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CCFP > Dementia > Flashcards

Dementia Flashcards

1
Q

What is a synonym for “Dementia”?

A

Major neurocognitive disorder

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2
Q

Diagnostic criteria for dementia (4)

A
  1. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains both subjectively and objectively reported
  2. Deficits interfere with independent functioning
  3. No delirium
  4. No other more probable diagnosis
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3
Q

Name the cognitive domains (6)

A
  1. Complex attention
  2. Executive function
  3. Learning and memory
  4. Language
  5. Perceptual-motor
  6. Social cognition
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4
Q

Name 6 instrumental activities of daily living

A
  1. Dressing
  2. Eating
  3. Ambulating
  4. Toileting
  5. Hygiene
  6. Showering
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5
Q

Name 7 activities of daily living

A
  1. Shopping
  2. Housework
  3. Accounting
  4. Food preparation
  5. Telephone
  6. Transportation
  7. Taking medication
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6
Q

Differential diagnosis for Memory loss

A
  • Major neurocognitive disorder
  • Mild neurocognitive disorder
  • Delirium
  • Depression
  • Stoke/TIA
  • Seizure
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7
Q

Physical exam for patient with memory loss

A
  • Neurological exam
  • Gait assessment
  • Extrapyramidal symptoms assessment
  • Parkinson’s symptoms (cogwheeling, rigidity, tremors)
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8
Q

Investigations

A
  • Memory testing
  • Depression screening
  • HGB
  • WBC
  • Glucose
  • Creatinine
  • Calcium
  • TSH
  • B 12
  • Syphilis
  • CT Head
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9
Q

Name one investigation to do before initiating pharmacotherapy for dementia

A

EKG

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10
Q

Indications for CT head

A 
< 60 yo
Abrupt, rapid decline
Focal neurological symptoms
Urinary incontinence
Gait disorder
Previous malignancy
Trauma
Anticoagulants or history of bleeding disorder
If presence of cerebrovascular disease would change management
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11
Q

List four memory testing tools

A

MMSE
MOCA
Mini-cog (Clock drawing and 3 word recall)
Hopkins Verbal learning test

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12
Q

MMSE score for diagnosis of major neurocognitive disorder

A

<24/30

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13
Q

MoCA Interpretation

A

27-30 Normal
18-26 Mild impairment
10-17 Moderate impairment
<10 Severe impairment

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14
Q

MMSE Interpretation

A 
26 to 30 Normal
20 To 25 Mild cognitive impairment
10 to 18 moderate cognitive impairment 
3 to 9 severe cognitive impairment 
Less than 3 very severe cognitive impairment
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15
Q

Name possible causes of delirium

A 
Infection
Medications
Thyroid dysregulation
Sodium dysregulation
Glucose abnormalities
Vitamin B 12 deficiency
Pain
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16
Q

Name possible medication causes of Delirium

A 
Polypharmacy
Opioids
Cholinergic and anticholinergic
Benzodiazepines
Antidepressants
Antipsychotics
Steroids
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17
Q

Name 6 types of dementia

A 
Alzheimer’s disease
Vascular dementia
Mixed Alzheimer’s and vascular dementia
Lewy body dementia
Frontotemporal dementia
Parkingson’s disease with dementia
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18
Q

Which is the most common type of dementia?

A

Alzheimer’s disease accounts for 50% of dementia

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19
Q

Is the onset of Alzheimer’s disease gradual or abrupt?

A

Gradual onset

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20
Q

What is the initial and most prominent deficit in Alzheimer’s disease?

A

Amnestic impairment: impairment in learning and recall of recently learned information

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21
Q

Describe the evolution of vascular dementia

A

Abrupt onset with stepwise deterioration

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22
Q

Which type of risk factors are associated with vascular dementia?

A

Cardiovascular risk factors (Smoking, hypertension, dyslipidemia, previous myocardial infarction, previous strokes, documented TIAs, strong family history)

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23
Q

True or false. Impairment of executive function is associated with Alzheimer’s disease than with vascular dementia.

A

False: impairment of executive function is more related to vascular dementia.

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24
Q

If patient presents with history of memory loss and focal neurological features, which type of dementia do you suspect?

A

Vascular dementia

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25
Q

What are the main features of frontotemporal dementia?

A

Behavioural problems such as disinhibition and loss of social awareness

Language impairment

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26
Q

How do you differentiate between Louis body dementia and Parkinson disease with dementia?

A

In Lewy body dementia, dementia occurs at the same time as parkinsonian signs or dementia occurs before parkinsonian signs.

In Parkinson disease, dementia occurs more than one year after the appearance of parkinsonian signs.

27
Q

A patient with Parkinson disease can develop dementia with what type of impairments?

A

Impaired executive function and visual-spatial function

28
Q

What are the core features of Lewy body dementia? (4)

A

Fluctuating cognition
Detailed visual hallucinations
REM sleep behaviour disorder
Parkinsonism

29
Q

Name five parkinsonian signs

A 
Bradykinesia
Tremor
Rigidity
Postural instability
Shuffling gait
Masked faeces
Micrographia
Dystonia
30
Q

What are the major components of management in dementia?

