Dementia Flashcards
What is dementia?
Decline in memory, intellect and personality
Without impairment of consciousness
What are irreversible causes of dementia?
Alzheimer’s
Fronto-temporal dementia
Demenita with Lewy bodies
Vascular dementia
What are reversible causes of dementia
Normal pressure hydrocephalus
Intracranial tumours
B12, folate, thiamine deficiency
Endocrine
What is vascular dementia? CF?
Cerebrovascular disease - stroke or multiple infarcts or chronic changes - arteriosclerosis in small vessels
Stepwise deterioration Emotional and personality changes Memory loss Confusion Neurological features - spastic weakens, hyperreflexia, upgoing plantar UMN signs CVS disease signs
What is Lewy body demenita? CF?
Abnormal deposition of alpha-synuclein and LEwy bony formaiton in brainstem, SN and cortex
LBs cause cholinergic loss outside fo brainstem
LBs cause dopaminergic loss inside brainstem
Day to day fluctuations in cognitive performance Visual hallucinations Parkinsonism Recurrent falls Depression Sensitivity to neuroleptic drugs
What is fronto-temporal dementia? CF?
Atrophy of frontal and temporal lobes
Pick’s disease - protein tangles are seen
FHx Insidious onset Early personality changes - disinhibition, apathy, restlessness Worsening of social behaviour Repetitive behaviour Language problems
What are features of normal pressure hydrocephalus? cause?
Reduced CSF absorption at the arachnoid villi
Dementia
Urinary incontinence
Gait abnormality
What Ix and Mx in normal pressure hydrocephalus?
Enlarged fourth ventricle on CT head
Absence of sulcal atrophy
Mx:
Ventriculoperitoneal shunting
What are features of Alzheimer’s dementia?
Memory loss - names, places, words
Apraxia, confusion, language problems
Disorientation to time and place, incontinence, eating problems, depression
Apraxia - inability to carry out learned movements despite normal coordination and strength
agnosia: impaired recognition of sensory stimuli
What questions in history?
Forgetting things? Examples? OCDSTNPRAP
Get lost more easily
Confident handling money?
Has being forgetful stopped you doing anything
Are they repetitive
Has personality changed
Any change in behaviour
Any safety concerns
What conservative mx for dementia?
Supportive treatment OT home safety evaluation Fire risk assessment Motion sensors DVLA contact - annual review Advanced care planning Lasting power of attourney Advanced directive DNACPR Capacity assessments Risk factor management
Social support - support groups Carers Community dementia teams Information and education ELMS Home nursing Meals-on-wheels Befriending Day centres
SUPPORT FOR CARERS
FINANCIAL SUPPORT
What medical management for dementia?
Acetylcholinesterase inhibtors:
Donezepil, galantamine, rivastigmine
For mild/moderate
NMDA antagonist:
Memantine
For moderate with intolerace of ACHe Inhibitors or severe
CI of ACHE Inhibitors?
HRH
Arrhythmias
Severe renal or hepatic impairment
What SE of ACHE inhibitors?
GI disturbance
Bradycardia
Muscle spasm
What adjuncts for Mx?
Antidepressants
Antipsychotics
Insomnia Mx
