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4th year psych > Dementia > Flashcards

Dementia Flashcards

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1
Q

Is dementia a diagnosis or a clinical syndrome

A

syndrome

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2
Q

Most common type of dementia

A

55% Alzheimers

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3
Q

2nd most common type of dementia

A

25% vascular (can be mixed w alzheimers)

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4
Q

3rd most common type of dementia

A

Lewy body 10%

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5
Q

Prevalence of lewy body dementia?

A

5%

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6
Q

Prevalence of dementia at 90y

A

25%

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7
Q

Diagnostic criteria of dementia (3)

A

Multiple cognitive defecits

Resulting impairment in ADLs

Clear consciousness

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8
Q

Do pts with dementia normally have insight?

A

No often

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9
Q

Can pts with dementia get psychotic symptoms? If so which ones?

A

Yes

persecutory delusions (made worse by forgetfulness)

visual and auditory hallucinations

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10
Q

What are BPSDs?

A

Behavioural and psychological symptoms of dementia

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11
Q

What should you include in an assessment of susp. dementia (1st presentation)?

A
  1. ask about concerns, cognitive, behav and psych symptoms
  2. Risk factors, co-morbidities and drugs
  3. Discuss possibility of dementia
  4. Assess cognition
  5. Assess daily functioning
  6. Exacerbating factors for BPSD
  7. Examination
  8. Investigations
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12
Q

Which co-morbidities are especially relevant in an assessment of susp. dementia (1st presentation)?

A

Stroke

Epilepsy

Depression

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13
Q

Which risk factors are there in an assessment of susp. dementia (1st presentation)?

A

FHx

Learning disabilities

Stroke

Parkinsons

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14
Q

Which drugs are relevant in an assessment of susp. dementia (1st presentation)?

A

Benzos

Anticholinergics

Analgesics

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15
Q

Examples of cognitive symptoms to ask about in an assessment of susp. dementia (1st presentation)?

A

memory

concentration

Language

Orientation

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16
Q

Examples of behavioural sx to ask in an assessment of susp. dementia (1st presentation)?

A

aggression

wandering

restless

inappropriate behaviour

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17
Q

Examples of psych sx to ask in an assessment of susp. dementia (1st presentation)?

A

hallucinations

delusions

mood

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18
Q

What should you include when you discuss the possibility of dementia in an assessment of susp. dementia (1st presentation)?

A

advise more detailed assessment

Ask if they’d like to know the diagnosis

Who they would want to involve

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19
Q

How do you assess cognition in an assessment of susp. dementia (1st presentation)?

A

MMSE (accounting for e.g. education level, language, sensory deficits, previous functioning)

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20
Q

What do you assess in daily functioning in an assessment of susp. dementia (1st presentation)?

A

Personal care, managing finances, taking drug treatments

Safety and home and outside

Social functioning and support

Driving

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21
Q

What are exacerbating factors for BPSD in an assessment of susp. dementia (1st presentation)?

A

Co-morbs and acute illness (pain, infection, constipation, dehydration, anaemia, delirium)

Underlying psych

Sensory- visual and hearing

Drug SEs

Able to communicate verbally

Carer- emotional upset? Able to communicate w pt?

Environment- change, routine, over or under stimulated?

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22
Q

what examinations do you do in an assessment of susp. dementia (1st presentation)?

A

Neuro for FND

Gait and balance

Cardio- HTN, arrhyth…

Wt loss

Visual and auditory

Other acute illness

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23
Q

Investigations in an assessment of susp. dementia (1st presentation)?

A

Bloods: FBC, ESR, Ca, U&Es, LFTs, HbA1c, TFTs, B12 and folate

If indicated- MSU, CXR, ECG, syphilis screen, HIV

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24
Q

What are the 5 As of alzheimers?

A

amnesia

agnosia

aphasia

apraxia

associated BPSD

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25
Q

Key feature of Alzheimers?

A

Gradual onset with memory loss

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26
Q

Macroscopic changes seen in Alzheimers?

A

Cortical atrophy

Enlarged ventricles

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27
Q

Microscopic changes seen in Alzheimers?

A

Neurofibrillary tangles

Amyloid plaques (beta)

Decreased Acetylcholine

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28
Q

Describe the amyloid cascade hypothesis for Alzheimers

A

APP gene –>

amyloid precursor protein –>

Aβ protein plaques are cleaved off APP by secretase enzyme (which is coded for by presenelin 1 and 2 genes), these aggregate –>

toxicity, inflammation, oxidative stress, tau dysfunction and neurofibrin tangle formation–>

leads to neuronal death and dysfunction

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29
Q

What are three genes whose mutations are implicated in familial (early onset) Alzheimers?

A

APP gene

Presenelin 1

Presenelin 2

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30
Q

What are the three varients of the APO gene?

A

E2, E3, E4

31
Q

Which APO gene increases risk of Alzheimers?

A

APO E4

32
Q

Are there neurotransmitter changes seen in Alzheimers? Which ones? What does this lead to?

A

Yes- defecit of ACh, serotonin, noradrenaline and somatostatin- this leads to the loss of the cell bodies of neurones that secrete them.

33
Q

What are two pharmacological management options in Alzheimers

A

Acetylcholinesterase inhibitors- compensate for the loss of acetylcholine- this can arrest and temporarily reverse cognitive decline and may improve behaviour

Memantine in moderate to severe- glutamate antagonist- prevents excitatory neurotoxicity

34
Q

What is the progression of vascular dementia like?

