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Psychiatry > Dementia > Flashcards

Dementia Flashcards

1
Q

What is the ICD 10 definition of dementia?

A 
A decline in higher cortical functioning, including:
1. Memory
2. Orientation
3. Language
4. Emotions
5. Reasoning
6. Comprehension
With no clouding of consciousness
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2
Q

What is required for diagnosis of dementia?

A

Multiple cognitive defects that result in significant impairment in ADLs with clear consciousness that is chronic and progressive over 6 months.

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3
Q

What is cognitive impairment below this threshold called?

A

Mild Cognitive Impairment (MCI)

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4
Q

What is the pathophysiology of ALzheimers?

A

Deposits of insoluble beta amyloid peptide plaques in the hippocampus, amygdala and cerebral cortex. This is a normal protein, but balance of production and clearance is deranged.
Also neurofibrillary tangles in hippocampus, amygdala and Substantia Nigra. These also found in those with downs and normal ageing.
COMBINATION OF THE TWO= Alzheimers.
Overall both cause a loss of cortical Acetylcholine

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5
Q

What are the chromosomes involved in Alzheimers?

A

1
14
19
21

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6
Q

Early Symptoms:

A 
Worsening memory and orientation
Muddled ADLs
Wandering 
Irritability
(THINK STILL ALICE)
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7
Q

What are the 4 As of cognitive decline?

A

Apraxia
Agnosia
Aphasia
Amnesia

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8
Q

What are symptoms of Alzheimers?

A 
Aphasia
Apraxia so cant dress self
Incontinence
Gait abnormality
Weight loss
Tremor
Spasticity
EPSEs
Reduced executive functioning
Coarsened affect
Egocentricity
Paranoid Delusions
Auditory and visual hallucinations
Misidentification 
DEPRESSION
Aggressive
Sexually disinhibited
Searching behaviour
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9
Q

What are indicators for poor prognosis in Alzheimers?

A 
Late diagnosis
Male
Early Onset
Parietal lobe damage
Prominent behavioural issues
Apraxia
Depression
Absence of Misidentification
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10
Q

What investigations would you do in Alzheimers?

A 
MSE
Cognitive testing
Examine reflexes
FBC
U+E
Glucose
ESR
TSH
Ca
Mg
Phosphate
Syphilis serology
Vitamin B and folate
CRP
EEG to exclude delirium and Creutzfold Jakob disease
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11
Q

What does imaging show in Alzheimers?

A

CT: cortical atrophy (parietal and temporal) and ventricular enlargement
MRI: atrophy of grey matter in hippocampus, amygdala and temporal lobes
SPET: reduced blood flow
PET: 20-30% reduction in glucose and oxygen perfusion of temporal and parietal lobes

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12
Q

What is the main risk factor for Alzheimers?

A

Age

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13
Q

What are protective factors for Alzheimers?

A

HRT
NSAIDs
Vit E
Education

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14
Q

How can you treat Alzheimers? Name drug classes, mechanism and names.

A
  1. Acetycholineesterase Inhibitors- increase ACh: DONEPEZIL, RIVASTIGMINE, GALANTAMINE
  2. NMDA antagonise reduces Glutamate which is damaging- MEMANTINE
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15
Q

What is the effect of Alzheimers treatment on life expectancy and cure?

A

None, just slow rate of decline

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16
Q

What are the 3 kinds of vascular dementia causes?

A
  1. Stroke
  2. Progressive Small Vessel Disease
  3. Multi- infarct dementia
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17
Q

What happens in progressive small vessel disease to cause dementia?

A

Multiple infarcts leading to progressive lacunae formation and white matter leukaryosis on MRI. This causes a gradual intellect decline.

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18
Q

What areas of the brain do strokes cause dementia in?

A

Mid brain or thalamic strokes

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19
Q

What are the signs of a vascular dementia?

A 
Stepwise decline
Focal neurological signs
Expressive dysphasia
Prone to CVAs
Early emotional and personality change
Followed by functional change which fluctuates
Depression with confusion early evening
Some have seizures, pseudobulbar palsy, rigidity, akathisia
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20
Q

What is the lifespan with vascular dementia?

A

5 years.

21
Q

What repeated investigations must be done in vascular dementia?

