Dementia Flashcards
6CIT: 6 questions to asses brain function
What year is it? What month is it? Give an address with 5 parts (John, Smith, 42, High, St, Bedford) Count 20-1 Say months of year in reverse Repeat address
Diagnostic tests of Alzheimer’s disease
Structure (MRI or CT)
Pathology - non-invasive (amyloid and tau imaging)
Function-brain networks
Define dementia
A syndrome caused by a number of brain disorders (e.g. Alzheimer’s) which cause memory loss, difficulties with thinking, problem-solving or language as well as difficulties with activities of daily living
Revision question:
How would you make a clinical diagnosis of epilepsy
From history, there needs to be at least 2 unprovoked seizures occurring > 24hrs apart to DIAGNOSE EPILEPSY
Types of dementia
Alzheimers (50%)
Vascular (25%)
Lewy-body (17%)
Fronto-temporal
What is the most common cause of dementia
Alzheimers disease
Pathophysiology of Alzheimers disease
Accumulation of beta-amyloid peptide, a degradation product of amyloid precursor protein, results in progressive neuronal damage, neurofibrillary tangles, increases in the number of amyloid plaques and the loss of ACh.
Degenration of the cerebral cortex (with cortical atrophy)
Risk factors of Alzheimers
Down's syndrome due to increased APP gene load Familial gene associations Hypothyroidism Previous head trauma Family history of Alzheimer's disease
Examples of familial gene associations for Alzheimer’s disease
Amyloid precusor protein (APP) - chromosome 21
Presenilin-1 (chromosome 14)
Presenilin-2 (chromosome 1)
Apolipoprotein E4 (ApoE4) alleles - chromosome 19
Signs and symptoms of Alzheimers disease
Amnesia Disorientation Changes in personality Decreasing self care Apraxia Agnosia Aphasia Lexical anomia Paranoid delusions Depression Wandering Aggression Sexual disinhibition
Investigations of Alzheimers disease
Mini Mental State Examination
Addenbrooke’s Cognitive Examination (ACE-III)
Bloods - FBC, U&Es, LFTs, TFTs, CRP, ESR, glucose, magnesium, phosphate, VDRL, HIV, serology, vitamin B12 and folate levels, blood culture
ECG, lumbar puncture, CXR, CT scan, MRI scan, SPECT
Histology
3 main findings on histology of Alzheimers
BAT
Beta amyloid plaques
decreased Acetylcholine
neurofibrillary Tangles
Complications of Alzheimers
Amnesia Increased risk of infection Dysphagia Urinary incontinence Increased risk of falls
Treatment of Alzheimers
Memantine
Donepezil
Rivastigmine
How does Memantine work?
inhibits glutamate by blocking N-methyl-D-asparate (NMDA) receptors
How does Donepezil work?
Acetylcholinesterase inhibitor
How does Rivastigmine work?
Acetylcholinesterase inhibitor
What is second most common cause of dementia
Vascular dementia
Aetiology of Vascular dementia
Caused by infarcts of small and medium sized vessels in the brain
Brain damage due to cerebrovascular disease (major stroke, multiple unrecognised strokes or chronic changes in smaller vessels)
Genetic association with cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) on chromosome 19
Vascular dementia - follows a deteriorating stepwise progression. What are the 3 types
Vascular dementia following stroke
Multi-infarct dementia following multiple strokes
Binswanger disease following microvascular infarcts
Signs and symptoms of vascular dementia
Follows a deteriorating stepwise progression Amnesia Disorientation Changes in personality Decreasing self care Depression Signs of UMN lesions e.g. brisk reflexes Seizures
Investigations of vascular dementia
Mental state examination ACE-III
Bloods - FBC, U&Es, LFTs, TFTs, CRP, ESR, glucose, calcium, magnesium, phosphate, VDRL, HIV serology, vitamin B12 and folate levels, cholesterol levels, vasculitis screen, syphilis serology, ECG, lumbar puncture, CXR, CT scan, MRI scan, SPECT
Treatment of vascular dementia
Dietary advice
Smoking cessation
Treat DM and hypertension
Aspirin
Complications of vascular dementia
Significant co-morbidity e.g. cardiovascular disease and renal disease