Dementia Flashcards
Major types of dementia
Alzheimer’s
Vascular
Lewy body
Fronto temporal dementia
What is a normal ageing memory deficit vs abnormal ageing memory deficit
Normal ageing everyone experiences a change in cognition
Key is this doesn’t get in the way of everyday function
Cognitive impairment everyday function is affected to some extent
What are the stages of abnormal ageing memory deficit
Pre clinical
- silent phase where there are brain changes without and measurable symptoms , changes may be noticed but are not detected on screening, patient knows but the doctor doesn’t
MCI
-Cognitive changes are of concern to the individual or the family
One or more cognitive domain are significantly impaired, preserved ADLs
Dementia
Cognitive impairment
-Severe enough to affect ADLs
What are the 3 main drugs in Alzheimer’s
Donepazil
Galantipine
Rivastigmine
Which is the best AZ drug
Donepazil cheapest and the efficacy not different between them and has the best SE profile
Type of drug is used in AZ
Cholinesterase
Risk factors for AZ
Inc age Female Obesity smoking diabetes APOE 4 - genetic variant associated with an inc risk Head injury ? Homocysteine
Protective factors for dementia
Higher level of education , IQ, Higher socioeconomic Exercise ? Wine coffee turmeric, med diet Brain training Living with someone - married. Bilingualism
What are the pathological finding in AZ brain
Beta amyloid plaques
Neurofibrillary tangles
Biomarkers
CSF - AB42
Amyloid PET
CSF - tau
MRI + FDG PET
These may be detected before any cognitive impairment By the time MCI of dementia is detected thee would have been present for some time from damage caused by the inc of these proteins
What is the amyloid hypothesis
APP
Is snipped by alpha secretase and gamma secretase in normal health
Abnormaly in AZ
APP is snipped by beta and gamma secretase releasing beta amyloid these clump together toxic the oligomer is beta amyloid plaque
Dementia defined
Global syndrome of cognitive impairment where memory is significantly affected
What do you say to patients regarding the treatment effectiveness
Rule of 3s
1/3 will have some improvement
1/3 will have none
1/3 will have to stop taking them because of SE
Dementia in hospital
Common
Under diagnosed
Severe
Poor outcomes
How does dementia come to hospital
Behavioural symptoms BPSD
Falls, infection, NOF fracture , TLOC - Transient Loss of consciousness
Decompensation of other conditions COPD, CVD
Social breakdown - dementia in crisis a person roaming streets getting lost
Neglect/ abuse