A 
Lifestyle management
Pharmacotherapy
Management of Behavioural and psychological symptoms of dementia
Referral
Genetic testing
Driving assessment
Caregiver assessment
31
Q

When do you refer in dementia?

A

Rapidly progressive dementia
Young patient
Frontotemporal, Lewy body or Parkinson dementia

32
Q

When do you suspect it genetic causes for Alzheimer’s disease?

A

In patients with early onset disease and a Mendelian pattern of transmission

33
Q

Which proportion of the general population above 55 years old happy first-degree relative with dementia?

A

25%

34
Q

What is the lifetime risk of dementia in the general population?

A

10%

35
Q

What is the lifetime risk of dementia in those with a family history?

A

20%

36
Q

How do you assess for unsafe driving?

A 
Memory testing with MMSE of 24 or less
Self restricted driving
Family concerns
Multiple tickets
Accidents
Aggressive or impulsive behaviour
History of feeling lost on the road
37
Q

Which tool can you use to assess risk of driving?

A

Clinical dementia rating scale

38
Q

Patient with dementia presents with severe agitation and violent behavior. What are the possible underlying causes?

A

Physical: Pain, constipation, infection
Environmental: set routines, sounds and lights, position, daytime activities
Psychiatric conditions: depression
Medications

39
Q

Name some environmental interventions for behavioural and psychological symptoms of dementia

A

Relaxation techniques
Social contact
Sensory interventions such as music and aromatherapy
Increased services and care

40
Q

Which medications can be considered for behavioural and psychological symptoms of dementia?

A

Newer anti-psychotics

Risperidone, olanzapine, Seroquel

41
Q

What are the possible adverse outcomes of the use of antipsychotics in the geriatric patient with dementia?

A 
Increased risk of death
CVA
EPS
Falls
Somnolence
Weight gain
Diabetes
42
Q

Name three acetylcholine esterase inhibitors

A

Donepezil
Rivastigmine
Galantamine

43
Q

In which patients do you consider treatment with Donepezil?

A

In patient with mild to moderate Alzheimer’s disease

44
Q

What are the possible adverse effects of Acetylcholine esterase inhibitors?

A

G.I.: nausea, diarrhoea, vomiting
Cardiac: bradycardia, hypotension, dizziness, syncope
Sleep: insomnia
QT prolongation and torsades de point

45
Q

What is the class and generic name for a medication used in severe Alzheimer’s disease?

A

Memantine, NMDA receptor antagonist

46
Q

Which medications can be used to manage frontotemporal dementia?

A

SSRI: Paroxetine or trazodone

47
Q

True or false. There is evidence for the use of acetylcholine esterase inhibitors in frontotemporal dementia and vascular dementia.

A

False

48
Q

How do you manage vascular dementia differently?

A

Manage hypertension, diabetes, smoking, dyslipidaemia

49
Q

What is the risk of using antipsychotics and Lewy body dementia?

A

It may cause neuroleptic malignant syndrome

50
Q

When can you consider using an acetylcholinesterase inhibitor?

A

Alzheimer’s disease
Lewy body dementia
Parkinson disease with dementia

51
Q

Name five lifestyle management points that you should bring up with patients and their families when dealing with dementia

A

Creating a will, power of attorney, personal directives
Safety issues at home and on the road
Healthy diet
Smoking cessation
Exercise program
Eliminating medications
Alternative therapies such as aromatherapy, multi sensory stimulation, music therapy, animal assisted therapy, massage therapy

52
Q

Name community resources to which you can refer the patient with dementia and their family

A

The Alzheimer Society
Occupational therapy
Social services
Home care services

53
Q

How often should you follow up with a patient with mild neurocognitive disorder?

A

Follow up every 3 to 6 months.

54
Q

Define mild neurocognitive disorder

A

Decline reported by patient informant or clinician with an objective findings of deficits in one or more domain typically memory, with preserved function

55
Q

What is the risk of conversion of mild neurocognitive disorder into Alzheimer’s disease on a yearly basis?

A

15% of patients with mild neurocognitive disorder will convert into Alzheimer’s disease every year

56
Q

What is severe neuroleptic sensitivity?

A

Increased risk of neuroleptic malignant syndrome seen in patients with Lewy body dementia

57
Q

What are the features of neuroleptic malignant syndrome?

A 
Parkinsonism
Drowsiness
Falls
Hyperthermia
Autonomic instability
58
Q

A patient presents with fluctuating cognition and newly onset parkinsonism as well as postural instability and hypersomnia. What is the most likely cause of his dementia?

A

Lewy Body dementia

59
Q

A patient with dementia presents with autonomic dysfunction and depression. What is the most likely cause of his dementia?

A

Lewy body dementia

60
Q

A patient with dementia presents with worsening function, what should you do?

A

Do not assume the dementia is worsening.

Look for other possible causes such as depression, infection or medications.

61
Q

How do you disclose the diagnosis of dementia?

A

Disclose the diagnosis of dementia compassionately, and respect the patients right autonomy, confidentiality, and safety.

62
Q

In patients with dementia assess ________, in order to see whether they can make their own decisions or not.

A

Competency

63
Q

In patients with dementia, how do you follow up?

A

Assess function and cognition on an ongoing basis

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