Dementia Flashcards
Dementia - definition
A syndrome caused by brain disorders causing memory loss, reduced cognition and difficulties with ADLs
Dementia: General symptoms - 3 categories with examples
Behavioural/personality
- Mood, hallucinations, restless, rigid routines
Cognitive impairment
- Speech impairment, thinking slow/muddled, poor memory (with confabulation)
Difficulties with ADLs
-driving, eating, shopping, dressing
Dementia: Epidemiology Qs
1) how many people affected in UK?
2) how many deaths attributable to dementia/year in UK?
3a) %prevalence at age 65-69@?
3b) %prevalence at age 95+?
1) 800,000
2) 60,000
3a) 1.5%
3b) 25%
Name 4 main causes of dementia
Alzheimers (50%)
Vascular (50%)
Dementia with Lewy bodies (15%)
Frontotemporal dementia (5%)
Mixed dementia common
Causes continued: name the reversible causes of dementia
Substance misuse (MCV, folate, B12)
Hypothyroidism (TSH, T4)
Space occupying intracranial lesion (CT/MRI)
Normal pressure hydrocephalus
Syphilis (serology)
Vitamin b12/folate/b3 (pellagra) deficiency
Alzheimer’s disease - pathophysiology (1/3)
1) Cerebral cortex atrophy
2) Neurofibrillary tangles and amyloid plaques
3) Decreased ACh production from affected neurons
Amyloid Precursor protein - normally repairs neurons and is effectively broken down. When badly broken down - the reminenants accumulate into B plaques. These cause Tau (on microtubules) to accumulate - which are tangles. Affected neurons are bad at neurotransmission
Alzheimer’s disease - the 4 A’s (2/3)
Amnesia - memory probs
Agnosia - inability to interpret sensations and hence to recognize things
Aphasia - speech probs
Aprexia - motor probs
Alzheimer’s disease - pharmacological management (3/3)
Acetylcholinesterase inhibitors
- Donepezil, galantamine, rivastigmine
2nd line - Memantine
Vascular dementia - pathophysiology (1/2)
Cerebrovascular damage - big stroke or mini strokes, or chronic changes in small vessels
Vascular dementia - how might it seem different to other types? (2/2)
Visual, sensory, motor problems, seizures
MRI will look different
QRISK
Dementia with Lewy bodies
Overview
Lewy bodies in brainstem/neocortex
Mild parkinsonian signs, faints
FLUCTUATING attention/concentration
Frontotemporal dementia
Specific degeneration of frontal/temporal lobes in lobar fashion, rather than diffuse as in AD
Dementia: making a diagnosis
Clinical - collateral history important
Mini mental state examination or equivalent
Tests of exclusion
Bloods - FBC. B12, folate, B3, (MCV), ESR, U&Es, LFTs, GGT, Ca, TSH, syphilis serology,
CT/MRI
Management of Dementia
Carers - needs assessments
Practical stuff - routines, leaving notes/reminders
CBT for depression etc
* be careful with antidepressants which interfere with ACh
Can you drive with dementia?
DVLA must be informed of diagnosis.
Won’t be able to drive buses, but cars may be okay
Mild cognitive impairment (MCI)
What?
Decreased cognitive function, greater than expected for age.
Often a pre-dementia state.
Mr C. is a 56 yr old teacher who has been admitted to the Medical Assessment Unit after a large overdose of paracetamol
He believes that the Ebola crisis is all his fault. He went to Africa last year on holiday and thinks that he may have passed on a cold he had which then mutated into Ebola and spread locally.
He is absolutely convinced by this, so much so that he has tried to kill himself
He has been under a lot of stress at work and has been feeling low. He has been unable to concentrate at work, he forgets important things, he is not sleeping well and he has lost a lot of weight. At times he does not feel real.
He was signed off sick with stress by his GP, last week and felt bad about missing work. He was watching TV last week and made the connection with his visit to Africa. He has felt very guilty about this and made the decision to end his life, believing that this may cure all those afflicted.
This is manic depression.
= Severe depression with psychotic symptoms.
The other type of severe depression is
severe depression without psychotic symptoms (:
Alzheimers dementia - early/late onset differences
Is early onset caused by a dominant or recessive gene?
Sporadic/late onset - 90-95% cases
Caused by genes which are bad at copping up plaques
Familial/early onset - 5-10%
Caused by dominant genes
Alzheimer dementia - progression of symptoms
Short term memory problems
loss of motor skills
language problems
long term memory problems (forget significant people)
disorientated
bedridden
death usually due to infection (pneumonia)
Lewy body dementia
what happens in the early phase?
Misfolded proteins accumulate and cause the cell to die
Cognitive symptoms come first
- focus problems
- memory problems
- visual hallucinations
- speech problems
- depression
Lewy body dementia - late phase symptoms
Motor symptoms are late
resting tremor
stiff/slow movements
facial expression changes
a bit like parkinsons - lewy bodys accumulate in substantia nigra
sleep disorders also occur
Delirium - causes
Acute infections Prescribed drugs (benzo's, morphine, steroids etc) Post-operative Vascular disorder Metabolic causes vitamin causes endocrine cause trauma, epilepsy, neoplastic syndrome urinary retention/faecal impaction
Symptoms of hyperactive delirium
agitated aggressive incoherent disorganised thoughts delusions (things that havent happened/or long time ago) hallucinations disorientation
Hypoactive symptoms of delirium
sluggish, drowsy
less reactive
looks withdrawn
