Dementia Flashcards
Define dementia
Clinical syndrome of generalised decline of memory, intellect and personality, but without impairment of consciousness. This leads to functional impairment.
What is “early-onset” dementia?
Dementia with onset before age 65
List some causes of dementia
- Neurodegenerative, e.g. Alzheimer’s, Pick’s, Parkinson’s
- Infection, e.g. CJD, HIV
- Toxins, e.g. alcohol
- Vascular - CVD
- Head injury
- Reversible, e.g. tumours, Cushing’s, hypothyroid
List 4 RFs for dementia
- Increasing age
- FHx
- Genetics
- Down’s syndrome
- Low IQ
- Stroke/vascular RFs
Outline the pathophysiology of Alzheimer’s disease
Degeneration of cholinergic neurones in hippocampus/temporal lobe, leading to decreased ACh
List some macroscopic and microscopic changes seen in Alzheimer’s
Macroscopic - cortical atrophy, widened sulci, enlarged ventricles
Microscopic - neurofibrillary tangles (phosphorylation of Tau proteins), and B-amyloid plaques
Outline the pathophysiology of vascular dementia
Cerebrovascular disease results in multiple mini infarcts in cortex
Outline the pathophysiology of Lewy-Body dementia
Abnormal deposition of Lewy body protein within neurones of brainstem/substantia nigra/neocortex
Outline the pathophysiology of fronto-temporal dementia (inc Pick’s disease)
Idiopathic atrophy of frontal and temporal lobes
Describe the major clinical features of dementia, common to all types
- Loss of memory - short-term first –> present for >6 months
- Decreased cognitive abilities, such as thinking, planning, language
- Decreased emotional control, e.g. irritability, aggression, apathy
- Psychotic symptoms
Outline the stages of Alzheimer’s disease and their clinical features
- Early stage - gradual loss of memory, e.g. forgetting names, losing keys
- Moderate stage - apraxia, confusion, loss of language, agnosia
- Late stage - wandering, disorientation, aggression, hallucinations
What are the main clinical features of vascular dementia?
- Stepwise progression
- Personality change possible prior to memory loss
- Confusion
- May be UMN signs
- CVS RFs
What are the main clinical features of Lewy-Body dementia?
- Day to day fluctuation
- Visual hallucinations
- Parkinsonism +/- depression
- Recurrent falls
What are the main clinical features of fronto-temporal dementia/Pick’s disease?
- Usually onset between 50 and 60
- FHx in 50% of cases
- Disinhibition
- Restlessness
- Repetitive behaviour
- Loss of speech
- Memory loss occurs later
What is “pseudo-dementia”?
The phenomenon whereby depression in older people can mimic dementia
