Dementia Flashcards

1
Q

Define dementia?

A

“severe impairment or loss of intellectual capacity and personality integration, due to the loss of or damage to neurons in the brain”

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2
Q

What are the diagnostic criteria for dementia?

A
  1. Evidence if impaired memory + 1 of the following:
    - Language impairment
    - Apraxia
    - Agnosia
    - Impairment of executive functioning
  2. Impairment of functioning
  3. No other psychiatric or medical cause
  4. Duration > 6 months
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3
Q

Name the main types of dementia?

A
Alzheimers 62%
Vascular 17%
Mixed 10%
Lewy Body 4%
Frontotemporal 2%
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4
Q

What are the early, medium and late symptoms of dementia?

A

Early:
Short term memory loss
Repetition of questions
Difficulty embracing change

Medium term:
Difficulty with daily tasks
Needs prompting
Failure to recognise people

Late:
Personality change (aggression)
Incontinence
Weight loss
Decline in speech
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5
Q

Describe some features to help you differentiate between the different types of dementia?

A

Alzhiemer’s: slow development, most common

Vascular: Medium onset 6 months, or suddenly in the case of stroke, should be able to see a deficit on a head scan

Lewy Body: Parkinson’s features, visual hallucinations, fluctuating during the day.

Other features of LBD are: falls, syncope, increased sensitivity to antipsychotics and abnormalities in rem sleep behaviour

Fronto-temporal:
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

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6
Q

What is the difference between delirium and dementia?

A

Delirium is an acute confusional state which is fluctuating and has an underlying organic cause.

Dementia is a chronic degenerative condition with no reversible organic cause.

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7
Q

What are the 4 key features of delirium and what is needed for a diagnosis?

A
  1. Acute onset and fluctuating time course
  2. Inattention (easily distracted)
  3. Disorganised thinking
  4. Altered level of consciousness

1, 2 and either 3 or 4 are needed for a diagnosis

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8
Q

What are the differentials which should be considered for dementia? (8)

A
Brain:
SOL
Sub dural haemorrhage
Delirium
Normal Pressure Hydrocephalus 
Vitamin deficiency:
Thiamine deficiency 
B6 deficiency (pellagra)
B12 deficiency

Hypothyroidism
Iatrogenic
Heavy Metal poisoning

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9
Q

Outline an investigation plan to exclude treatable causes of dementia?

A

Bedside: Urinalysis + send MSU

Bloods: FBC, U&E, LFT, CRP, TFTs, glucose, Ca2+ B12 and folate (red cell folate).

Head CT to rule out any SOL, haemorrhage, or normal pressure hydrocephalus (shows ventricular enlargement)

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10
Q

Describe the presentation of normal pressure hydrocephalus?

A

Dementia: with memory loss and inattention being prominent symptoms

Incontinence: usually urinary but may also be bowel

Gait disturbance: slow, broad based shuffling gait. May present as a fall.

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11
Q

Describe the non pharmacological management of dementia?

A

MDT approach

Should involve patient education at an early stage of the disease so that they can make decisions about there future care.

Cognitive stimulation programmes are thought to help slow progression of certain types of dementia.

Treatment should aim to be in the community; there should be good communication between secondary care team and carers.

If dementia is due to a vascular cause lifestyle measures such as smoking cessation, balanced diet and exercise should be encouraged.

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12
Q

Describe the pharmacological management of Alzheimer’s disease?

A

AChE inhibitors:
Donepezil
Galantamine
Rivistigamine

NMDA receptor antagonists:
Memantine

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13
Q

What are the indications for medication in dementia?

A

AChE inhibitor:

  • Mild Alzheimers.
  • Can also be considered for LBD
  • Note: may worsen FTD

NMDA receptor antagonist:

  • Mild to moderate alzheimer’s where AChE inhibitors cannot be used.
  • Severe alzheimer’s
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