Dementia Flashcards
What are the three differentials for cognitive impairment?
- dementia
- delirium
- depression (psuedodementia)
What is dementia? (definition) is it progressive? is it irreversable?
- acquired, global impairment of higher cortical functions including memory (both short and long term)
- often progressive although not necessarily irreversable
describe 5 clinical features of dementia? is there a clouding of consciousness?
- impaired abstract thinking
- impaired judgement
- other disturbances of higher cortical function (agnosia/visuospatial difficulties)
- change in personality
- memory impairment and intellectual impairment cause significant social and occupational impairments
- NO clouding of consciousness
what are the 4 types of dementia?
1- alzheimers disease (65%)
2-vascular dementia (can have mixed vascular and alzheimers)
3- lewy body dementia
4 - frontotemperal dementia AKA pick’s disease
Which dementia:
memory problems for a period of a few years and is gradual, initially short term memory loss, insidious onset
Alzheimers disease
Which dementia:
steep stepwise decline, physical symptoms such as walking problems/broad based gait
vascular dementia
Which dementia:
memory problems, visual hallucinations, parkinsonism, unexplained falls
lewy body dementia
Which dementia:
Late 50’s, behavior/personality changes
frontotemporal dementia
Where does alzheimers disease begin?
nucleus basilis of meynert (medial part of the temporal lobe)
describe 5 clinical features of alzheimers disease?
- word finding and name difficulties
- geographic disorientation
- disinterest in surrounding
- sleep disturbance
- behavioral changes
What is the pathophysiology of lewy body dementia?
protein deposits (lewy bodies) are in neurons and this kills them
Describe 5 clinical features of lewy body dementia
- fluctuating cognitive ability
- sleep disturbance
- parkinsonism (if pt. has parkinson’s disease >1yr they have parkinson’s dementia NOT LBD)
- unexplained falls
- visual hallucinations
What treatment is important NOT to use for lewy body dementia
-antipsychotics (typical) for LBD or parkinson’s
What age group does frontotemporal dementia affect?
younger age group than other dementias (50’s)
what changes are seen in frontotemporal dementia? what is the nature of the cognitive impairment?
- personality/behavioral changes (not conforming to social norms)
- more subtle cognitive impairment (verbal fluency/proverb difficulty/abstract thought/sequencing)
What are some reversable causes of cognitive impairment? (8)
- korsakoff’s syndrome (has some degree of reversability), not progressive if stop alcohol
- delirium
- depressive pseudodementia
- fugue (conversion disorder due to a mental trauma)
- normopressure hydoencephaly
- B12 deficiency
- folate deficiency
- hypothyroid
What is normopressure hydroencephaly?
Ataxia Cognitive impairment Urinary incontinent (Walking/Wet/Wacky) -this is due to slow accumalation of CSF
What is the difference between anteretrograde amnesia and retrograde amnesia?
Anteretrograde amnesia: difficulties acquiring new material and remembering of events since onset of illness/injury
Retrograde amnesia: difficulties to remember information prior to illness/injury
How to diagnose dementia? (8) what should be used in the diagnosis according to SIGN?
2+ of:
- forgetfulness
- memory loss
- confusion
- poor reasoning and logic
- personality changes
- poor judgement
- ability to focus
- visual perception
If suspected cognitive impairment, MMSE used in diagnosis of dementia
-initial cognitive tests can be improved by use of addenbrooks.
What four areas of cognition does MMSE test?
- orientation
- memory
- visuospatial
- language
What are the advantages of MMSE? (2)
- quick
- diff. language
What are the disadvantages of MMSE? (6)
- not adjusted for age
- poor examination of executive functioning
- poor in severe impairment = floor effect (Q’s too difficult for sample)
- poor in high pre-morbid functioning
- may not indicate problems in early stages
- significant focus on verbal functioning to exclusion of non-verbal skills
What 6 areas of cognition does the addenbrooks examination test? how long does this take?
- orientation
- memory
- attention
- exec. function
- language
- visuospatial functioning
15mins - bridges the gap between MMSE and neuropsychological assessments
When should neuropsychological assessments be used according to SIGN? where is this undertaken?
- should be used in dementia diagnosis, esp. when not clinically obvious
- undertaken with psychological therapy services
What is a neuropsychological assessment used for? (8)
- identify areas of deficits/preserved functioning in cognitive profile
- aids diagnostic process
- obtain baseline assessment of functioning
- provide prognostic information
- inform/facilitate interventions and strategies
- monitor change in cognitive functioning
- evaluate effectiveness of interventions
- provide indicators regarding rate of recovery
