Dementia: Flashcards
You suspect a patient may have a form of dementia - what may you use to assess their cognitive state?
- GPCOG
- Mini-mental state examination (MMSE)
- Six-item Cognitive Impairment Test (6CIT)
(dont use AMT score - too short/not effective enough)
What 3 reversible causes may present as Dementia?
- Normal pressure hydrocephalus
- Tumour (meningioma)
- Subdural haematoma
What would you seen on MRI in someone with Alzheimers?
Atrophy, in:
- Hippocampus
- Amygdala
- Temporal neocortex
- Subcortical nuclei
What medication class would you use to manage Alzheimers? Give and example of 2 drugs in this class:
Acetylcholinesterase inhibitors.
E.g. Donepezil, rivastigmine
What would you see on biopsy in someone with Alzheimers?
- Beta-amyloid plaques
- Neurofibrillary tangles
- Loss of acetycholine neuronal damage
In someone with Lewy Body dementia, what would you see on MRI?
Lewy bodies in brainstem and neocortex
What is a prominent feature in Lewy Body dementia which usually isn’t present in other forms?
Visual hallucinations
What pharmaceutical management could be used in Lewy body dementia?
- Antipsychotics
- Acetylcholinesterase inhibitors (e.g. Donepezil, rivastigmine)
Why should antipsychotics be used with caution in those with Lewy Body dementia?
Increase risk of:
- Parkinsonism
- Neuroleptic malignant syndrome
What would you see on biopsy of someone with Lewy Body dementia?
In brainstem and neocortical nuclei:
- Eosinophilic intracytoplasmic neuronal inclusions
- Ubiquitin and alpha-synuclein
- Neuronal loss
What is Lewy body dementia associated with?
Parkinsonism
What features are commonly present in Lewy body dementia?
- Poor sleep
- Fluctuations from day to day in symptoms
- Visual hallucinations
What features are present in Alzheimers?
Global impairment: - Visuo-spatial skill - Memory - Verbal abilities - Executive function Later: - Irritability - Psychosis
What criteria is used to define Vascular dementia?
NINDS-AIREN criteria
What is the progression of vascular dementia like?
Step-wise - due to cerebrovascular events.
What might you see on MRI in someone with vascular dementia?
(cerebrovascular disease)
- Lacunar infarcts
- White matter lesions
What features are typically present in vascular dementia?
- Focal neuro features
- Seizures
- Depression/anxiety
- Disturbance in gait (early)
- Bladder symptoms
What management is useful in those with vascular dementia?
- Addressing CV risk factors
- Cognitive stimulation
What is Fronto-temporal dementia also know as?
Picks dementia
What can be seen of MRI in those with fronto-temporal dementia?
Fronto- temporal atrophy.
No plaque formation.
What features are present in the presentation of fronto-temporal dementia?
- Behavioural changes
- Non-fluent aphasia
- Emotional blunting
What is the management in those with fronto-temporal dementia?
SSRI - behavioural symptoms
Atypical antipsychotic
Speech therapy
Outline the common causes of delirium:
(PICHME - as in ‘I think I’m delirious - PINCH ME’)
P - Pain I - Infection N - Nutrition C - Constipation H - Hydration
M - Medication
E - Environment
What investigations would you perform in someone with delirium?
- ABCDE
- AMT score (abbreviated mental test)
- Search for cause of delirium….
