Dementia Flashcards

1
Q

What are irreversible causes of dementia?

A
  1. Alzheimer’s
  2. Diffuse vascular disease
  3. Lewy-body dementia
  4. Fronto-temporal
  5. Mixed
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2
Q

What are reversible causes of dementia?

A
  1. Subdural haematoma
  2. Hydrocephalus
  3. Hypothyroidism
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3
Q

What is required for a diagnosis of dementia?

A
Impairment in at least two cognitive domains leading to significant functional decline that can’t be explained by another disorder or adverse effects of medication, these domains can be:
•	Memory
•	Language
•	Behaviour
•	Visuospatial
•	Executive function
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4
Q

Using the MSE, what are the symptoms of dementia?

A
  1. Behaviour: restless, repetitive and purposeless activity, rigid, fixed routines
  2. Personality changes: sexual disinhibition, social gaffes*, shoplifting, blunting
  3. Speech: syntax errors, dysphasia, mutism
  4. Thinking: slow, muddled, poor memory (w confabulations), no insight
  5. Perception: illusions, hallucinations
  6. Mood: irritable, depressed, labile mood and crying
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5
Q

What are the Ix of dementia? explain the rationale behind them

A
  1. FBC, B12, folate (increased MCV suggests alcoholism or reduced B12/folate)
    U&E, LFT, gamma GT
  2. Ca - renal/hepatic failure, alcoholism, malignancy
  3. TSH - hypothyroidism
  4. Serology: syphilis, HIV
  5. CT/MRI - excludes tumours, hydrocephalus, subdural, stroke
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6
Q

What is the general management in regards to law w the patient?

A

Advance statements - what they wish to be done if they lose capacity
Advance decisions - refusing rx in future
Lasting power of attorney

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7
Q

Explain the poss. pharmacological rx of dementia

A

Acetylcholinesterase inhibitors (rivastigmine, donepezil, galantamine) for MILD-MOD ALZHEIMERS
Memantine for mod Alzheimers if AChEi CI
or for SEVERE alzheimers

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8
Q

How do Acetylcholinesterase inhibitors work?

A

by inhibiting the enzyme that causes the breakdown of acetylcholine (activates muscles, supports cognitive functions)

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9
Q

What is the mean survival of Alzheimers?

A

7 yrs from diagnosis

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10
Q

How do people usually die from Alzheimers?

A

bronchopneumonia

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11
Q

What is the pathophysiology of Alzheimers?

A

amyloid plaques build up in the brain causing reduction in cholinergic transmission and later reduction in synthesis of acetylcholine

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12
Q

What are the 4 A’s of amnesia?

A

agnosia - inability to process sensory info
amnesia
aphasia - inability to speak
apraxia - inability too perform learned movements

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13
Q

What is the pathophysiology behind vascular dementia?

A

result of many small infarcts

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14
Q

What is the typical course of vascular d?

A

stepwise progression w drops in function

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15
Q

What is the management of vascular d?

A
  • Aspirin/warfarin therapy
  • Control BP
  • Anticholinesterases
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16
Q

What is the pathophysiology of DLB

A

⇒ Presence of cortical and subcortical Lewy bodies

17
Q

How does DLB typically present?

A

repeated falls
transient Loc
parkinsonian features
autonomic dysfunction

18
Q

What occurs in autonomic dysfunction

A

impaired swallowing
incontinence and constipation
postural hypotension

19
Q

When does memory impairment usually occur in DLB?

A

LATER

20
Q

What drug can help treat DLB

A

rivastigmine

21
Q

What is the pathophysiology of frontotemporal dementia?

A

progressive degeneration of the frontal +/- temporal loves

22
Q

What is the typical course FTD?

A

insidious personality change and behavioural disturbance

23
Q

When does FTD typically present?

A

middle age

24
Q

What is early onset dementia?

A

dementia under 65 yrs