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Geriatrics > Dementia > Flashcards

Dementia Flashcards

1
Q

What is the diagnostic criteria for dementia?

DSMIV criteria

A 
Impairment of memory +1 of the following:
Aphasia
Agnoisa
Apraxia
Executive dysfunction

Impairment in functioning

Present for at least 6 months

No other medical or psychiatric explanation

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2
Q

What are the dementia subtypes?

A 
Alzheimers 
Vascular
Mixed 
Lewy-body 
Frontotemptoral 
Parkinson's
Other
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3
Q

How common are each subtype?

A 
Alzheimers - 62%
Vascular - 17% 
Mixed - 10%
Lewy-body - 4%
Frontotemptoral - 2%
Parkinson's - 2% 
Other - 3%
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4
Q

Describe the pathophysiology of vascular dementia briefly

A

Ishaemia multiple cortical infarcts

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5
Q

Describe the pathophysiology of AD briefly

A

atrophy
plaques (beta amyloid)
Tangles (tau proteins) Decreased neurotransmitters

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6
Q

What are the modifiable RFs for dementia?

A 
smoking 
atherosclerosis 
alcohol
high cholesterol
obesity 
low standard education
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7
Q

What are the non modifiable RFs

A

genetics
Age
Mild cognitive impairment

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8
Q

What is the function of the frontal lobe?

A

Voluntary motor
speaking
behaviour
personality

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9
Q

What is the function of the parietal lobe?

A

Sensory information
sequencing
proprioception
calculation

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10
Q

What is the function of the temporal lobe?

A

attention
verbal memory
visual memory
learning

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11
Q

What percentage of over 65s have dementia?

A

5%

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12
Q

What percentage of over 80s have dementia?

A

20%

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13
Q

How many people in the UK currently have dementia ?

A

estimated 820 000

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14
Q

How does the brain appear macroscopically in AD?

A

brain appears atrophic - particularly hippocampus

enlargement of ventricles

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15
Q

How does the brain appear microscopically in AD?

A

reduced neurotransmitter function

presence of neurofibrillary tangles and amyloid plaques caused by abnormal protein deposition

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16
Q

Which three genes are mutated in rare forms of early onset dementia?

A

APP
PSEN 1
PSEN 2

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17
Q

What gene is implicated in later-onset AD?

A

APOE

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18
Q

What is the second most common form of dementia?

A

Vascular dementia

19
Q

Causes of VD?

A

problems with bloods supply to the brain such as atherosclerosis or stroke

20
Q

What are the further subtypes of VD?

A

multi-infarct dementia - caused by small strokes in the cortex of the brain

subcortical vascular dementia - caused by damage to small vessels deeper within the brain

post stroke dementia

21
Q

Which lifestyle factors increase the risk of developing pathological changes in VaD?

A

smoking
high fat diet
diabetes
HTN

22
Q

What is mixed dementia?

A

mixed picture of AD and VaD

23
Q

What are the featured of lewy body dementia?

A

fluctuation in cognition
early visual hallucinations
parkinsonism

24
Q

What is the disease process of lewy body dementia?

A

abnormal protein structures, called lewy bodies build up in the brian cortex and basal ganglia causing disruption to neurotransmitter function

25
Q

How are LBD and PD different?

A

similar pathological basis but are differentiated depending on the sequence of symptom development

In LBD cognitive dysfunction presents within 2 years of motor function, in PDD it presents later

26
Q

What are the features of frontotemporal dementia

A

changes in behaviour, emotion and language before memory is affected

27
Q

what causes FTD?

A

degeneration of frontal and temporal lobes

28
Q

What percentage of cases are inherited?

A

50%

29
Q

what are the other subtypes of dementia?

A

Huntington’s
Alcohol related dementia
Progressive supranuclear palsy (PSP)
HIV related cognitive impairment

30
Q

what is a mild cognitive impairment (MCI)?

A

relatively new concept used to describe impairment of memory greater than expected with normal ageing but not significant to affect an individuals function significantly enough to suggest dementia

31
Q

what does having MCI increase your risk of

A

dementia

32
Q

Reversible causes of MCI?

A

reversible - depression and physical illness

33
Q

What are the stages of dementia? (easy)

A

Early
Mid
End

34
Q

Features of early stage dementia?

A

memory loss
slower to grasp new ideas
errors of judgement

35
Q

Features of mid stage dementia?

A

difficulty with daily tasks
decline in language
behaviour change

36
Q

Features of end stage dementia?

A

increased care needed
communication impaired
incontinence
swallowing difficulties

37
Q

What are the key differentials?

A

mood disorders - depression
metabolic - hypothyroidism, vit B12 deficiency
trauma - subdural haematoma
poisons - heavy metals, recreational drugs
nutrition - thiamine deficiency
medication - multiple e.g. steroids, anti-depressants
Other - normal pressure hydrocephalus

38
Q

How is dementia managed?

Cognitive

A

Cognitive

  • pharmacological (AD)
  • -> AchE-1
  • -> NDMA antagonists

these slow the progression of cognitive decline

in vascular dementia reducing risk factors such as high BP, cholesterol

Behavioural and psychological

  • pharmacological
  • non pharmacological
  • -> MDT support
  • -> orientation
  • -> complementary therapies
39
Q

Describe history taking in patients with dementia

A

elicit the difficulties patient has been having and link these to areas of brain affected

speed and pattern of progression will help to determine dementia subtype

Collateral history important - when was patient last ‘normal’?

PMH, DH, FH, SH important too

40
Q

Which investigations would you order for a suspected dementia patient?

A

Bloods - FBC, vit B and folate, ESR, renal and liver function, glucose and lipids

Baseline ECG

Imaging - to exclude reversible causes - CT head first line, MRI and HMPoA-SPECT provide more detail

41
Q

Describe examination of patient with suspected dementia?

A

physical exam including cardio and neuro

mental state exam - MMSE, MoCA, ACE-R

42
Q

what needs to be discussed when dementia is diagnosed?

A

driving
advanced care planning
legal issues - lasting power of attorney

43
Q

How is dementia managed?

behavioural and psychological

A

Behavioural and psychological

  • pharmacological
  • -> anti-psychotics and acetylcholinesterase’s can be prescribed by specialists
  • non pharmacological
  • -> MDT support
  • -> orientation and reassurance
  • -> complementary therapies

Geriatrics (17 decks)

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