Dementia Flashcards
cog abilities ^ until age ___
30
types of dementia:
alzheimer’s, vascular dementia, lewy body dementia, frontotemporal dementias, other
how to diagnose dementia
med exam to rule out other causes, significant cognitive decline via neuropsych assessment, interference with independence, not due to delirium, not due to other mental disorder
neurocog domains:
complex attention, executive function, learning and memory, language, perceptual-motor, social cognition
most common type of dementia with memory decline predominant feature, plaques and tangles, impaired judgement/reasoning/language
alzheimer’s
second most common type of dementia, damage to brain cells cuz stroke/TIA/damaged BV/circulation, executive function impairments, stepwise progression (cortical presentation, subcortical insidious)
vascular
other dementias associated with:
parkinson’s, huntington’s, head trauma, HIV, alcohol, CJD, corticobasal degeneration, progressive supranuclear palsy
3 variants of progression:
behavioural, progressive non-fluent, semantic
lewy bodies are :
a protein (alpha-synuclein)
dementia cuz lewy bodies characterized by:
fluctuating cognition, attention, hallucinations, parkinsonism, REM sleep disorder, antipsychotic sensitivity, frequent falls, excessive sleepiness
typically young onset (<65), memory preserved, behavioural/language presentations, misdiagnosed as psychiatric
FTD (frontotemporal dementia)
why need to know underlying cause?
treat symptoms and slow progression (although there is no cure)–>2ndary and tertiary prevention
what does BPSD stand for?
behavioural and psych symptoms of dementia
BPSD for alzheimers:
memory loss, cog impairments, decreased sense of smell, decreased oral health, repetitive actions, irritable/agitated, loss of appetite, dyspraxia
BPSD of vasular
affective disturbances and agitation, apathy, depressive, low motivation, motor difficulties, paranoia/delusions, diurnal rhythm disturbance, emotional lability, irritability
BPSD of lewy body disease
fluctuating cognition/alertness, sleep disturbances, issues with judgement, decreased concentration/attention, visual/auditory hallucinations, physical fx difficulties
BPSD of frontotemporal lobar degeneration
eating disturbances such as binge eating, perseverated eating, overeating; change in taste preference to predominantly sweet flavor, disinhibition and socially inappropriate behaviour, poor judgement and impulsivity, difficulty with motor coordination, hyperorality and hyperphagia
why wt loss common symptom?
damage to brain cause ^ energy expenditure and ^ pro-inflammatory cytokines, inflammation, oxidative stress; behavioural factors ; socioenviro factors
clinical syndrome meeting 3+ of 5 criteria (weakness, slowness, low lvl activity, exhaustion, unintentional wt loss)
frailty phenotype
cumulative deficits model
frailty index
frailty is an _____ of dementia, and vice versa
independent predictor
goals of nutr care and dementia
maintain quality of life, preserve fx, prevent decline
how to monitor
wt, functional status, BPSD and impacts, quality of life, goal attainment scaling
non modifiable risk factors for dementia
age, familial and genetic risk factors, family history of cognitive complaint
modifiable risk factors
obesity, DM, cardiac disease, CKD, hypertension, hyperlipidemia, smoking, depression
protective factors to prevent dementia:
physical activity, mediterranean style diet, veg/fruit consumption, cognitive activity, social activity
what is MIND diet?
3+ servings whole grain a day, one dark green salad and one other vegetable each day, berries 2+ times a wk, 1 oz nuts each day, beans/legumes, poultry, fish, red wine, limit butter and replace with olive oil, limit cheese/fried/fast food, limit sweets
