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….
What AMT score would you be concerned over?
Less than or equal to 6.
What is the difference between dementia and delirium?
Dementia:
- Onset = gradual (months)
- Course = progressively worse
- LOC = Alert
- Thoughts = Reduced
- Hallucinations = sometimes
Delirium:
- Onset = Acute (hours/days)
- Course= fluctuant
- LOC= Impaired
- Thoughts = Complicated and vivid
- Hallucinations = very common - visual
How does one assess capacity in someone?
1) Understand the information
2) Retain the information
3) Weight up benefits and risks (of receiving care)
4) Communicate a decision
( It is TIME and DECISION specific)
What are the main principles of the mental capacity act?
1) Presumed to have capacity
2) Steps taken to help you make decision
3) An unwise decision does not mean you lack capacity
4) Decisions must be in your best interest
5) Decisions and actions must be as least restrictive as possible
If someone lacks capacity, how is decision making done?
1) Consider family options (Lasting Power of Attorney)
2) Any Advanced Directives made?
3) If no family: Consider Independent Mental Capacity Advocate (IMCA) and the persons best interests
4) If time is critical, act in the persons best interest
What is a Independent Mental Capacity Advocate (IMCA)?
Legal safeguard for people who lack the capacity to make specific important decisions. Represent someone when there is no such family member or friend.
