Dementia Flashcards
Definition: Alzheimer’s Disease
- Most common cause dementia
- Progressive degeneration of cerebral cortex
- Starts at least decade before symptoms
Risk factors: Alzheimer’s Disease
- Genetic (esp early onset)
- Female
- Ageing
- Caucasian
- Vascular disease
- Head injury
- Smoking and alcohol
Epidemiology: Alzheimer’s Disease
5.4% of UK pop >65yrs
Familial autosomal dominant form v. rare
Features: Alzheimer’s Disease
EARLY
- Family complaints
- Memory lapses
- Forgetting names of people and places
- Inability to remember recent events/appointments
MIDDLE
- Language problems
- Apraxia
- Sundowning - confusion more in evening
- Problems decision making/planning
LATE
- Wandering, disorientated
- Apathy
- Hallucinations/delusions
- Disinhibition. aggression, agitation
- Altered eating
- Incontinence
Invesitgations: Alzheimer’s Disease
Rule out organic cause
Management: Alzheimer’s Disease
GENERAL
- Cognitive group sessions
- Memory enhancement strategies
- CBT for depresison & anxiety
- Other relaxing techniques
MEDICAL
- MILD-MODERATE: acetylcolinesterase inhibitor
- e.g. donepezil, galantaine, rivastigmine
- SE: peptic ulcers, GI upset, insomnia, liver dysfunction - SEVERE: NMDA R blocker
- e.g. MEMANTINE
- Only prescribed by specialists
Definition: Vascular Dementia
Group of syndromes causing cognitive impairment due to cerebrovascular event
Epidemiology: Vascular Dementia
Male+
2nd most common
17% of dementia
Life expectancy < 5-6yrs
Risk Factors: Vascular Dementia
FHx stroke/CVD/TIA
AF HTN DM CHD Obesity Smoking Hyperlipidaemia
Clinical Features: Vascular Dementia
- Stepwise decline (particualrly after infection/fall)
- Emotional/personality changes often first followed by memory
Vascular symptoms
- visual disturbances, sensory + motor signs
- Extrapyrimidal signs
- Seizures
- Bladder symptoms
Investigations: Vascular Dementia
Routine dementia screening
-ECG, CXR, CT & MRI
Management: Vascular Dementia
- Treat causative disease
- Daily aspirin
- Control HTN
Definition: Lewy Body Dementia
Dementia characterised by eosinophilic intracytoplasmic neuronal inclusion bodies in brainstema nd neocortex
-can overlap with PD
Epidemiology: Lewy Body Dementia
Age 50-83 yrs
Clinical Features: Lewy Body Dementia
Dementia (sparing STM)
Fluctuating levels of awareness
Auditory & visul hallucinations
Sleep disorder
- nocturnal cramps
- restless leg syndrome
- REM disorder
Parkinsonism
- Rigidity/tremors
- Frequent falls
Investigations: Lewy Body Dementia
Dementia screen
CT/MRI (relative sparing medial temporal lobe)
MIBG scintography to differentiate between LBD and PD
Management: Lewy Body Dementia
NB
AVOID antipsychotics = severe sensitivity reactions in 50% e.g. irreversible PD, impairment of consciousness, neuroleptic malignant syndrome
AVOID anti-parkinsonian treatment = worsens psychosis
AChEi may be beneficial
Definition: Frontotemporal Dementia
Dementia w/ atrophy of Frontotemporal lobes - rather than diffuse as seen in AzD
Clinical Features: Frontotemporal Dementia
Inappropriate social conduct behaviour
Perseverative behaviours (e.g. drinking form empty cup)
Concrete thinking (difficulty changing topic)
Impaired insight
Dietary changes
MORE RAPID ONSET
Investigations: Frontotemporal Dementia
Frontal assessment battery
- Concepts (what way are bananas and oranges different)
- Lexical fluency (name objects beginning with s)
- Motor (fist, edge, palm)
- Conflict (tap twice when I tap once)
- GO NO GO
- Prehension behvaiour (do not take my hands)
Management: Frontotemporal Dementia
SSRIs to help with depression
AChEi unlikely to help
