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Psychiatry > Dementia > Flashcards

Dementia Flashcards

1
Q

List 3 diagnostic criteria for dementia

A

History of global cognitive decline lasting months-years - with respect to previous cognition
Decline in level of function
No evidence of reversible cause

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2
Q

Give 3 examples of cognitive assessment tools

A

ACE-3
MoCA
FAB

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3
Q

Who carries out a cognitive performance test?

A

Occupational Therapy

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4
Q

What is a cognitive performance test?

A

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

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5
Q

What are the key features of Alzheimer’s Disease?

A

Memory Loss
Dysphasia
Dyspraxia
Agnosia

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6
Q

What is the definition of dementia?

A

A syndrome of irreversible progressive and global intellectual deterioration without the impairment of consciousness

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7
Q

What is the incidence of dementia in >65y/o

A

6%

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8
Q

List some reversible causes of cognitive impairment:

A 
Alcohol
Medication
Brain lesions
Depression
endocrine disorders 
Delirium
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9
Q

What scores would suggest mild cognitive impairment in ACE-III and MoCA tests?

A

80-90 ACE-III

24-26 MoCA

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10
Q

How often should you repeat cognitive assessments if patients show mild impairment?

A

Yearly

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11
Q

What are the main features of Alzheimer’s disease?

A

Memory loss (short term)
Dysphasia
Dyspraxia
Agnosia

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12
Q

What might be seen on a CT of a patient with Alzheimer’s?

A 
Normal 
or
Medial temporal lobe atrophy 
or
Temporoparietal Atrophy
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13
Q

What class of medications can be used in the treatment of Alzheimer’s disease?

A

Cholinesterase Inhibitors

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14
Q

Give some examples of cholinesterase inhibitors:

A

Donepezil
Rivastigmine
Galantamine

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15
Q

What is the main role of cholinesterase inhibitors?

A

Slow cognitive decline

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16
Q

What must be checked before prescribing or changing the dose of cholinesterase inhibitors?

A

Pulse

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17
Q

When are cholinesterase inhibitors contra-indicated?

A

Active peptic ulcer disease

Severe asthma / COPD

18
Q

Other than cholinesterase inhibitors, what is another drug licensed for Alzheimer’s disease?

A

Memantine

19
Q

When should you start memantine?

A

Moderate dementia

20
Q

What symptoms are much more common in Vascular Dementia than Alzheimer’s?

A

Dysphasia
Dyscalculia
Frontal lobe symptoms
Affective symptoms

21
Q

What will be seen on an MRI/CT of a patient’s brain who has vascular dementia?

A

Moderate - severe small vessel disease

Multiple lacunar infarcts

22
Q

What are the three main syndromes of frontotemporal dementia?

A
  • Behavioral variant
  • Primary progressive aphasia
  • Semantic dementia
23
Q

Give the symptoms of behavioral variant syndrome associated with frontotemporal dementia?

A 
Behavioral changes
Executive dysfunction inhibition
Impulsivity 
Loss of social skills
Apathy
Obsessions
Change in diet
24
Q

Explain the primary progressive aphasia seen in frontotemporal dementia:

A

Effortful non-fluent speech
Speech sound/articulatry errors
Lack of grammar
Lack of words

25
Q

Explain what is meant by semantic dementia seen in frontotemporal dementia:

A

Impaired understanding of meaning of words
Fluent but empty speech
Difficulty retrieving names

26
Q

How many patients with Parkinson’s will develop Parkinson’s dementia?

A

80% (by 15-20 years)

27
Q

How long must a patient have had Parkinson’s for it to be considered Parkinson’s dementia?

A

At least 1 year

28
Q

What is the typical pattern of dementia in Lewy Body Dementia (DLB)

A

Early involvement of reduced attention, executive function and visuospatial skills

29
Q

List the criteria that a patient with DLB must have at least 2 of to meet the diagnosis:

A 
Visual hallucinations
Fluctuation cognition
REM sleep behavior disorder
Parkinsonism (at least 1 year)
Positive DAT scan
30
Q

What is a DAT scan?

A

Dopamine Active Transporter Scan

Diagnostic for lewy body and Parkinson’s dementia

31
Q

What type of scan is most useful for frontotemporal dementia?

A

SPECT scan

32
Q

What type of scan is most useful if the patient is young, showing rapid progression or has atypical features?

A

MRI

33
Q

Other than Alzheimer’s what other forms of dementia can be treated with cholinesterase inhibitors?

A

Parkinson’s

Lewy Body

34
Q

What are some non-cognitive psychological symptoms of Dementia’s?

A 
Irritability
Aggression
Hallucinations
Wondering
Mood disturbances
35
Q

In dementia, is neuronal involvement asymmetrical or symmetrical?

A

Symmetrical degeneration

This is what differentiates it from MS etc

36
Q

What is another name for frontotemporal dementia?

A

Picks disease

37
Q

What macroscopic pathological changes are seen in Alzheimer’s?

A 
Decreased size & weight of brain
Atrophy of lobes
Widening of sulci
Narrowing of gyri
Compensatory dilation of ventricles
38
Q

What lobes of the brain are typically spared in Alzheimer’s?

A

Occipital
Cerebellum
Brainstem

39
Q

What 2 microscopic abnormalities are associated with Alzheimer’s?

A

Neurofibrillary tangles

Neuritic plaques

40
Q

Why are people with Down’s syndrome more likely to develop Alzheimer’s?

A

Amyloid precursor protein (APP) is coded for on chromosome 21
APP is linked to Alzheimer’s disease - creates neuritic plaques

41
Q

What test is positive for amyloid?

A

Congo red staining

Psychiatry (15 decks)

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