Dementia Flashcards
What is dementia?
Progressive global decline
Irreversible
What is the purpose of post diagnostic support in dementia?
Time of uncertantiy for people with dementia and their carers when tailored information and support is needed
Advance planning should be encourages while patients have the capacity to decide about future needs
Practical and legal; power of attorneys, driving etc
How is dementia diagnosed?
History consistent with global cognitive decline over months/ years
Decline in level of function
No evidence of reversible cause
What are the different types of cognitive testing?
Addenbrookes cognitive assessment
MoCA
Frontal Assessment Battery
Detailed neuropsychological testing
What is commonly used to take a collateral history?
Short informant questionnaire on cognitive decline (Short IQCODE)
What is the function of OT assessment in dementia?
Observation of activities; washing, dressing, using a phone, shopping, making toast, travelling
Estimates cognitive level and level of supervision required for daily living
Common reversible causes of cognitive impairment?
Delirium Alcohol Depression Brain lesions Neuro infections/ inflammation Thyroid and other metabolic issues Medication; tramadol, steroids, anticholinergic
Describe mild cognitive impairment?
Noticable cognitive impairment with little deterioration of function ACE-3 75-90 MoCA usually 24-26 Annual conversion rate 10-15% Repeat cognitive testing yearly
What needs to be taken into consideration when giving a diagnosis of dementia?
Should bring a relative or friend Make sure you have adequate time What do they know and what do they want to know Clear explanation +/- type What do they think How do they feel Address specific concerns Management plan including support
Describe the deficit in alzheimer’s disease
Short term memory loss
Dysphasia
Dyspraxia
Agnosia
Describe the imaging changes seen in alzheimer’s?
CT/]MRI can be normal
Can see medial temporal lobe atrophy or temporoparietal atrophy 1`
What are the variants of alzheimer’s?
Frontal
Posterior cortical atrophy
Describe the deficit in vascular dementia?
Dysphasia, dyscalculia, frontal lobe symptoms and affective symptoms
Focal neurological signs
Vascular risk factors
Step wise decline
What can be seen on imaging in vascular dementia?
CT/MRI; moderate-severe small vessel disease or multiple lacunar infarcts
SPECT; patchy reduction in tracer uptake throughout the brain
For what type of dementia is a SPECT scan most helpful?
Frontotemporal dementia
What are the different types of FTD?
Behavioural variant
Primary progressive aphasia
Semantic dementia
Describe the behavioural variant of FTD?
Behavioural changes Executive dysfunction Disinhibition Impulsivity Loss of social skills Apathy Obsessions Change in diet
Describe the primary progressive aphasia variant of FTD?
Effortful non-fluent speech
Speech sound/ articulatory errors
Lack of grammar
Lack of words
Describe the semantic variant of FTD?
Impaired understanding of meaning word
Fluent but empty
Difficult retrieving names
Describe the changes seen on imaging for FTD?
Frontotemporal atrophy
Frontotemporal reduction in tracer uptake
Criteria for diagnosis of dementia with lewy bodies
2 of: Visual hallucinations Fluctuating cognition REM sleep behaviour disorder Parkinsonism (not more than 1 year prior to onset of dementia) Positive DAT scan
Criteria for diagnosis of dementia in parkinson’s disease?
Must have parkinsonism for at least 1 year prior to onset of dementia
Clinical presentation is similar to DBL but different pathology
Positive DAT scan
What can be seen on the CT scan of someone with alzheimer’s?
Atrophy of medial temporal lobes
What do the different colours mean on a SPECT scan?
Red; high blood flow
Blue; bad
What can be seen on a DaT scan of someone with a parkinsonian syndrome?
Striatum (putamen and caudate) look like a full stop instead of a comma
When should you CT someone with suspected dementia?
Don’t scan if over 80 with typical history of alzheimer’s
Helpful to exclude tumour/ bleed/ large stroke/ quantifying vascular changes or identifying structural changes of alzheimer’s
When should you MRI someone with suspected dementia?
Young
Fast progression
Or atypical features
When should you SPECT someone with suspected dementia?
FTD
Useful to clarify alzheimer’s diagnosis
When should you DaT for suspected dementia?
Suspected DLB/ DPD when there aren’t enough supporting features to be sure of a diagnosis
Which drugs are used for alzheimer’s?
Cholinesterase inhibitors
Donepezil
Rivastigmine
Galantamine
What drugs are used for treatment of DLB/ DPD?
Rivastigmine, donepezil
What is the purpose of cholinesterase inhibitors?
Slow cognitive decline
What are the side effects of cholinesterase inhibitors?
GI (nausea, diarrhoea), headache, muscle cramps, bradycardias, worsen COPD asthma
What should be assessed before prescribing a cholinesterase inhibitor?
Pulse
In what situations are cholinesterase inhibitors CI?
Active peptic ulcer or severe asthma/ COPD
In what condition is memeatine licensed?
Alzheimer’s disease
Moderate dementa
What are the side effects of memantine?
Generally well tolerated
May cause hypertension, sedation, dizziness, headache and constipation
Describe driving in dementia
Always discuss driving at diagnosis
MUST be reported to the DVLA
Patient fills in a CG1 form; DVLA request report from doctor
The doctor will determine if the patient can drive while investigations ongoing
What test can be used to assess driving capability in dementia?
Rookwood Driving Battery
What symptoms become more prominent the further the illness progresses?
Behavioural and psychiatric aspects
Physical comorbidity also increases
Reduced ability to carry out activities of daily living independently and hence greater need for support services
What behavioural and psychiatric symptoms are assoc with dementia?
Hallucinations Delusions Insomnia anxiety Disinhibition Agitation Aggression Depression
What is the initial management in dementia?
Antecedents, behaviours and consequences
Review physical symptoms, further investigation s
Consider medication SE
Comfort; thirst, hunger, uncomfortable, sensory agids
Environemtn
Exercise
Sleep hygiene
What is the pharmacological management of agitation in alzheimer’s?
Antipsychotics Citalopram Memantine Analgesia Dextromethorphan
What is the pharmacological management for agitation in FTD?
Trazodone
What is used for depression in dementia?
ADs +/- adjuncts such as antipsychotics
What is used for anxiety in dementia?
ADs
ZD
Pregabalin
What is used for visual hallucinations in dementia?
Cholinesterase inhibitors
Antipsychotics
What is used for insomnia in dementia?
Melatonin
Z drugs
BZD
Sedating ADs
Should you prescribe antipsychotics in lewy body dementia?
NO; don’t prescribe typical antipsychotics
