; slow deterioration over months to years.
What is the prevalence of dementia in the population? What is the prevalence in people over 80 years old?
8% overall. 20% for over 80yo.
What is the difference between Mild Cognitive Impairment and Dementia? What is the link - does MCI always progress to dementia?
MCI does not impact on function (eg. still independent in ADLs).
No, but if memory loss is dominant then 50% develop Alzheimer’s in 5 years.
What are 4 most common forms/causes of dementia?
Alzheimer’s disease; Vascular dementia; Frontal lobe dementia; Lewy body dementia.
What is the most common form of dementia - what % of cases? What 3 deficits are most common and what is usually affected first?
Alzheimer’s disease - 50-70% of cases. Memory (first), language and visuospatial/praxis.
What kind of memory function is usually affected in Alzheimer’s disease? Episodic or semantic? Short or long term? Forming or retriving? What part of the brain is affected first.
Primarily episodic, short term memory and problems forming new memory. Hippocampus first - where new memory links are made.
What are 2 pathological hallmarks of Alzheimer’s disease? What drug class may be benefical in treatment? What % may benefit and what kind of side effects are common?
Amlyoid plaques and neurofibrillary tangles. Cholinesterase inhibitors (eg. donepezil) may delay decline - only in 30-60% of patients. GIT side effects common (N/V diarrhoea).
What are 6 advantages of an early recognition of dementia?
Educate/counsel patients & families; start community support; address other medical issues; plan lifestyle/legal issues; start treatment; minimise risk factors.
What are 2 screening tools used in dementia? What are their relative merits? What scores suggest impairment?
MMSE - easy to use,
Are neuroimaging and a neuropsych evaluation necessary when assessing a possible dementia?
Not essential. Imaging may be useful to exclude other pathology. Neuropsych if unsure.
Describe the pathophysiology of vascular dementia. What class of risk factors are significant?
Large stroke or stroke in key area or multiple small vessel occlusions (esp in white matter). Vascular risk factors.
What are some features of subcortical dysfunction from vascular impairment?
Impaired attention/concentration; difficulty initiating or stopping a thought/action; slowed processing. Motor: shuffling gait; bradykinesia. Slow slurred speech.
What is the classic triad of features seen in normal pressure hydrocephalus?
Gait disturbance, incontinence and cognitive impairment.
What is the difference in memory impairment seen in vascular dementia compared to Alzheimer’s disease?
Vascular - can create memories, but information coming in is poor &slowly processed. Big thing is difficulty to retrieve, but prompting helps.
ADs - can’t form new and prompting won’t help as memory never formed.
Are consciousness and attention usually preserved in dementia?
Yes, perhaps only affected in late stages. Consider delirium first.
What are 3 features that may be affected in fronto-temporal dementias? What tests may be useful and what common test may yield a normal result?
Behavioural changes, executive dysfunction and language disturbance. Neuroimaging (structural and functional changes) useful. MMSE doesn’t test frontal - may seem normal.
What are 2 epidemiological features of frontotemporal dementia compared to other dementia types?
Earlier age than others - 45 to 65. Stronger genetic component - 50% of patients have 1st degree relative with dementia.
What is the difference between Parkinson’s dementia and Lewy Body dementia? How much more likely is a person with Parkinson’s disease to develop dementia?
Same features, but called Parkinson’s if it develops >12 months after features of Parkinson’s disease. All on a spectrum.
6 times more likely to develop dementia than without disease.
What are the features of Lewy body dementia?
Fluctuating cognitive ability/impaired attention - executive dysfunction; visuospatial difficulty; visual hallucinations. Not really memory.
What drugs are people on the Parksinson’s disease dementia spectrum sensitive to?
Antipsychotics like haloperidol and risperidone - bad side effects.
What are 10 required screening investigations in assessing dementia? (listed in guide book)
FBE, ESR, electrolytes, renal & liver function, calcium, thyroid, B12, folate, structural brain imaging.
What diagnoses are suggested by: hallucinations and fluctuations? behavioural changes and with surgery?
Hallucinations/fluctuations: Lewy body dementia and delirium.
Behaviour and surgery: frontotemporal, vascular dementia.
What diagnoses are suggested by: abrupt onset? Gait disorders?
Abrupt: delirium, vascular dementia.
Gait: Vascular, Parkinson’s, normal pressure hydrocephalus.
What are 3 risk factors for Alzheimer’s disease? What are some other risk factors for dementia? What are 3 possible protective factors against dementia?
Age, down syndrome, genetic predisposition (Apo E4 - especially if homozygous). Vascular RF: BP, diabetes, smoking, obesity.
Protective: education, physical activity, social engagement, cognitive activity.
What does BPSD stand for? What does it encompass?
Behavioural & Psychological Symptoms of Dementia. Non-cognitive symptoms associated with dementia - psychosis, delusions, depression, agitation, disinhibition.
What are 4 things to remember when first diagnosing BPSD.
Assess for delirium and causes; review medications; review environmental factors; consider psychiatric diagnosis.
