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HCOLL > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia

A

Severe impairment or loss of intellectual capacity or personality integration - due to loss of / damage to neurons in the brain

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2
Q

What are the reversible causes of cognitive impairment? (12)

A 
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
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3
Q

What do you consider on physical exam for cognitive impairment (6)

A

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

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4
Q

Investigations cognitive impairment

A 
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
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5
Q

Presentation of cognitive impairment

A

Impairment of memory AND 1 of language skills, executive function, agnosia, apraxia
Impairment of functioning
6+ months
No other medical/ psych explanation

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6
Q

Early sx of cognitive impairment

A

Short term memory loss, repeating questions, difficulty embracing change

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7
Q

Middle sx of cognitive impairment

A

Failure to recognise faces, need prompting, difficulty with daily tasks

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8
Q

Late sx of cognitive impairment

A

Weight loss, incontinence, aggression, decline in speech

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9
Q

What is dyspraxia

A

Inability to manipulate objects despite no motor/sensory loss

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10
Q

What is dysphasia

A

Unable to ‘find the words’ / comprehend what is said

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11
Q

What is agnosia

A

Failure to recognize familiar noises/ objects despite sensory modalities

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12
Q

What is dysexecutive syndrome

A

Inability to carry out activities to do with decision making - involves developing plans, setting goals and maintaining attention

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13
Q

What are behavioural and pyschological symptoms of dementia

A

Symptoms of disturbed perception, thought content and mood and behaviour that frequently occur in pts with dementia

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14
Q

What are the psychological sx of BPSD (4)

A

Hallucinations, delusions, anxiety and depression

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15
Q

What are the behavioural sx of BPSD (7)

A

Screaming, agitation, cursing, sexual disinhibition, wandering, shadowing, aggression

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16
Q

What are the risk factors of dementia (6)

A

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

17
Q

What is cortical and subcortical dementia

A

Cortical - language, thinking, social and memory

Subcortical - emotional, movement and memory

18
Q

Sx of alzheimers

A

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

19
Q

Pathophysiology of alzheimers

A
  1. loss of synaps and neurons in the cerebral cortex and certain subcortical regions
  2. gross atrophy of affected regions- temporal, parietal, cingulate gyrus, frontal cortex
  3. ventricles get enlarged
  4. formation of b amyloid placques - stops cell to cell signalling/ activated immune system causing inflammation and cell death in the brain
  5. excess of tangles - made up of fibres of tau protein - breaks down the transport system of the cell - falls apart and cell dies
20
Q

DSM - IV criteria of alzheimers (6)

A

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

21
Q

What is vascular dementia

A

Lack of blood supply to the brain, M>W, potentially preventable, higher mortality than alzheimers, increase w/ age

22
Q

What are the subtypes of vascular dementia

A

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

23
Q

What are the symptoms of vascular dementia (11)

A

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

24
Q

NINDS Airen criteria for vascular dementia (3)

A

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

25
Q

Lewy body dementia pathophysiology

A

Lewy body made of protein alpha synuclein - disrupts brains functioning by disrupting the activity of ACH and dopamine
Causes degeneration of cortex
Shrinkage of brain - mainly affects parietal, temproal and cingulate gyrus
If in substantia nigra - parkinsons

26
Q

Sx of lewy body (6)

A

Features of parkinsonism
Fluctuating cognition - if within a year of parkinsonism - likely to be LBD
Visual hallucinations - not always distressing, but detailed and complex
REM sleep behaviour - act/speak/move
Falls, syncope
Sensitivity to neuroleptics - may develop parkinsonism

27
Q

McKeith criteria for lewy body

A

Progressive cognitive decline
Reduced ability to perform ADLs
Deficits on tests of attention and frontal sub cortical skills and visuospatial ability
1/2 of : Fluctuating cognition with pronounced variations in attention and alertness, recurrent visual hallucinations well formed and detailed, spontaneous motor features of parkinsonism

28
Q

Pathophysiology and epidemiology of frontotemporal dementia

A

<65, can happen in 20-30, 1 in 500, Fhx, lasts 10-15 years
Degeneration of frontal and temporal lobes
Effects language, emotion and behaviour
Involves abnormal tau protein aggregation in brain cells

29
Q

Symptoms of frontotemporal dementia (9)

A

In early stages - cognition intact
Behaviour changes - extroverted and disinhibited
Eating changes - overindulge/ sweet tooth/ hyperphagia
Language changes- word finding difficult, reduced speech
Primitive reflexes
Decline in personal hygiene and grooming
Incontinence
Akinesia
Tremor

30
Q

Lund Manchester criteria of frontotemporal dementia (5)

A

Insidious onset and gradual progression
Early decline in social interpersonal conduct
Early impairment in regulation of personal conduct
Early emotional blunting
Early loss of insight

31
Q

Parkinsons disease dementia - about

A

Cognitive profile + extra pyramidal effects timing critical
Typical PD - unilateral for a few years then subsequent decline in cognitive function. If bilateral + early cognitive decline - think LBD
30% of PD patients have dementia
Psychotic symptoms may be exacerbated by anti parkinson meds

32
Q

Management of BPSD (11)

A

Non pharmacological, family incl carers, encourage conversation, communication - short sentences non complex intstructions non verbal cues gentle touch, hallucinations - dont rebuke or contraindicate, orientation - encourage and help, mobility - esp safety, no sensory barriers - visual/ hearing, familiarity - stimulation on ward eg family pics and music, social services and care plan, pharmacological - senna for consitpation, citalopram for depression, paracetamol for pain, zopiclone for sleep, antipsychotic - risperidone but not in LBD / parkinsons

33
Q

Management of BPSD (11)

A

Non pharmacological, family incl carers, encourage conversation, communication - short sentences non complex intstructions non verbal cues gentle touch, hallucinations - dont rebuke or contraindicate, orientation - encourage and help, mobility - esp safety, no sensory barriers - visual/ hearing, familiarity - stimulation on ward eg family pics and music, social services and care plan, pharmacological - senna for consitpation, citalopram for depression, paracetamol for pain, zopiclone for sleep, antipsychotic - risperidone but not in LBD / parkinsons

34
Q

Drugs for alzheimers

A

Acetylcholinesterase inhibitors - rivastigmine, glutamine, donepezil - Inhibits breakdown of achesterase - leaving more ach around in the brain - used in mild- mod, and may be used in LBD
NMDA receptor antagonist - memantine - prevents glutamate from working which is made by breakdown of brain cells and is toxic - severe alzheimers/ if cant use ache inhibitors

HCOLL (2 decks)

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