Dementia Flashcards
Define dementia?
“severe impairment or loss of intellectual capacity and personality integration, due to the loss of or damage to neurons in the brain”
What are the diagnostic criteria for dementia?
- Evidence if impaired memory + 1 of the following:
- Language impairment
- Apraxia
- Agnosia
- Impairment of executive functioning - Impairment of functioning
- No other psychiatric or medical cause
- Duration > 6 months
Name the main types of dementia?
Alzheimers 62% Vascular 17% Mixed 10% Lewy Body 4% Frontotemporal 2%
What are the early, medium and late symptoms of dementia?
Early:
Short term memory loss
Repetition of questions
Difficulty embracing change
Medium term:
Difficulty with daily tasks
Needs prompting
Failure to recognise people
Late: Personality change (aggression) Incontinence Weight loss Decline in speech
Describe some features to help you differentiate between the different types of dementia?
Alzhiemer’s: slow development, most common
Vascular: Medium onset 6 months, or suddenly in the case of stroke, should be able to see a deficit on a head scan
Lewy Body: Parkinson’s features, visual hallucinations, fluctuating during the day.
Other features of LBD are: falls, syncope, increased sensitivity to antipsychotics and abnormalities in rem sleep behaviour
Fronto-temporal:
Insidious onset and gradual progression
Early decline in social interpersonal conduct
Early impairment in regulation of personal conduct
Early emotional blunting
Early loss of insight
What is the difference between delirium and dementia?
Delirium is an acute confusional state which is fluctuating and has an underlying organic cause.
Dementia is a chronic degenerative condition with no reversible organic cause.
What are the 4 key features of delirium and what is needed for a diagnosis?
- Acute onset and fluctuating time course
- Inattention (easily distracted)
- Disorganised thinking
- Altered level of consciousness
1, 2 and either 3 or 4 are needed for a diagnosis
What are the differentials which should be considered for dementia? (8)
Brain: SOL Sub dural haemorrhage Delirium Normal Pressure Hydrocephalus
Vitamin deficiency: Thiamine deficiency (vitamin B1) B6 deficiency (pellagra) B12 deficiency (cobalamin deficiency)
Hypothyroidism
Iatrogenic
Heavy Metal poisoning
Outline an investigation plan to exclude treatable causes of dementia?
Bedside: Urinalysis + send MSU
Bloods: FBC, U&E, LFT, CRP, TFTs, glucose, Ca2+ B12 and folate (red cell folate).
Head CT to rule out any SOL, haemorrhage, or normal pressure hydrocephalus (shows ventricular enlargement)
Describe the presentation of normal pressure hydrocephalus?
TRIAD
Dementia: with memory loss and inattention being prominent symptoms
Incontinence: usually urinary but may also be bowel
Gait disturbance: slow, broad based shuffling gait. May present as a fall.
Describe the non pharmacological management of dementia?
MDT approach
Should involve patient education at an early stage of the disease so that they can make decisions about there future care.
Cognitive stimulation programmes are thought to help slow progression of certain types of dementia.
Treatment should aim to be in the community; there should be good communication between secondary care team and carers.
If dementia is due to a vascular cause lifestyle measures such as smoking cessation, balanced diet and exercise should be encouraged.
Describe the pharmacological management of Alzheimer’s disease?
AChE inhibitors:
Donepezil
Galantamine
Rivistigamine
NMDA receptor antagonists:
Memantine
What are the indications for medication in dementia?
AChE inhibitor:
- Mild Alzheimers.
- Can also be considered for LBD
- Note: may worsen FTD
NMDA receptor antagonist:
- Mild to moderate alzheimer’s where AChE inhibitors cannot be used.
- Severe alzheimer’s
