Dementia Flashcards
What is the diagnostic criteria for dementia?
DSMIV criteria
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
What are the dementia subtypes?
Alzheimers Vascular Mixed Lewy-body Frontotemptoral Parkinson's Other
How common are each subtype?
Alzheimers - 62% Vascular - 17% Mixed - 10% Lewy-body - 4% Frontotemptoral - 2% Parkinson's - 2% Other - 3%
Describe the pathophysiology of vascular dementia briefly
Ishaemia multiple cortical infarcts
Describe the pathophysiology of AD briefly
atrophy
plaques (beta amyloid)
Tangles (tau proteins) Decreased neurotransmitters
What are the modifiable RFs for dementia?
smoking atherosclerosis alcohol high cholesterol obesity low standard education
What are the non modifiable RFs
genetics
Age
Mild cognitive impairment
What is the function of the frontal lobe?
Voluntary motor
speaking
behaviour
personality
What is the function of the parietal lobe?
Sensory information
sequencing
proprioception
calculation
What is the function of the temporal lobe?
attention
verbal memory
visual memory
learning
What percentage of over 65s have dementia?
5%
What percentage of over 80s have dementia?
20%
How many people in the UK currently have dementia ?
estimated 820 000
How does the brain appear macroscopically in AD?
brain appears atrophic - particularly hippocampus
enlargement of ventricles
How does the brain appear microscopically in AD?
reduced neurotransmitter function
presence of neurofibrillary tangles and amyloid plaques caused by abnormal protein deposition
Which three genes are mutated in rare forms of early onset dementia?
APP
PSEN 1
PSEN 2
What gene is implicated in later-onset AD?
APOE
What is the second most common form of dementia?
Vascular dementia
Causes of VD?
problems with bloods supply to the brain such as atherosclerosis or stroke
What are the further subtypes of VD?
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
Which lifestyle factors increase the risk of developing pathological changes in VaD?
smoking
high fat diet
diabetes
HTN
What is mixed dementia?
mixed picture of AD and VaD
What are the featured of lewy body dementia?
fluctuation in cognition
early visual hallucinations
parkinsonism
What is the disease process of lewy body dementia?
abnormal protein structures, called lewy bodies build up in the brian cortex and basal ganglia causing disruption to neurotransmitter function
How are LBD and PD different?
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
What are the features of frontotemporal dementia
changes in behaviour, emotion and language before memory is affected
what causes FTD?
degeneration of frontal and temporal lobes
What percentage of cases are inherited?
50%
what are the other subtypes of dementia?
Huntington’s
Alcohol related dementia
Progressive supranuclear palsy (PSP)
HIV related cognitive impairment
what is a mild cognitive impairment (MCI)?
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
what does having MCI increase your risk of
dementia
Reversible causes of MCI?
reversible - depression and physical illness
What are the stages of dementia? (easy)
Early
Mid
End
Features of early stage dementia?
memory loss
slower to grasp new ideas
errors of judgement
Features of mid stage dementia?
difficulty with daily tasks
decline in language
behaviour change
Features of end stage dementia?
increased care needed
communication impaired
incontinence
swallowing difficulties
What are the key differentials?
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
How is dementia managed?
Cognitive
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
Describe history taking in patients with dementia
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
Which investigations would you order for a suspected dementia patient?
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
Describe examination of patient with suspected dementia?
physical exam including cardio and neuro
mental state exam - MMSE, MoCA, ACE-R
what needs to be discussed when dementia is diagnosed?
driving
advanced care planning
legal issues - lasting power of attorney
How is dementia managed?
behavioural and psychological
Behavioural and psychological
- pharmacological
- -> anti-psychotics and acetylcholinesterase’s can be prescribed by specialists
- non pharmacological
- -> MDT support
- -> orientation and reassurance
- -> complementary therapies
