Dementia Flashcards
5 most common types of dementia:
Alzheimer's disease Vascular dementia Dementia with lewy bodies Frontotemporal dementia Mixed Other
Mixed dementia =
Alzheimer’s disease + Vascular dementia
ICD-10 defines dementia =
- Chronic or progressive
- Multiple higher cortical functions
- Consciousness not clouded
Forgetfulness is normal with
Age
MCI =
Mild cognitive impairment
Mild-cognitive impairment =
Syptoms worse than expected for age but not severe enough to impair ADLs
Dementia vs MCI
Dementia = impairs ADLs
Potential differentials for dementia:
Dementia Aging MCI Depression Delirium Physical: metabolic (hypothyroidism, B12, NPH), trauma (subdural haemorrhage, cerebral tumour)
Dementia effecting frontal lobe =
Emotional expression Personality Problem solving Judgement Motor function Expressive language Motivation Social behaviour
Dementia effecting temporal lobe =
Memory Speech Language comprehension Auditory and visual perceptions Emotional responses Facial recognition
Dementia effecting parietal lobe =
Learned skills: reading, writing, calculations
Ability to perform complex skills: driving, constructing
Recognition of objects
Spatial awareness
Dementia effecting occipital lobe =
Spatial processing Ability to determine between different colours Spatial awareness Colour and object recognition Hand eye coordination
3 basic groups of dementia symptoms:
memory problems
impairments in cognitive abilities
impairments in communication
Impairments in communication:
Repetitive
Reading and writing
Following and engaging in conversation
Most common type of dementia =
Alzheimer’s
3 mechanisms of Alzheimer’s pathology:
- Beta-amyloid plaques
- Neurofibillary tangles
- Reduced Ach
APP =
Amyloid precursor protein, helps neurone grow and repair
What recycles APP
alpha-secretase and gamma-secretase
What recycles APP in AD?
beta-secretase instead of alpha
Beta-amyloid plaques are where in neurone
Outside neuron
What is found on microtubules of cytoskeleton?
Tau proteins
What happens to Tau in AD?
Hyperphosphorylated and forms neurofibrillary tangles
How do these cause disease in AD?
- Ca2+ and glutamate influx
- Inflammatory response - free radicals
- Neural death
- Tau broken - loss of structural integrity
AD on scan:
Diffuse cerebral atrophy
Ventricular dilation
Widened sulci
Narrowed gyri
Hippocampus is in what lobe?
Temporal
Insidious onset =
Slow
5 A’s of alzheimer’s
Apraxia Agnosia Aphasia Amnesia Associated symptoms
Symptoms of AD:
Difficulty remembering recent events langaue problems changes in ability to process and interpret visual info decision making, problem solving, planning, sequencing disorientation not recogniting familiar faces reduces ADLs altered personality
Altered personality in AD:
Apathy
Irritability
Age of AD tends to be:
> 65 years
At >80 years what is the chance of developing AD
1/6th
Gender of AD:
More common in females
With genetic AD, the disease tends to be:
Earlier in onset <65 yrs
Risk facotrs of AD:
- > 65
- Women
- Genetics
- Poor physical health: heart disease, diabetes
- Lifestyle: smoking, lack of exercise, alcohol
2 drugs used in AD:
- Acetylcholine esterase inhibitors
2. NMDA antagonists
Ex of AchEi
Doneprezil
Ex of NMDA antagonist
Memantine
Memantine an help with which symptoms
Behavioural
NMDA antagonists moa:
Blocks effects of excess glutamate
Most common form of dementia >65s
Vascular dementia
Vascular dementia can be caused by:
TIAs
Arteriosclerosis
Haemorrhage
Multiple-infarct dementia follows a
Stroke
Ex of a cause of vascular demntia with ischaemic changes
Small vessel disease (SVD)
Features of small vessel disease:
Slow thought, apathy
Problems with executive functioning (planning and performing tasks)
Reduced attention
In SVD there is a relative preservation of
Higher cortical functions
Risk factors of vascular dementia:
- Hypertension, raised cholesterol, diabetes, smoking, ischemic heart disease, AF
- > 65s
- Men
- Family Hx of stroke, heart disease, diabetes
- Lifestyle and poor physical health
Management of vascular dementia:
- Adequate management of BP, cholesterol, heart disease, diabetes, weight
- Lifestyle changes: smoking, alcohol, exercise, diet
3rd most common form of dementia =
Lewy body dementia
What gets misfolded into lewy-bodies?
Alpha-synuclein
Where do lewy bodies effect?
Cortex and substantia nigra
3 features of LBD:
- Alertness, confusion, concentration : memory, mood
- Persistent, well-formed hallucinations. REM sleep problems
- Parkinsonian features: TRAP
Distinguishing LBD with AD:
- Movement symptoms more early
- Hallucination, delusions, identification of familiar people in early
- REM sleep disorders
Distinguishing LBD with PD:
- Earlier cognitive symptoms
Sex and LBD:
Effects men and women equally
Dementia not common in >65s
Frontotemporal dementia
2nd most common dementia in people <65
Frontotemporal dementia
Prominent pathologies with FTD:
Tau gene mutation
TDP43 protein
Types of frontotemporal dementia:
- Behavioural variant frontotemporal dementia (pick’s)
2. Primary progressive aphasia
Pick’s disease =
Behavioural varient frontotemporal dementia
Types of primary progressive aphasia =
Semantic dementia
Progressive non-fluent aphasia
Behavioural variant frontotemporal dementia:
Prominent changes in personality, interpersonal relationships and conduct
Behavioural variant FTD occurs at what age
50s-60s (early 20s)
Initial symptoms of behaviours FTD:
Changes in personality and behaviour Apathy and withdrawal Obsessive and repetivie behaviour Loss of empathy Emotional blunting Changes in appetite and food Problems with decision making, problem solving and concentration
Semantic dementia:
Loss of ability to understand or formulate words in a spoken sentence. Loss of knowledge of meaning of words.
Progressive non-fluent aphasia:
Progressive difficulty in language. Hesitant, laboured and ungrammatical speech
Sex with frontotemporal dementia:
Men and women equally
genetics and FTD:
up to 1/3 of cases familial
Management of dementia can be broken down into:
Psychosocial
Medial management
Psychosocial management:
Diagnosis and counselling
Identify strengths and weaknesses
Target interventions, social stimulation
Lifestyle changes, modifications of risk factors
Planning for future, practical, financial etc.
Carer support
Social and home care services
Medical management includes:
Drugs: for dementia, symptomatic
Risk factor modification