Dementia Flashcards
What is dementia?
Refers to a progressive decline in higher cortical function
Leads to a global impairment of memory, intellect and personality
What are the causes of dementia?
Alzheimer’s disease
Dementia with Lewy-bodies
Vascular dementia
Fronto-temporal dementia
Which causes of dementia are the most and least common?
Most common - Alzheimer’s disease
Least common - fronto-temporal dementia
What are the signs and symptoms of dementia?
Memory deficit
Behavioural changes
Physical difficulties
Language disorder
Visuospatial disorder
Apraxia
What is the most common symptom of dementia?
Memory deficit
What are the features of memory deficit in dementia?
Short-term memory loss
Then progresses to long-term memory loss
What are the features of behavioural changes with dementia?
Altered personality
Disinhibition of abnormal behaviour
Fluctuating emotions
Wandering
What are the features of physical difficulties with dementia?
Incontinence
Difficulty swallowing
What are the features of language disorder with dementia?
Anomic aphasia
Difficulty understanding language
What is anomic aphasia?
Can speak fluently and describe what they mean but cannot name it
What is apraxia?
Difficulty with motor planning, inability to perform learned purposeful movements
Why is there such a wide range of signs and symptoms with dementia?
Due to any of the lobes of the brain being affected
How is dementia diagnosed?
Full history, mini mental state examination, collateral history from family
Full neurological examination
Blood tests
CT/MRI head
Memory clinic follow up
How does the mini-mental state examination work?
Four types of cognitive function tested
Give points based on their response
Add up points to get total
Result is baseline of cognitive function
What are the uses of the mini-mental state examination in dementia?
Part of diagnosis of dementia
To classify into mild, moderate or severe dementia
Monitor rate of cognitive decline, and hence progression of dementia
Why is a full neurological examination done in patients with dementia?
To rule out other causes
What blood tests are done for patients with dementia? Why?
Thyroid function tests
Vitamin B12
To rule out thyroid disorder, vitamin deficiency, as these can present with an acute reversible cognitive decline
What is used to distinguish between delirium and dementia?
Confusion assessment method CAM
How does the Confusion assessment method work?
Acute change or fluctuating mental status
Altered consciousness
Inattention
Disorganised thinking
Give a point for each feature
Add up points
Total of 2 or more means delirium
What is meant by altered consciousness in the Confusion assessment method?
E.g. hypoactive meaning withdrawn
E.g. hyperactive meaning agitated
How can inattention be tested for?
Asking the patient questions, can’t keep to the point
Asking the patient to count backwards, they can’t do this
What are the causes of delirium in the elderly?
Infection
Pain
How is delirium treated?
Treat underlying cause, gives return to baseline cognitive function
Why are CT/MRI head scans done for a patient with dementia?
To rule out vascular pathology, tumours
As these can present with an acute cognitive decline
What is seen on a CT scan of a patient with dementia?
Atrophy of cortical matter
Dilation of ventricles
What can be seen on an MRI scan of a patient with dementia?
Thinner gyri
Wider sulci
What is the rate of cognitive decline with Alzheimer’s disease?
Steady decline over a few years
What is the rate of cognitive decline with vascular dementia?
A vascular event occurs e.g. stroke, causing a sudden drop in cognitive function
Then patient continues with this level of cognitive function until the next vascular event
What is the rate of cognitive decline with Lewy-body dementia?
Cognitive function increases and decreases for short periods of time
But there is an overall cognitive decline
What is the macroscopic pathology of Alzheimer’s disease?
Loss of cortical grey matter and subcortical white matter
Narrow gyri, wide sulci
Ventricular dilation
What is the microscopic pathology of Alzheimer’s disease?
Amyloid beta plaques
Neurofibrillary tangles
How do amyloid beta plaques form?
Breakdown of amyloid precursor protein into amyloid beta peptide
Occurs excessively in patients with Alzheimer’s disease
What are the stages of Alzheimer’s disease?
Mild
Moderate
Severe
What are the features of mild dementia?
Minor memory loss, short-term memory loss
What are the features of moderate dementia?
Confusion
Poor judgement
Difficulty communicating
Behavioural changes e.g. anger, anxiety
What are the features of severe Alzheimer’s disease?
Patients are completely incapacitated
Violent episodes of aggression
What is the pathology of vascular dementia?
Atherosclerosis of blood vessels supplying the brain
Reduced blood supply to parts of the brain, ischaemia and infarction
How is vascular dementia managed?
Reduce risk factors of cardiovascular disease e.g. hypertension, hyperlipidaemia
To prevent further vascular events and cognitive decline
What is pathology of dementia caused by Lewy-bodies?
Lewy bodies in the cortex and substantia nigra
What other symptoms can dementia with Lewy-bodies cause? Why?
Parkinson’s symptoms
Due to substantia nigra being affected too
What is the pathology in fronto-temporal dementia?
Tau proteins form Pick bodies in frontal lobe
What are the particular signs and symptoms in fronto-temporal dementia? Why?
Behavioural changes e.g. altered personality, disinhibition of abnormal behaviour
Language expression decreases to aphasia
Due to frontal lobe dysfunction
How is dementia managed?
Social care e.g. risk assessment, care needs, mental capacity act
Drugs
Memory aids e.g. orientation boards, life stories
Therapies e.g. pets, babies
What drugs are used to manage dementia?
Cholinesterase inhibitors
How effective are cholinesterase inhibitors at managing dementia?
Only prevent progression of Alzheimer’s disease in a few patients for a few months
