Dementia Flashcards
What is dementia?
Umbrella term used to describe a range of symptoms associated with cognitive impairment.
Describe the syndrome of dementia itself.
- Chronic, acquired global decline in brain functions.
- Usually progressive and irreversible.
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Neuropsychological deficits:
- Amnesia (memory)
- +
- Aphasia (communication)
- Apraxia (motor execution)
- Agnosia (recognition)
- Executive function (synthesis)
- +
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Significant deterioration in activities of daily living (ADLs):
- Instrumental
- Basic
What are the differential diagnoses of dementia-like symptoms?
- Delirium (acute)
- Depression
- Low mood, poor concentration, ‘don’t know’ answers, good orientation.
- MCI
- Amnestic, ADLs intact.
- Normal ageing
- Person aware and concerned, WFD, important things are rememebered and function is preserved.
Describe the basic brain anatomy outlining which areas of the brain are responsible for which functions.
Which area of the brain is implicated in dementia?
The hippocampus
What is the frontal lobe responsible for?
How do you test this?
- Executive function
- Planning (e.g. clock drawing)
- Sequencing (luria)
- Fluency (naming words beginning with the same letter)
- Cognitive estimates
- Initiative
- Inhibition
- Personality
What are the temporal lobes responsible for?
How do you test this?
- Memory
- Speech (left)
- Address test
- Object recall
- Serial 7s (deduct 7 from 100 and keep subtracting), spelling
- Phrase repetition (fluent receptove aphasia)
- Mood
What are the parietal lobes responsible for?
How do you test this?
- Spatial awareness (R)
- Language (L)
- Serial 7s (L)
- Clock drawing - shared between the parietal and frontal lobe
- Naming objects (pen, watch), severe nominal (expressive) dysphasia.
- 3-stage command (dyspraxia).
- Copying cube and interlocking shapes (visuospatial agnosia and constructed dyspraxia) (R).
- Writing a sentence (L).
- Agnosia.
Which test can be used to monitor dementia?
- Mini-mental state examination.
- Dementia patients lose approximately 3 points per year in the test.
- Problem is that is has been copyrighted so is no longer in popular use.
What does the MoCA test?
- Sensotivity = 90%
- Specificity = 87%
- Short term memory
- Recall
- Visuospatial abilities
- Executive function
- Attention
- Concentration
- Working memory
- Language
- Orientation
What does the TYM test?
- Orientation
- Ability to copy a sentence
- Semantic knowledge
- Calculation
- Verbal fluency
- Similarities
- Visuospatial abilities
- Recall of copied sentence
Describe the Addenbrookes Cognitive Examination.
- 20-25 minutes
- Multi-domain
- Good reliability
- Cut-off 82/100
- Sensitivity 0.93
- Specificity 1
- Cut-off 88/100
- Sensitivity 1
- Specificity 0.96
What are the 3 stages of dementia?
- Preclinical - changes in biomarkers.
- MCI - biomarkers may help determine progression to Alzheimer’s disease.
- Alzheimer’s disease - biomarkers may be helpful in excluding AD as a cause.
Describe the timeline of disease progression.
What defines mild cognitive impairment?
- Subjective memory impairment and cognitive impairment not meeting dementia diagnostic criteria and in particular with no impairment in core ADLs.
- Amnestic MCI in which the prominent impairment is one of memory has a conversion rate from 10-15% per year in clinic-based studies.
- Conversion is not inevitable, up to 25% in some studies show subsequent recovery of normal cognitive function.