Dementia Flashcards
List 3 diagnostic criteria for dementia
History of global cognitive decline lasting months-years - with respect to previous cognition
Decline in level of function
No evidence of reversible cause
Give 3 examples of cognitive assessment tools
ACE-3
MoCA
FAB
Who carries out a cognitive performance test?
Occupational Therapy
What is a cognitive performance test?
Observing the patient carrying out daily living activities e.g. dressing, washing, shopping etc
Estimates their ability to live at home based on their cognition
What are the key features of Alzheimer’s Disease?
Memory Loss
Dysphasia
Dyspraxia
Agnosia
What is the definition of dementia?
A syndrome of irreversible progressive and global intellectual deterioration without the impairment of consciousness
What is the incidence of dementia in >65y/o
6%
List some reversible causes of cognitive impairment:
Alcohol Medication Brain lesions Depression endocrine disorders Delirium
What scores would suggest mild cognitive impairment in ACE-III and MoCA tests?
80-90 ACE-III
24-26 MoCA
How often should you repeat cognitive assessments if patients show mild impairment?
Yearly
What are the main features of Alzheimer’s disease?
Memory loss (short term)
Dysphasia
Dyspraxia
Agnosia
What might be seen on a CT of a patient with Alzheimer’s?
Normal or Medial temporal lobe atrophy or Temporoparietal Atrophy
What class of medications can be used in the treatment of Alzheimer’s disease?
Cholinesterase Inhibitors
Give some examples of cholinesterase inhibitors:
Donepezil
Rivastigmine
Galantamine
What is the main role of cholinesterase inhibitors?
Slow cognitive decline
What must be checked before prescribing or changing the dose of cholinesterase inhibitors?
Pulse
When are cholinesterase inhibitors contra-indicated?
Active peptic ulcer disease
Severe asthma / COPD
Other than cholinesterase inhibitors, what is another drug licensed for Alzheimer’s disease?
Memantine
When should you start memantine?
Moderate dementia
What symptoms are much more common in Vascular Dementia than Alzheimer’s?
Dysphasia
Dyscalculia
Frontal lobe symptoms
Affective symptoms
What will be seen on an MRI/CT of a patient’s brain who has vascular dementia?
Moderate - severe small vessel disease
Multiple lacunar infarcts
What are the three main syndromes of frontotemporal dementia?
- Behavioral variant
- Primary progressive aphasia
- Semantic dementia
Give the symptoms of behavioral variant syndrome associated with frontotemporal dementia?
Behavioral changes Executive dysfunction inhibition Impulsivity Loss of social skills Apathy Obsessions Change in diet
Explain the primary progressive aphasia seen in frontotemporal dementia:
Effortful non-fluent speech
Speech sound/articulatry errors
Lack of grammar
Lack of words
Explain what is meant by semantic dementia seen in frontotemporal dementia:
Impaired understanding of meaning of words
Fluent but empty speech
Difficulty retrieving names
How many patients with Parkinson’s will develop Parkinson’s dementia?
80% (by 15-20 years)
How long must a patient have had Parkinson’s for it to be considered Parkinson’s dementia?
At least 1 year
What is the typical pattern of dementia in Lewy Body Dementia (DLB)
Early involvement of reduced attention, executive function and visuospatial skills
List the criteria that a patient with DLB must have at least 2 of to meet the diagnosis:
Visual hallucinations Fluctuation cognition REM sleep behavior disorder Parkinsonism (at least 1 year) Positive DAT scan
What is a DAT scan?
Dopamine Active Transporter Scan
Diagnostic for lewy body and Parkinson’s dementia
What type of scan is most useful for frontotemporal dementia?
SPECT scan
What type of scan is most useful if the patient is young, showing rapid progression or has atypical features?
MRI
Other than Alzheimer’s what other forms of dementia can be treated with cholinesterase inhibitors?
Parkinson’s
Lewy Body
What are some non-cognitive psychological symptoms of Dementia’s?
Irritability Aggression Hallucinations Wondering Mood disturbances
In dementia, is neuronal involvement asymmetrical or symmetrical?
Symmetrical degeneration
This is what differentiates it from MS etc
What is another name for frontotemporal dementia?
Picks disease
What macroscopic pathological changes are seen in Alzheimer’s?
Decreased size & weight of brain Atrophy of lobes Widening of sulci Narrowing of gyri Compensatory dilation of ventricles
What lobes of the brain are typically spared in Alzheimer’s?
Occipital
Cerebellum
Brainstem
What 2 microscopic abnormalities are associated with Alzheimer’s?
Neurofibrillary tangles
Neuritic plaques
Why are people with Down’s syndrome more likely to develop Alzheimer’s?
Amyloid precursor protein (APP) is coded for on chromosome 21
APP is linked to Alzheimer’s disease - creates neuritic plaques
What test is positive for amyloid?
Congo red staining
