Dementia Flashcards
What are irreversible causes of dementia?
- Alzheimer’s
- Diffuse vascular disease
- Lewy-body dementia
- Fronto-temporal
- Mixed
What are reversible causes of dementia?
- Subdural haematoma
- Hydrocephalus
- Hypothyroidism
What is required for a diagnosis of dementia?
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
Using the MSE, what are the symptoms of dementia?
- Behaviour: restless, repetitive and purposeless activity, rigid, fixed routines
- Personality changes: sexual disinhibition, social gaffes*, shoplifting, blunting
- Speech: syntax errors, dysphasia, mutism
- Thinking: slow, muddled, poor memory (w confabulations), no insight
- Perception: illusions, hallucinations
- Mood: irritable, depressed, labile mood and crying
What are the Ix of dementia? explain the rationale behind them
- FBC, B12, folate (increased MCV suggests alcoholism or reduced B12/folate)
U&E, LFT, gamma GT - Ca - renal/hepatic failure, alcoholism, malignancy
- TSH - hypothyroidism
- Serology: syphilis, HIV
- CT/MRI - excludes tumours, hydrocephalus, subdural, stroke
What is the general management in regards to law w the patient?
Advance statements - what they wish to be done if they lose capacity
Advance decisions - refusing rx in future
Lasting power of attorney
Explain the poss. pharmacological rx of dementia
Acetylcholinesterase inhibitors (rivastigmine, donepezil, galantamine) for MILD-MOD ALZHEIMERS
Memantine for mod Alzheimers if AChEi CI
or for SEVERE alzheimers
How do Acetylcholinesterase inhibitors work?
by inhibiting the enzyme that causes the breakdown of acetylcholine (activates muscles, supports cognitive functions)
What is the mean survival of Alzheimers?
7 yrs from diagnosis
How do people usually die from Alzheimers?
bronchopneumonia
What is the pathophysiology of Alzheimers?
amyloid plaques build up in the brain causing reduction in cholinergic transmission and later reduction in synthesis of acetylcholine
What are the 4 A’s of amnesia?
agnosia - inability to process sensory info
amnesia
aphasia - inability to speak
apraxia - inability too perform learned movements
What is the pathophysiology behind vascular dementia?
result of many small infarcts
What is the typical course of vascular d?
stepwise progression w drops in function
What is the management of vascular d?
- Aspirin/warfarin therapy
- Control BP
- Anticholinesterases