A

Stepwise pattern of FND

35
Q

Difference between vascular and Alzheimers dementia?

A

Vascular more ‘patchy’ cognitive impairment and stepwise.

36
Q

Many people have mixed ______ and vascular dementia

A

Alzheimers

37
Q

Vascular dementia has at least one area of __________ _________

A

Cortical infarction

38
Q

Following a stroke, the risk of dementia is increased by ???

A

9 times

39
Q

Vascular risk factors apply to both _____ and ______ dementia

A

Vascular and alzheimers

40
Q

What are the vascular risk factors?

A

Smoking, DM, HTN, high cholesterol

41
Q

What can you do as well as controlling vascular risk factors to try reduce the risk of further stroke related deterioration in VD?

A

low dose aspirin

42
Q

How does Lewy Body dementia present? (4)

A

Fluctuating cognition and alertness

Vivid visual hallucinations

Spontaneous parkinsonism

Sleep disorder

43
Q

Can you give antipsychotics to LBD?

A

No- severe reaction

44
Q

What is a pharmacological treatment option for LBD?

A

AChEi

45
Q

What is the microscopic changes found in LBD?

A

lewy bodies and neurites in basal ganglia and cerebral cortex

Often also Alzheimer’s-like changes

46
Q

Parkinson’s disease dementia is similar to what type? When can it be diagnosed?

A

Lewy body

If the parkinson’s preceded the dementia by >1y

47
Q

what % people with parkinson’s develop dementia?

A

25% (and if they survive 20y, 80%)

48
Q

Frontotemporal dementia has a younger or older mean age of onset?

A

Younger

49
Q

Features of FTD?

A

Early personality changes

Relative intellectual sparing- memory problems tend to come later

50
Q

Which lobes are affected in FTD?

A

frontal

anterior temporal

51
Q

What is the pathology of FTD?

A

It varies… tend to have ubiquitin or tau positive inclusions

52
Q

Diagnostic criteria for alcohol related dementia

A

Aren’t any.

Difficult to distinguish from other types, especially Alz. May occur in combination.

53
Q

Features of alcohol related dementia

A

Global deterioration in intellectual function

Some have frontal lobe damage- disinhibition, worse planning and executive function

Korsakoff’s features- memory changes.

Generally somewhere on a spectrum between global dementia and Korsakoff’s psychosis.

Can have psychosis, depression, anxiety, apathy, personality changes

May also get peripheral neuropathy and cerebellar ataxia.

54
Q

Can alcohol related dementia be treated?

A

Yes if early enough- stop alcohol and replace vitamins (esp thiamine)

55
Q

Onset and severity of alcohol related dementia directly linked to _____

A

amount of alcohol consumed

56
Q

Onset of alcohol related dementia can be as early as ___ but is normally ___–____

A

30

50-70

57
Q

Why does damage occur in alcohol related dementia?

A

Alcohol is a neurotoxin

Or because of malnutrition- thiamine defic.

58
Q

What are other forms of dementia?

A

Repeated head trauma

Subdural haematoma

SAH/head inj/meningitis –> normal pressure hydrocephalus

Huntington’s Chorea

MND

Infection (HIV, syphilis, prion)

Metabolic (rare) (hyperparathyroid and hypothyroid)

59
Q

MND dementia is always what type?

A

Fronto-temporal

60
Q

Which dementias can have pharmacological treatment? Which treatments?

A

AChEi in Alzheimers and Lewy body

Memantine in Alzheimers

Aspirin in vascular

61
Q

What is it important to rule out in dementia?

A

Reversible causes (these could be superimposed)

62
Q

Psycho management of dementia?

A

Cognitive stimulation e.g. group activities

Teach carers techniques for behavioural management

63
Q

Social management of dementia

A

Home care

Day centres

Intermittent respite

Residential/nursing care

64
Q

What do people with dementia often die of ?

A

Bronchopneumonia

65
Q

How is the life expectancy of someone with dementia altered?

A

Reduced even accounting for physical health

66
Q

Is vascular dementia prognosis worse or better than alzheimers?

A

worse- progression less consistent and vulnerable to cardiac and stroke related death

67
Q

What are 4 reasons for cognitive impairment without dementia?

A

mild cognitive impairment

Subjective cognitive impairment

Severe depression in old age

Slowly progressive acute confusional state

68
Q

What is mild cognitive impairment?

A

Deterioration in cognition insufficient to meet dementia criteria. About 15%–> dementia within a year. 50% within 3 years

69
Q

What is subjective cognitive impairment?

A

Report cognitive impairment e.g. remembering names, but perform within normal ranges on psychometric tests for age and education

70
Q

How do MCI and SCI link?

A

MCI often preceded by 15y of SCI

71
Q

What proportion of the population report being forgetful?

A

1/3

72
Q

Severe depression in old age can present as____? Features?

A

pseudodementia- prominent forgetfulness and poor self care

73
Q

what are slowly progressive acute confusional states?

A

May present with a dementia-like picture e.g. subdural haematoma, myxoedema, vitamin deficiencies.

74
Q

Does a diagnosis of dementia stop you from driving?

A

Must inform the DVLA. Doesn’t in itself stop you, but must do so when unsafe. Can do an assessment with DVLA if you want. The Alzheimer’s society website has v good advice. Most people stop within about 3y

4th year psych (15 decks)

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