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Psychiatry > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia?

A

Progressive global decline

Irreversible

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2
Q

What is the purpose of post diagnostic support in dementia?

A

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

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3
Q

How is dementia diagnosed?

A

History consistent with global cognitive decline over months/ years
Decline in level of function
No evidence of reversible cause

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4
Q

What are the different types of cognitive testing?

A

Addenbrookes cognitive assessment
MoCA
Frontal Assessment Battery
Detailed neuropsychological testing

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5
Q

What is commonly used to take a collateral history?

A

Short informant questionnaire on cognitive decline (Short IQCODE)

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6
Q

What is the function of OT assessment in dementia?

A

Observation of activities; washing, dressing, using a phone, shopping, making toast, travelling
Estimates cognitive level and level of supervision required for daily living

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7
Q

Common reversible causes of cognitive impairment?

A 
Delirium
Alcohol
Depression 
Brain lesions
Neuro infections/ inflammation 
Thyroid and other metabolic issues 
Medication; tramadol, steroids, anticholinergic
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8
Q

Describe mild cognitive impairment?

A 
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
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9
Q

What needs to be taken into consideration when giving a diagnosis of dementia?

A 
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
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10
Q

Describe the deficit in alzheimer’s disease

A

Short term memory loss
Dysphasia
Dyspraxia
Agnosia

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11
Q

Describe the imaging changes seen in alzheimer’s?

A

CT/]MRI can be normal

Can see medial temporal lobe atrophy or temporoparietal atrophy 1`

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12
Q

What are the variants of alzheimer’s?

A

Frontal

Posterior cortical atrophy

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13
Q

Describe the deficit in vascular dementia?

A

Dysphasia, dyscalculia, frontal lobe symptoms and affective symptoms
Focal neurological signs
Vascular risk factors
Step wise decline

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14
Q

What can be seen on imaging in vascular dementia?

A

CT/MRI; moderate-severe small vessel disease or multiple lacunar infarcts
SPECT; patchy reduction in tracer uptake throughout the brain

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15
Q

For what type of dementia is a SPECT scan most helpful?

A

Frontotemporal dementia

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16
Q

What are the different types of FTD?

A

Behavioural variant
Primary progressive aphasia
Semantic dementia

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17
Q

Describe the behavioural variant of FTD?

A 
Behavioural changes 
Executive dysfunction 
Disinhibition 
Impulsivity 
Loss of social skills 
Apathy 
Obsessions 
Change in diet
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18
Q

Describe the primary progressive aphasia variant of FTD?

A

Effortful non-fluent speech
Speech sound/ articulatory errors
Lack of grammar
Lack of words

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19
Q

Describe the semantic variant of FTD?

A

Impaired understanding of meaning word
Fluent but empty
Difficult retrieving names

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20
Q

Describe the changes seen on imaging for FTD?

A

Frontotemporal atrophy

Frontotemporal reduction in tracer uptake

21
Q

Criteria for diagnosis of dementia with lewy bodies

A 
2 of: 
Visual hallucinations 
Fluctuating cognition 
REM sleep behaviour disorder 
Parkinsonism (not more than 1 year prior to onset of dementia) 
Positive DAT scan
22
Q

Criteria for diagnosis of dementia in parkinson’s disease?

A

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

23
Q

What can be seen on the CT scan of someone with alzheimer’s?

A

Atrophy of medial temporal lobes

24
Q

What do the different colours mean on a SPECT scan?

A

Red; high blood flow

Blue; bad

25
Q

What can be seen on a DaT scan of someone with a parkinsonian syndrome?

A

Striatum (putamen and caudate) look like a full stop instead of a comma

26
Q

When should you CT someone with suspected dementia?

A

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

27
Q

When should you MRI someone with suspected dementia?

A

Young
Fast progression
Or atypical features

28
Q

When should you SPECT someone with suspected dementia?

A

FTD

Useful to clarify alzheimer’s diagnosis

29
Q

When should you DaT for suspected dementia?

A

Suspected DLB/ DPD when there aren’t enough supporting features to be sure of a diagnosis

30
Q

Which drugs are used for alzheimer’s?

A

Cholinesterase inhibitors
Donepezil
Rivastigmine
Galantamine

31
Q

What drugs are used for treatment of DLB/ DPD?

A

Rivastigmine, donepezil

32
Q

What is the purpose of cholinesterase inhibitors?

A

Slow cognitive decline

33
Q

What are the side effects of cholinesterase inhibitors?

A

GI (nausea, diarrhoea), headache, muscle cramps, bradycardias, worsen COPD asthma

34
Q

What should be assessed before prescribing a cholinesterase inhibitor?

A

Pulse

35
Q

In what situations are cholinesterase inhibitors CI?

A

Active peptic ulcer or severe asthma/ COPD

36
Q

In what condition is memeatine licensed?

A

Alzheimer’s disease

Moderate dementa

37
Q

What are the side effects of memantine?

A

Generally well tolerated

May cause hypertension, sedation, dizziness, headache and constipation

38
Q

Describe driving in dementia

A

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

39
Q

What test can be used to assess driving capability in dementia?

A

Rookwood Driving Battery

40
Q

What symptoms become more prominent the further the illness progresses?

A

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

41
Q

What behavioural and psychiatric symptoms are assoc with dementia?

A 
Hallucinations
Delusions 
Insomnia
anxiety 
Disinhibition 
Agitation 
Aggression 
Depression
42
Q

What is the initial management in dementia?

A

Antecedents, behaviours and consequences
Review physical symptoms, further investigation s
Consider medication SE
Comfort; thirst, hunger, uncomfortable, sensory agids
Environemtn
Exercise
Sleep hygiene

43
Q

What is the pharmacological management of agitation in alzheimer’s?

A 
Antipsychotics 
Citalopram
Memantine
Analgesia
Dextromethorphan
44
Q

What is the pharmacological management for agitation in FTD?

A

Trazodone

45
Q

What is used for depression in dementia?

A

ADs +/- adjuncts such as antipsychotics

46
Q

What is used for anxiety in dementia?

A

ADs
ZD
Pregabalin

47
Q

What is used for visual hallucinations in dementia?

A

Cholinesterase inhibitors

Antipsychotics

48
Q

What is used for insomnia in dementia?

A

Melatonin
Z drugs
BZD
Sedating ADs

49
Q

Should you prescribe antipsychotics in lewy body dementia?

A

NO; don’t prescribe typical antipsychotics

Psychiatry (35 decks)

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