Dementia Flashcards
What is dementia?
Acquired and persistent generalised disturbance of higher mental functions
What happens in dementia?
Progressive loss of neurones
What is the most common cause of dementia?
Alzheimers
What are the risk factors for Alzheimers?
advanced age familial history genetics Downs syndrome cerebrovascular disease hyperlipiaemia
What is the hallmark feature of Alzheimers?
memory decline with loss of recent memory first
What happens later on in Alzheimers?
irritability mood disturbance behavioural change psychosis agnosia (may not recognise self in mirror)
What causes alzheimers?
Both environmental and genetic factors
Accumulation of B amyloid peptide
What genes are associated with Alzheimers?
APP (amyloid precursor protein)
Presnelin 1 and 2
apoprotein E allele E4
What are the key factors in Alzheimers diagnosis?
presence of risk factors
memory loss
disorientation
nominal dysphasia
What are the investigations for Alzheimers?
bedside cognitive testing
CT/MRI
drug screening
What is the treatment of Alzheimers?
supportive
cholinesterase inhibitors: donepezil, rivastigmine, galantamine
treat depression, insomnia,
What happens to the brain in Alzheimers?
cortical atrophy
increased width of sulci
gyri thinning
decreased weight of brain
What is vascular dementia?
Cumulative effects of many small strokes
What is the onset and course of vascular dementia?
abrupt onset and stepwise progression
What is more affected in vascular dementia: memory or executive function?
executive function such as planning
What are key diagnostic factors in vascular dementia?
history of stroke
difficulty solving problems
apathy
disinhibition
What are risk factors for vascular dementia?
obesity
hypertension
age >60
smoking
What is the treatment of vascular dementia?
anti platelet therapy - aspirin, clopidogrel
lifestyle modification
cholinesterase inhibitors or memantine
What are examples of cholinesterase inhibitors?
donepezil, rivastigmine, galantamine
What are the key diagnostic factors in Lewy Body dementia?
cognitive fluctuation
visual hallucinations
motor symptoms (parkinsonism - bradykinesia, rest tremor, rigidity)
REM sleep disturbance
What is the treatment of Lewy Body dementia?
cholinesterase inhibitors treat depression (SSRI), psychosis, sleep disorders, extrapyramidal symptoms
What is memantine?
A NMDA receptor antagonist
What is characteristic of frontotemporal dementia?
Coarsening of personality, social behaviour and habits
Loss of language fluency
What is the treatment of frontotemporal dementia?
supportive
treat symptoms and comorbidities
