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Psychiatry > Dementia > Flashcards

Dementia Flashcards

1
Q

Definition: Alzheimer’s Disease

A
  • Most common cause dementia
  • Progressive degeneration of cerebral cortex
  • Starts at least decade before symptoms
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2
Q

Risk factors: Alzheimer’s Disease

A
  • Genetic (esp early onset)
  • Female
  • Ageing
  • Caucasian
  • Vascular disease
  • Head injury
  • Smoking and alcohol
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3
Q

Epidemiology: Alzheimer’s Disease

A

5.4% of UK pop >65yrs

Familial autosomal dominant form v. rare

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4
Q

Features: Alzheimer’s Disease

A

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
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5
Q

Invesitgations: Alzheimer’s Disease

A

Rule out organic cause

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6
Q

Management: Alzheimer’s Disease

A

GENERAL

  • Cognitive group sessions
  • Memory enhancement strategies
  • CBT for depresison & anxiety
  • Other relaxing techniques

MEDICAL

  1. MILD-MODERATE: acetylcolinesterase inhibitor
    - e.g. donepezil, galantaine, rivastigmine
    - SE: peptic ulcers, GI upset, insomnia, liver dysfunction
  2. SEVERE: NMDA R blocker
    - e.g. MEMANTINE
    - Only prescribed by specialists
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7
Q

Definition: Vascular Dementia

A

Group of syndromes causing cognitive impairment due to cerebrovascular event

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8
Q

Epidemiology: Vascular Dementia

A

Male+
2nd most common
17% of dementia
Life expectancy < 5-6yrs

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9
Q

Risk Factors: Vascular Dementia

A

FHx stroke/CVD/TIA

AF
HTN
DM
CHD
Obesity
Smoking
Hyperlipidaemia
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10
Q

Clinical Features: Vascular Dementia

A
  • 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
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11
Q

Investigations: Vascular Dementia

A

Routine dementia screening

-ECG, CXR, CT & MRI

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12
Q

Management: Vascular Dementia

A
  • Treat causative disease
  • Daily aspirin
  • Control HTN
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13
Q

Definition: Lewy Body Dementia

A

Dementia characterised by eosinophilic intracytoplasmic neuronal inclusion bodies in brainstema nd neocortex
-can overlap with PD

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14
Q

Epidemiology: Lewy Body Dementia

A

Age 50-83 yrs

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15
Q

Clinical Features: Lewy Body Dementia

A

Dementia (sparing STM)
Fluctuating levels of awareness
Auditory & visul hallucinations

Sleep disorder

  • nocturnal cramps
  • restless leg syndrome
  • REM disorder

Parkinsonism

  • Rigidity/tremors
  • Frequent falls
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16
Q

Investigations: Lewy Body Dementia

A

Dementia screen
CT/MRI (relative sparing medial temporal lobe)
MIBG scintography to differentiate between LBD and PD

17
Q

Management: Lewy Body Dementia

A

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

18
Q

Definition: Frontotemporal Dementia

A

Dementia w/ atrophy of Frontotemporal lobes - rather than diffuse as seen in AzD

19
Q

Clinical Features: Frontotemporal Dementia

A

Inappropriate social conduct behaviour
Perseverative behaviours (e.g. drinking form empty cup)
Concrete thinking (difficulty changing topic)
Impaired insight
Dietary changes

MORE RAPID ONSET

20
Q

Investigations: Frontotemporal Dementia

A

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)
21
Q

Management: Frontotemporal Dementia

A

SSRIs to help with depression

AChEi unlikely to help

Psychiatry (12 decks)

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