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Mental health > Dementia > Flashcards

Dementia Flashcards

1
Q

Define mild cognitive impairment

A
  • Focal cognitive impairment
  • Not severe enough to interfere with daily life and function
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2
Q

What is dementia?

A

A syndrome characterised by:

  • Progressive global cognitive deficits
  • Compared to baseline
  • Significant impairment of normal functioning
  • Definite Dx: symptoms lasting 6+ months
  • Tentative Dx: symptoms lasting less than 6 months
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3
Q

What is included in the routine dementia screen?

A
  • TFTs
  • Vit B12; folate
  • FBC; ESR; CRP: anaemia and vasculitis
  • LFTs; U+Es
  • Glucose
  • CT head
  • Neurosyphilis test
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4
Q

What are the cognitive deficits seen in dementia?

A
  • Memory impairment
  • Impaired executive function
  • Dysphagia
  • Agnosia
  • Apraxia (loss of motor function)
  • Personality disintegration
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5
Q

What is executive function?

A

A set of cognitive processes that enable planning, organisation, and completion of tasks.

e.g. Problem solving, abstraction, reasoning, decision making, judgement, planning, organisation, processing

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6
Q

Name four risk factors for Dementia

A
  • Older age
  • Mild cognitive impairment
  • Intellectual difficulties
  • Genetics; FHx of young-onset dementia
  • CVD risk factors; stroke
  • Parkinson’s disease
  • Depression; Alcohol abuse
  • Low educational attainment; low social engagement/support
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7
Q

Name four protective factors for Dementia

A
  • Diet: Vitamin E and C
  • Exercise
  • Mental and social activity
  • More complex work ➔ reduced hippocampal atrophy
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8
Q

What are the common causes of dementia?

A
  • Alzheimer’s disease (50-60%)
  • Vascular dementia (20-25%)
  • Mixed dementia
  • Lewy body dementia (10-15%)
  • Frontal-temporal dementia (7%)
  • Other e.g. CJD, AIDS dementia, Alcohol dementia (3%)
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9
Q

List three behavioural and psychological symptoms of dementia (BPSD)

A
  • Psychosis: delusions and/or hallucinations
  • Agitation; emotional lability
  • Depression; anxiety
  • Withdrawal; apathy
  • Disinhibition: social or sexually inappropriate behaviour
  • Motor disturbance: wandering; restlessness
  • Sleep cycle disturbance; insomnia
  • Echolalia (tendency to repeat phrases or questions)
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10
Q

What differential diagnoses must be excluded for a diagnosis of dementia?

A
  • Delirium
  • Depression
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11
Q

Name three reversible causes of dementia

A
  • Subdural haematoma
  • Normal pressure hydrocephalus
  • Chronic alcohol misuse
  • Metabolic
    • Vitamin B12 deficiency
    • Hypothyroidism
    • Hypoglycaemia
  • Neurosyphilis
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12
Q

What is the characteristic of fronto-temporal cortical dementia?

A

Prominent personality change

May manifest as frontal lobe syndrome: damage of higher functioning processes eg. motivation, planning, behaviour

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13
Q

What is Alzheimer’s disease?

A
  • Commonest form of dementia
  • Degenerative disease of the brain
  • Prominent cognitive and behavioural impairment.
  • Significantly interferes with social and occupational function
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14
Q

List three risk factors for Alzheimer’s disease

A
  • Increasing age
  • FHx of AD or early-onset AD
  • Down’s syndrome
  • FHx of Down’s syndrome
  • Previous head injury
  • Hypothyroidism
  • Parkinson’s disease
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15
Q

What is the association between Alzheimer’s disease and Down’s syndrome

A

Chromosome 21:

  • AD: gene for amyloid precursor protein ➔ amyloid plaques
  • DS: Down’s syndrome have an extra Chromosome 21 ➔ accelerated production of amyloid plaques ➔ earlier dementia
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16
Q

What are the three symptomatic domains of Alzheimer’s disease?

