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Sem 4 - Nervous System > Dementia > Flashcards

Dementia Flashcards

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1
Q

What is dementia?

A

Refers to a progressive decline in higher cortical function

Leads to a global impairment of memory, intellect and personality

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2
Q

What are the causes of dementia?

A

Alzheimer’s disease

Dementia with Lewy-bodies

Vascular dementia

Fronto-temporal dementia

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3
Q

Which causes of dementia are the most and least common?

A

Most common - Alzheimer’s disease

Least common - fronto-temporal dementia

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4
Q

What are the signs and symptoms of dementia?

A

Memory deficit

Behavioural changes

Physical difficulties

Language disorder

Visuospatial disorder

Apraxia

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5
Q

What is the most common symptom of dementia?

A

Memory deficit

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6
Q

What are the features of memory deficit in dementia?

A

Short-term memory loss

Then progresses to long-term memory loss

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7
Q

What are the features of behavioural changes with dementia?

A

Altered personality

Disinhibition of abnormal behaviour

Fluctuating emotions

Wandering

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8
Q

What are the features of physical difficulties with dementia?

A

Incontinence

Difficulty swallowing

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9
Q

What are the features of language disorder with dementia?

A

Anomic aphasia

Difficulty understanding language

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10
Q

What is anomic aphasia?

A

Can speak fluently and describe what they mean but cannot name it

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11
Q

What is apraxia?

A

Difficulty with motor planning, inability to perform learned purposeful movements

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12
Q

Why is there such a wide range of signs and symptoms with dementia?

A

Due to any of the lobes of the brain being affected

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13
Q

How is dementia diagnosed?

A

Full history, mini mental state examination, collateral history from family

Full neurological examination

Blood tests

CT/MRI head

Memory clinic follow up

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14
Q

How does the mini-mental state examination work?

A

Four types of cognitive function tested
Give points based on their response
Add up points to get total
Result is baseline of cognitive function

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15
Q

What are the uses of the mini-mental state examination in dementia?

A

Part of diagnosis of dementia

To classify into mild, moderate or severe dementia

Monitor rate of cognitive decline, and hence progression of dementia

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16
Q

Why is a full neurological examination done in patients with dementia?

A

To rule out other causes

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17
Q

What blood tests are done for patients with dementia? Why?

A

Thyroid function tests

Vitamin B12

To rule out thyroid disorder, vitamin deficiency, as these can present with an acute reversible cognitive decline

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18
Q

What is used to distinguish between delirium and dementia?

A

Confusion assessment method CAM

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19
Q

How does the Confusion assessment method work?

A

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

20
Q

What is meant by altered consciousness in the Confusion assessment method?

A

E.g. hypoactive meaning withdrawn

E.g. hyperactive meaning agitated

21
Q

How can inattention be tested for?

A

Asking the patient questions, can’t keep to the point

Asking the patient to count backwards, they can’t do this

22
Q

What are the causes of delirium in the elderly?

A

Infection

Pain

23
Q

How is delirium treated?

A

Treat underlying cause, gives return to baseline cognitive function

24
Q

Why are CT/MRI head scans done for a patient with dementia?

A

To rule out vascular pathology, tumours

As these can present with an acute cognitive decline

25
Q

What is seen on a CT scan of a patient with dementia?

A

Atrophy of cortical matter

Dilation of ventricles

26
Q

What can be seen on an MRI scan of a patient with dementia?

A

Thinner gyri

Wider sulci

27
Q

What is the rate of cognitive decline with Alzheimer’s disease?

A

Steady decline over a few years

28
Q

What is the rate of cognitive decline with vascular dementia?

A

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

29
Q

What is the rate of cognitive decline with Lewy-body dementia?

A

Cognitive function increases and decreases for short periods of time
But there is an overall cognitive decline

30
Q

What is the macroscopic pathology of Alzheimer’s disease?

A

Loss of cortical grey matter and subcortical white matter

Narrow gyri, wide sulci

Ventricular dilation

31
Q

What is the microscopic pathology of Alzheimer’s disease?

A

Amyloid beta plaques

Neurofibrillary tangles

32
Q

How do amyloid beta plaques form?

A

Breakdown of amyloid precursor protein into amyloid beta peptide
Occurs excessively in patients with Alzheimer’s disease

33
Q

What are the stages of Alzheimer’s disease?

A

Mild

Moderate

Severe

34
Q

What are the features of mild dementia?

A

Minor memory loss, short-term memory loss

35
Q

What are the features of moderate dementia?

A

Confusion

Poor judgement

Difficulty communicating

Behavioural changes e.g. anger, anxiety

36
Q

What are the features of severe Alzheimer’s disease?

A

Patients are completely incapacitated

Violent episodes of aggression

37
Q

What is the pathology of vascular dementia?

A

Atherosclerosis of blood vessels supplying the brain

Reduced blood supply to parts of the brain, ischaemia and infarction

38
Q

How is vascular dementia managed?

A

Reduce risk factors of cardiovascular disease e.g. hypertension, hyperlipidaemia
To prevent further vascular events and cognitive decline

39
Q

What is pathology of dementia caused by Lewy-bodies?

A

Lewy bodies in the cortex and substantia nigra

40
Q

What other symptoms can dementia with Lewy-bodies cause? Why?

A

Parkinson’s symptoms

Due to substantia nigra being affected too

41
Q

What is the pathology in fronto-temporal dementia?

A

Tau proteins form Pick bodies in frontal lobe

42
Q

What are the particular signs and symptoms in fronto-temporal dementia? Why?

A

Behavioural changes e.g. altered personality, disinhibition of abnormal behaviour
Language expression decreases to aphasia

Due to frontal lobe dysfunction

43
Q

How is dementia managed?

A

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

44
Q

What drugs are used to manage dementia?

A

Cholinesterase inhibitors

45
Q

How effective are cholinesterase inhibitors at managing dementia?

A

Only prevent progression of Alzheimer’s disease in a few patients for a few months

Sem 4 - Nervous System (25 decks)

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