Dementia Flashcards
What is dementia
Severe impairment or loss of intellectual capacity or personality integration - due to loss of / damage to neurons in the brain
What are the reversible causes of cognitive impairment? (12)
BAN VEAL So Bad H M S B12 deficiency AIDs Normal pressure hydrocephaly - worsening confusion, abnormal gait, urinary incontinence Vit b1 and 6 deficiency Exposure to lead/ other metals Alcohol/ drugs Lyme disease Subdural hematoma Brain tumor - direct/ toxins released Hypothyroid Medication side effects Syphilis - untreated
What do you consider on physical exam for cognitive impairment (6)
CVS eg AF/ htn- more likely to be vascular dementia
Thyroid- hypo/hyper
Movement disorder - parkinsonism, chorea - huntingtons, myocolonus - creutzfeldt jakob disease
Gait - parkinsonism, apraxia, ataxia, peripheral neuropathy
Liver -alc
Investigations cognitive impairment
Bloods - FBC, UE, LFT, TFT, Cr, Ca, Glucose, ESR, B12+ folate, lipids ECG Urine/ csf / serum - microbiology CT head - then maybe MRI/ DaT Maybe EEG
Presentation of cognitive impairment
Impairment of memory AND 1 of language skills, executive function, agnosia, apraxia
Impairment of functioning
6+ months
No other medical/ psych explanation
Early sx of cognitive impairment
Short term memory loss, repeating questions, difficulty embracing change
Middle sx of cognitive impairment
Failure to recognise faces, need prompting, difficulty with daily tasks
Late sx of cognitive impairment
Weight loss, incontinence, aggression, decline in speech
What is dyspraxia
Inability to manipulate objects despite no motor/sensory loss
What is dysphasia
Unable to ‘find the words’ / comprehend what is said
What is agnosia
Failure to recognize familiar noises/ objects despite sensory modalities
What is dysexecutive syndrome
Inability to carry out activities to do with decision making - involves developing plans, setting goals and maintaining attention
What are behavioural and pyschological symptoms of dementia
Symptoms of disturbed perception, thought content and mood and behaviour that frequently occur in pts with dementia
What are the psychological sx of BPSD (4)
Hallucinations, delusions, anxiety and depression
What are the behavioural sx of BPSD (7)
Screaming, agitation, cursing, sexual disinhibition, wandering, shadowing, aggression
What are the risk factors of dementia (6)
Smoking - mental decline + atherosclerosis
Alcohol
Genetics
Mild cognitive impairment
Age - esp alzheimers / vascular
Atherosclerosis - increase risk of vascular and maybe alzheimers - htn, hypercholersteremia, diet high in sat fats, low physical activity, cvs disease, diabetes
What is cortical and subcortical dementia
Cortical - language, thinking, social and memory
Subcortical - emotional, movement and memory
Sx of alzheimers
Earliest sx- short term memory loss and errors of judgement
Progression - language skills, difficulty with daily functioning and familiar tasks, wandering, agitation
End stages- incontinence, intense level of care, communication severely impaired
Pathophysiology of alzheimers
- loss of synaps and neurons in the cerebral cortex and certain subcortical regions
- gross atrophy of affected regions- temporal, parietal, cingulate gyrus, frontal cortex
- ventricles get enlarged
- formation of b amyloid placques - stops cell to cell signalling/ activated immune system causing inflammation and cell death in the brain
- excess of tangles - made up of fibres of tau protein - breaks down the transport system of the cell - falls apart and cell dies
DSM - IV criteria of alzheimers (6)
Memory deficit that can be demonstrated on objective test, impairment of one more cognitive function - aphasia, atraxia, agnosia or executive functioning, gradual onset and progressive course, no other medical/neuro cause, reduced ability to do daily activities, decline from previous level of functioning
What is vascular dementia
Lack of blood supply to the brain, M>W, potentially preventable, higher mortality than alzheimers, increase w/ age
What are the subtypes of vascular dementia
Post stroke dementia
Multi infarct dementia - step wise gradual decline after series of small strokes in cerebral cortex
Subcortical vascular dementia - effects inner parts of the brain, more likely w/ htn or demyelination of nerve sheaths, if widespread then called binswangers disease
What are the symptoms of vascular dementia (11)
Memory problems may be less apparent early on, step wise decline in stable disease and then sudden deteriorations, incontinence, seizures, behaviour changes, visual impairment with problems of perception, emotional lability, depression, difficulty in conc and comm, s&s of stroke, early gait disturbance unsteadiness falls
NINDS Airen criteria for vascular dementia (3)
Cognitive decline with memory impairment + impairment in further cognitive domain, cerebrovascular disease on imaging and clinical judgement, limitation with activities of daily living not due to the physical effects of stroke alone
