Dementia Flashcards
what is the stages of memory processing
attention»_space; encoding»_space; storage»_space; retrieval
what are typical presenting complaints of memory problems
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
what are the types of amnesia
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
what Sx are needed for a diagnosis of dementia
forgetfulness memory loss confusion poor reasoning and logic personality changes poor judgement ability to focus visual perception
what is assessed in cognitive function
memory attention and concentration executive functioning visuospatial functioning language
what are the features of the MMSE
out of 30
cut off <24/30
what is dementia characterised by
global cognitive decline
what are the risk factors for vascular dementia
age > 60y/o obesity hypertension smoking Hx of stroke
what are Sx of vascular dementia
apathy disinhibition slowed processing of information poor attention retrieval memory deficit jaw-jerk (sign of frontal cognitive syndrome)
what test can help differentiate between vascular dementia and Alzheimers
Hachinskil Ischaemic Score (HIS)
what Tx is given in vascular dementia
anti-platelet + statin
Aspirin 75-300mg
Clopidogrel 75mg
Simvastatin 5-40mg
what neuropathology is seen in DLB
Lewy bodies = alpha-synuclein proteins within the cytoplasm of neurones
loss of dopamine in the substantial nigra
loss of acetylcholine producing neurones
what can DLB get confused with
dementia in Parkinson disease
how can you tell apart DLB and DPD
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
what are Sx of DLB
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
what Ix can be done for DLB
immunochemical staining for protein ubiquitin = shows formation of lewy bodies
what is Pick’s disease
type of frontotemporal dementia
onset usually between 50-60y/o
what is Pick’s disease characterised by
slowly progressing changes in character and social deterioration
impairment of intellect, memory and language
symptoms related to damage to frontal and temporal lobes
what is the pathology seen in Pick’s Disease
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)
Sx of Pick’s disease
personality and behavioural changes
speech and communication problems
changes in eating habits
reduced attention span
what are features that need to be seen for a diagnosis of alcohol related dementia
Memory impairment + 1 of:
- Apraxia
- Aphasia
- Agnosia
- Disturbance of executive function
- Functional impairment
what is the triad seen in thiamine deficiency
Confusion
Ataxi
Ophthalmoplegia (paralysis of muscles around or in the eye)
how is alcohol related dementia Tx
Thiamine
what is the most common cause of dementia
AD
what is the neuropathology of AD
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
what is EOFAD
early onset familial Alzhemier’s disease
Autosomal dominant
patients present before 65
what are the mutations seen in EOFAD
APP mutations (Chromosome 21) Presenilin 1 (Chromosome 14) Presenilin 2 (Chromosome 1)
what are risk factors for AD
Down’s syndrome (or FH of Down’s Syndrome)
Previous head injury
Hypothyroidism
Parkinson’s disease
how can the progression of Sx in AD be described
Stage 1
Stage 2
Stage 3
what are stage 1 Sx of AD
amnesia
spatial disorientation
what are stage 2 Sx of AD
personality disintegration e.g. with aggression,
psychosis
agitation
depression
focal parietal signs e.g dysphasia, apraxia, agnosia, acalculia
parkinsonism
what are stage 3 Sx of AD
apathy wasting immobility incontinence seizures spasticity
what Ix are done in AD
MMSE
what is the 1st line Tx for AD
Cholinesterase inhibitors i.e. Donepezil, Rivastigmine, Galantamine
what are S.E for Cholinesterase inhibitors
GI upset (which settles after few weeks) tiredness headache sleep disturbance bradycardia
what is 2nd line Tx for AD
Memantine 5mg each morning
what are S.E for memantine
confusion headache hallucinations, tiredness, vomiting, anxiety, hypertonia, cystitis, increase libido