A

Regular CTs
BP
Cholesterol
BMs

22
Q

What are treatments for Vascular Dementia?

A

Statin
Antihypertensive
Aspirin
Diabetes treatment

23
Q

What symptoms are characteristic of Lewy Body Dementia?

A
  1. Fluctuating onset and cognition
  2. Recurrent visual hallucinations (well formed, complex and detailed)
  3. Spontaneous motor features of Parkinsonism
    Fluctuations in alertness and cognition
    REM sleep disorders
    Also supportive:
    Syncope, falls, TLC, neuroleptic sensitivity, delusions and hallucinations in other modalities, depressive episodes
24
Q

How fast does Lewy Body Dementia progress?

A

Similar rate to Alzheimers and motor features at a similar rate to Parkinsons.

25
Q

What is the pathophysiology of Lewy Body Dementia?

A

Lewy Bodied in Basal ganglia and cortex
Alzheimers changes present
Neurone loss in basal ganglia and brainstem
Reducing ACh transmission
Neuritic degeneration in substantia nigra and hippocampus

26
Q

What percentage of people with Parkinsons get Lewy Body Dementia?

A

25%- when people with Parkinsons get dementia its Parkinsons dementia

27
Q

What is the management of Lewy Body Dementia?

A

Little that is effective
Antipsychotics can worsen Parkinsonism irreversibly, impair consciousness and cause NMS
AChE-Is are not NICE recommended but can improve
Clonazepam for sleep disturbances

28
Q

What age is the onset of Fronto Temporal Dementia?

A

50s and 60s

29
Q

What is the other name for Fronto Temporal Dementia?

A

Pick’s Disease

30
Q

What are the presenting early symptoms of Fronto Temporal Dementia?

A 
Personality change and spared intellect:
Apathy
Disinhibition
Emotional Blunting
Decreased sociability
31
Q

What are the later signs of Pick’s Disease?

A

Language: Echolalia, mutism and verbal stereotypes
Worse intellectual functioning
Parkinsons signs: akinesia, tremor, rigidity
Low and labile BP
Incontinence
MND signs in some cases

32
Q

What are the macroscopic structural changes in Pick’s disease?

A

Bilateral atrophy of frontal and anterior temporal lobes and degeneration of striatum

33
Q

What are the 3 microscopic types of Fronto Temporal Dementia?

A
  1. Loss of cortical nerve cells, spongiform degeneration with no swelling
  2. Pick’s type- Loss of large cortical nerve endings, widespread gliosis, minimal spongiform change and swollen neurones in limbic system.
  3. MND associated
34
Q

What is the recommended treatment for Fronto Temporal Dementia?

A

Currently none

SSRIs for behaviour

35
Q

What is the prion disease associated with dementia?

A

Creutzfold Jakob Disease

36
Q

How and how fast does Creutzfold Jakob disease develop?

A

Develops and progresses fast and spontaneously with multifocal spongy atrophy causing dementia, cerebellar and EP signs, myoclonus and death in a year

37
Q

What does an EEG show for prion disease?

A

Periodic complexes

38
Q

When does Huntingtons disease onset?

A

After person has reproduced

39
Q

What are the signs of Huntingtons?

A

Progressive dementia and worsening chorea.

40
Q

What chromosome is Huntingtons affected by?

A

4

41
Q

What is the inheritance pattern in Huntingtons?

A

Autosomal Dominant

42
Q

What is the pathophysiology of Huntingtons?

A

Decreased GABA neurons in the basal ganglia leading to increased stimulation of the thalamus and cortex

43
Q

What are the psychiatric symptoms in Huntingtons?

A 
Depression
Anxiety
Psychosis early
Agression
Apathy
Violence
Amnesia
44
Q

what is the life expectancy of Huntingtons?

A

10-12 years from onset

45
Q

What are 2 infective causes of dementia?

A

HIV

Neurosyphilis

46
Q

What chromosome is Wilson’s disease on?

A

13

47
Q

Where in the brain do copper deposits form in Wilsons?

A

Basal Ganglia

48
Q

What is the treatment for Wilsons?

A

Penecillamine

49
Q

How do you detect Wilsons?

A

Cu in urine and plasma

Decreased caeruloplasmin

Psychiatry (13 decks)

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