A
  • Cognitive
  • Functional: ADLs
  • Neuropsychiatric
    • Mood/affect disturbances
    • Aggression
    • Anxiety
    • Psychosis
    • Sleep disturbances
17
Q

Describe the memory problems in Alzheimer’s disease

A
  • Early impairment of immediate and short-term memory
    • Due to atrophy of the hippocampus.
  • Long-term (remote) memory declines with progression
  • Common to also have disorientation of time and place
18
Q

List three early symptoms of Alzheimer’s disease

A
  • Impaired immediate and short-term memory
  • Disorientation of time and place
  • Muddled efficacy with ADLs
  • Spatial dysfunction
  • Behavioural: Wandering, irritability
19
Q

List three middle symptoms of Alzheimer’s disease

A
  • Intellectual and personality deterioration
  • Aphasia
  • Apraxia
  • Agnosia (inability to process sensory information)
  • Impaired executive function
  • Impaired visuospatial skills: getting lost, impaired driving
20
Q

List three late symptoms of Alzheimer’s disease

A
  • Fully dependent
  • Physical deterioration
  • Incontinence
  • Gait abnormalities
  • Spasticity Seizures (3%)
  • Tremors
  • Extrapyramidal signs
21
Q

How does early-onset Alzheimer’s disease differ from typical AD?

A
  • More aphasia and apraxia
  • Rapid course with severe intellectual decline
  • Poor survival rate
22
Q

Request four investigations for Alzheimer’s disease

A
  • Cognitive testing: Clock drawing test, MMSE
  • FBC
  • TFTs
  • Haematinics: B12; folate
  • Neurosyphilis screen
  • LFT, U+Es, TSH, HIV
  • CT head:
    • Cortical atrophy esp in medial temporal lobes (hippocampus), ventricular enlargement
23
Q

Outline the management of Alzheimer’s disease

A
  • Promoting cognition, independence and wellbeing:
    • Group cognitive stimulation therapy
    • Cognitive rehabilitation; occupational therapy
  • Medication:
    • AChEi: donepezil; galantamine; rivastigmine
    • Memantine
24
Q

What are the indications for Memantine?

A
  • Moderate Alzheimer’s disease
    • AChEi contraindicated or not tolerated
  • Severe Alzheimer’s disease
25
Q

Name three risk factors for Vascular dementia

A
  • Male
  • PMH or FHx of cardiovascular disease
  • CV risk: smoking, diabetes, HTN, hyperlipidaemia
26
Q

List three characteristics suggestive of Vascular dementia

A
  • Sudden onset
  • Stepwise deterioration
  • Cardiovascular risk factors
27
Q

How can the presentation of vascular dementia be categorised?

A
  • Cognitive deficits following a single stroke
    • Deficits depend on site of infarct
  • Multi-infarct dementia
    • Stepwise deterioration in cognitive function
    • Relative stability between strokes
  • Binwangers disease: progressive small-vessel disease
    • Gradual intellectual decline
    • Generalised slowing
    • Motor problems
28
Q

List four presenting features of Vascular dementia

A
  • Acute onset; may follow a stroke
  • Early:
    • Emotional and personality changes
    • Cognitive deficits - fluctuate
    • Behavioural slowing and anxiety
  • Depression with affective lability and confusion, esp at night
  • Physical signs of arteriovascular disease
  • Neurological impairment
29
Q

Outline the management of Vascular dementia

A
  • Manage modifiable risk factors:
    • Diet; exercise
    • Smoking cessation; reduce alcohol intake
  • Medication:
    • Aspirin
    • Clopidogrel
    • Statins
    • ACEi
    • Anti-hyperglycaemics if needed
30
Q

When may a CXR be indicated when investigating dementia?

A

Indication of malignancy, esp of small-cell lung cancer

Paraneoplastic syndromes resembling neurological deficits in dementia

31
Q

Name one infectious cause of reversible dementia

A
  • HIV
  • Syphilis
  • TB
  • Meningitis
32
Q

Outline pathophysiology of Lewy body dementia

A

Accumulation of Lewy bodies (alpha-synuclein and ubiquitin) in the cerebrum and substantia nigra.

33
Q

Name two characteristic clinical features of Lewy body dementia

A
  • Fluctuating cognitive impairment
  • Spontaneous parkinsonism
  • Vivid visual hallucinations
  • Additional: REM sleep disturbance - treated with clonazepam
34
Q

Why should antipsychotics be avoided in Lewy body dementia?

A

Antipsychotics can:

  • Precipitate irreversible parkinsonism
  • Preceipitate autonomic dysregulation
    • similar to neuroleptic malignant syndrome
  • Reduce consciousness
  • Increases mortality rates (2-3x)
35
Q

Differentiate dementia from delirium

A

Delirium has altered consciousness and attention

Dementia:

  • Gradual onset (months to years); progressive
  • Normal consciousness; late perceptional disturbances
  • Normal sleep-wake cycle

Delirium:

  • Acute onset (hours to weeks); fluctuating course
  • Impaired consciousness; perceptional disturbances often
  • Disrupted sleep-wake cycle.

Mental health (27 decks)

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