Dementia Flashcards
What is dementia?
Progressive decline in higher cortical function leading to global impairment of memory, intellect, and personality, which affects the ability to cope with activities of daily living
What are the causes of pernament dementia?
- Alzheimer’s diesase
- Fronto-temporal dementia
- Dementia with Lewy-Bodies
- Vascular dementia
- Creutzfeldt-Jacob disease - rare
What are the reversible causes of dementia?
- Depression
- Trauma
- Vitamin deficiency
- Alcohol
- Thyroid disorders
How does dementia present?
- Memory deficit
- Behavioural
- Physical
- Language disorder
- Visuospatial disorder
- Apraxia
What memory deficits are present in dementia?
Struggle to learn new information and have short term memory loss initially, which progresses to long term memories
What are the behavioural symptoms of dementia?
- Altered personality
- Disinhibition
- Labile emotions
- Wandering
What are the physical presentations of dementia?
- Incontinence
- Reduced oral intake
- Difficulty swallowing
What language disorders might dementia present with?
- Anomic aphasia
- Difficulty understanding language
What visuospatial symptoms might dementia present with?
Unable to identify visual and spatial relationships between objects
What is apraxia?
Difficulty with motor planning, resulting in inability to perform leaned purposeful movements
What investigations should be done when a patient presents with suspected dementia?
- Full history and mini-mental state examination
- Full neurological examination
- Blood tests
- CT/MRI of the head
- Memory clinic follow up
What might be required when obtaining a full history from a patient with dementia?
Collateral history from family, as patient might be trying to hide it or not remeber
Why is a full neurological examination required in dementia?
As focal neurological signs might show different diagnoses
What is the use of CT/MRI scans in dementia?
Sometimes not that helpful, but show other causes, e.g. tumour or RICP
Why do blood tests need to be done in suspected dementia?
To check for reversible causes
What needs to be looked for in the blood tests of suspected dementia?
- TFTs to check for thyroid disorders
- Vitamin B12
Why is memory clinic follow up important in dementia?
Need someone to care for the patient after, e.g. home visits, social care
How is it decided if a patient has delirium or dementia?
CAM (confusion assessment method) score
What symptoms would indicate delirium rather than dementia?
- Acute change or fluctuating mental status
- Altered consciousness- hypo/hyperactive
- Inattention
- Disorganised thinking
What signs might be seen on the CT scan of someone with dementia?
- Dilation of ventricles
- Generalised atrophy
What signs might be seen on the MRI of someone with dementia?
Hippocampal atrophy
Describe the rate of progression of vascular dementia?
Normal and steady, then some sort of insult leading to abrupt decrease. It then stays level until there is another insult, when there is another abrupt decrease
Describe the state of decline of Alzheimers dementia
Steady rate with no improvement
Describe the rate of decline in Lewy-Body dementia?
More sporadic decline, with an overall decline but periods of improvement
What happens to the brain macroscopically in Alzheimers?
There is a loss of cortical and subcortical white matter, causing gyral atrophy with narrow gyri and wide sulci, along with marked ventricular dilation reflecting the loss of white matter
What is the microscopic pathology in Alzheimers?
- Formation of amyloid-beta plaques
- Formation of neurofibrillary tangles
What leads to the production of amyloid-beta peptide?
The proteolytic breakdown of amyloid precursor protei n
How long does the mild stage of Alzheimers last?
2-4 years
What is the mild stage of Alzheimers marked by?
Minor memory loss, as well as difficulty learning and remembering new information
What remains intact in mild Alzheimers disease?
Long-term memory and some reasoning
Why might it be difficult to diagnosis mild Alzheimers disease?
Patients may be aware of their decline, and hide it well
How long does the moderate stage of Alzheimers last?
2-10 years
What does the patient experience in the moderate stage of Alzheimers?
- Withdrawal
- Confusion
- Increasing difficulty in self care
- Daily tasks
- Poor judgement
- Difficulty communicating
What behavioural changes occur in moderate Alzheimers?
- Anger
- Anxiety
- Frustration
- Restlessness
How long does the severe stage of Alzheimers last?
1 to 3 years
What happens to the patient in the severe stage of Alzheimers?
- Completely incapacitated
- Will not eat unless fed
- May not speak
- Do not recgonise people
- Loss of bodily functoin control, e.g. swallowing, bladder, and bowel
- Violent episodes and aggression common
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Where do Lewy-Bodies form in Lewy-Body dementia?
In the cortex and substantia nigra
What are the key clinical features of Lewy-Body dementia?
- Substantial fluctations in the degree of cognitive impairment over time
- Parkinson’s symptoms
- Visual hallucinations
- Frequent falls
What is the pathology of vascular dementia?
Arteriosclerosis of the blood vessels supplying the brain leads to diffuse small vessel disease and infarcts, resulting in a decreased/cut off blood supply to specific parts of the brain
How is vascular dementia managed?
Assess cardiovascular risk, and treat hypertension/high cholesterol if present
What are frontotemporal dementias?
A diverse group of conditions, with similar presentation but different pathologies
What are the potential pathologies behind fronto-temporal dementias?
- Frontotemporal lobar degeneration with tau pathology
- Pick’s disease
- Familial tauopathies
What are the key clinical features of frontotemporal dementias?
- Alteration of social behaviour and personality, including agitation and depression
- Impaired judgement and insight
- Speech output falls, eventually to a state of mutism
What are the categories of management of dementia?
- Therapies
- Memory aids
- Social care
- Drugs
What memory aids can be used in dementia?
- Orientation boards
- Remembrance therapy
- Life stories
What social care considerations need to be made in a patient with dementia?
- Risk assessment
- Care needs
- Mental capacity act
What drugs are used in the treatment of dementia?
- Cholinesterase inhibitors
- Memantine
