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Psychiatry SB > Dementia > Flashcards

Dementia Flashcards

1
Q

what is the stages of memory processing

A

attention&raquo_space; encoding&raquo_space; storage&raquo_space; retrieval

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2
Q

what are typical presenting complaints of memory problems

A 
Forgetting a message 
Losing track of a conversation 
Forgetting to do things 
Inability to navigate in familiar places
Increased misplacing of things 
Struggling to remember names
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3
Q

what are the types of amnesia

A

anterograde - difficulty in acquiring new material and remembering events since the onset of the illness or injury.

retrograde - difficulty in remembering information prior to the onset of the illness or injury

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4
Q

what Sx are needed for a diagnosis of dementia

A 
forgetfulness
memory loss
confusion
poor reasoning and logic
personality changes
poor judgement
ability to focus
visual perception
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5
Q

what is assessed in cognitive function

A 
memory 
attention and concentration
executive functioning 
visuospatial functioning 
language
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6
Q

what are the features of the MMSE

A

out of 30

cut off <24/30

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7
Q

what is dementia characterised by

A

global cognitive decline

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8
Q

what are the risk factors for vascular dementia

A 
age > 60y/o
obesity
hypertension
smoking
Hx of stroke
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9
Q

what are Sx of vascular dementia

A 
apathy
disinhibition 
slowed processing of information 
poor attention
retrieval memory deficit 
jaw-jerk (sign of frontal cognitive syndrome)
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10
Q

what test can help differentiate between vascular dementia and Alzheimers

A

Hachinskil Ischaemic Score (HIS)

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11
Q

what Tx is given in vascular dementia

A

anti-platelet + statin

Aspirin 75-300mg
Clopidogrel 75mg
Simvastatin 5-40mg

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12
Q

what neuropathology is seen in DLB

A

Lewy bodies = alpha-synuclein proteins within the cytoplasm of neurones

loss of dopamine in the substantial nigra

loss of acetylcholine producing neurones

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13
Q

what can DLB get confused with

A

dementia in Parkinson disease

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14
Q

how can you tell apart DLB and DPD

A

in DLB = cognitive impairment occurs before or around same time as movement disorder

in DPD = movement disorder is present for a least a year prior to onset of cognitive impairment

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15
Q

what are Sx of DLB

A

cognitive impairment
defects in attention and executive function
fluctuations in mental state/consciousness

visual hallucinations
depression
extrapyramidal signs i.e. axial, postural instability, gait difficulties
REM sleep behaviour disorder

severe sensitivity to antipsychotic
repeated falls and syncope
unexplained LOC
tactile or auditory hallucinations
delusions
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16
Q

what Ix can be done for DLB

A

immunochemical staining for protein ubiquitin = shows formation of lewy bodies

17
Q

what is Pick’s disease

A

type of frontotemporal dementia

onset usually between 50-60y/o

18
Q

what is Pick’s disease characterised by

A

slowly progressing changes in character and social deterioration

impairment of intellect, memory and language

symptoms related to damage to frontal and temporal lobes

19
Q

what is the pathology seen in Pick’s Disease

A

extreme atrophy of cerebral cortex in frontal and temporal lobes

neuronal loss and astrocytosis

Pick’s cells (swollen neurones) and Pick’s bodies (intracytoplasmic filamentous inclusions)

20
Q

Sx of Pick’s disease

A

personality and behavioural changes
speech and communication problems
changes in eating habits
reduced attention span

21
Q

what are features that need to be seen for a diagnosis of alcohol related dementia

A

Memory impairment + 1 of:

  • Apraxia
  • Aphasia
  • Agnosia
  • Disturbance of executive function
  • Functional impairment
22
Q

what is the triad seen in thiamine deficiency

A

Confusion
Ataxi
Ophthalmoplegia (paralysis of muscles around or in the eye)

23
Q

how is alcohol related dementia Tx

A

Thiamine

24
Q

what is the most common cause of dementia

A

AD

25
Q

what is the neuropathology of AD

A

amyloid/senile plaques and neurofibrillary tangles (made of tau protein)

50% loss of neurones and synapses in the cortex and hippocampus

widening of sulci, narrowing of gyri

compensatory dilatation ventricles = secondary hydrocephalus

26
Q

what is EOFAD

A

early onset familial Alzhemier’s disease

Autosomal dominant
patients present before 65

27
Q

what are the mutations seen in EOFAD

A 
APP mutations (Chromosome 21)
Presenilin 1 (Chromosome 14)
Presenilin 2 (Chromosome 1)
28
Q

what are risk factors for AD

A

Down’s syndrome (or FH of Down’s Syndrome)
Previous head injury
Hypothyroidism
Parkinson’s disease

29
Q

how can the progression of Sx in AD be described

A

Stage 1
Stage 2
Stage 3

30
Q

what are stage 1 Sx of AD

A

amnesia

spatial disorientation

31
Q

what are stage 2 Sx of AD

A

personality disintegration e.g. with aggression,
psychosis
agitation
depression

focal parietal signs e.g dysphasia, apraxia, agnosia, acalculia

parkinsonism

32
Q

what are stage 3 Sx of AD

A 
apathy
wasting
immobility
incontinence
seizures 
spasticity
33
Q

what Ix are done in AD

A

MMSE

34
Q

what is the 1st line Tx for AD

A

Cholinesterase inhibitors i.e. Donepezil, Rivastigmine, Galantamine

35
Q

what are S.E for Cholinesterase inhibitors

A 
GI upset (which settles after few weeks)
tiredness
headache
sleep disturbance
bradycardia
36
Q

what is 2nd line Tx for AD

A

Memantine 5mg each morning

37
Q

what are S.E for memantine

A 
confusion
headache
hallucinations,
tiredness, 
vomiting, 
anxiety, 
hypertonia, 
cystitis, 
increase libido

Psychiatry SB (23 decks)

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