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Psychiatry > Dementia > Flashcards

Dementia Flashcards

1
Q

How would you describe dementia?

A

Dementia is a progressive neurodegenerative condition with:

  • Disturbance of multiple higher cortical function
  • No clouding of consciousness
  • Deterioration in judgement, thinking and processing information
  • Deterioration in emotional control, social behaviour and motivation
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2
Q

How long would a patient With dementia need to have symptoms to receive a diagnosis?

A

Six months

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3
Q

What is the most common cause of dementia?

A

Alzheimer’s disease

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4
Q

What is the epidemiology of Alzheimer’s disease?

A

– Female
– increased age
– 50% diagnosed above the age of 65

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5
Q

Name some risk factors for Alzheimer’s disease

A

-Age
-genetic predisposition (down syndrome, PSEN1/2 in chromosomes 1 and 14, ApoE in chromosome 19).
– Family history
– female
– limited social interaction
– lifestyle risk factors (smoking, alcohol, healthy eating)

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6
Q

Describe the neurochemical theory regarding ACh in Alzheimer’s dementia

A

In Alzheimer’s dementia, It is thought that ACh is reduced.

ACh is thought to improve transmission between neurons.

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7
Q

Name a few pathological findings of Alzheimer’s disease

A

– Amyloid plaques
– tau protein tangles (neurofibrillary tangles)
– ACh reduced
– cerebral atrophy (medial temporal lobe atrophy)
– senile plaques

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8
Q

Name some protective psychological factors for Alzheimer’s disease

A

High educational attainment and an engaged lifestyle

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9
Q

How quickly does Alzheimer’s disease present

A

It is a gradual onset

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10
Q

Name a few symptoms of Alzheimer’s disease (5 A’s)

A 
Amnesia – memory loss
Aphagia – speech
Agnosia – recognition
Apraxia – doing
Associated behaviours: behavioural and psychological symptoms of dementia (for example aggression, screaming, crying Hallucinations)
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11
Q

Should you treat behavioural and psychological symptoms of dementia with antipsychotics?
What would be the side-effect of doing so?
What should you do before providing antipsychotics?

A 
Antipsychotics should be avoided.
They have side-effects on patients with Alzheimer’s such as:
– strikes
– cardiovascular disease
– falls
– parkinsonism
– additional death
Only risperidone is licensed 
—
Antipsychotics should only be used for patients at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress
—
Before prescribing antipsychotics you should think of the pneumonic pinch me to identify any treatable causes of symptoms: (pain, infection, constipation, hydration, medication, environmental)
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12
Q

How would you assess a patient who has presented with Suspected Alzheimer’s disease?

A

– Take a history, including a collateral history
– physical examination, blood tests and urine tests (to exclude reversible causes)
-Cognitive tests
-Exclude reversible causes such as Delerium, depression, sensory impairments or cognitive impairments from medication
- Need to do an ECG and a CT head
– if needed can do an FDG – PGT or a SPECT or
Can examine cerebrospinal fluid looking at the TAU protein/amyloid protein

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13
Q

What is the first line medical treatment for mild/moderate Alzheimer’s disease?

A

ACetylycholinesterase (AChE) inhibitors.

  • Donepezil
  • Galantamine
  • Rivastigmine
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14
Q

When in Memantine indicted in Alzheimer’s disease and what does it do?

A

It is indicated when Anticholinesterase inhibitors are not tolerated Or in severe Alzheimer’s disease.
You can combine it with Ache inhibitors in moderate or severe Alzheimer’s
It protects the neurons from the harmful neurotoxic effect of glutamate which is raised in Alzheimer’s

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15
Q

Name some psychological treatments for Alzheimer’s patients

A

– Group cognitive stimulation

– group reminiscing therapy

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16
Q

How common is vascular dementia?

A

Approximately affects 150,000 people in the United Kingdom

The second most common cause of dementia over the age of 65

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17
Q

What is thought to cause vascular dementia?

A

It is caused by lack of bloodflow to the brain
—-
When bloodflow is interrupted this results in a stroke and damage to parts of the brain.
—
Post stroke dementia (Cortical dementia)
Can also be after a series of small strokes – this is called multi invite dementia
—
Small vessel disease (subcortical dementia)
The most common cause of dementia
Narrowing of small blood vassals lead to damage of white matter

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18
Q

Name some risk factors for vascular dementia

A 
– Previous stroke, heart disease, diabetes= double risk
-Diabetes
-Hypertension
-Obesity
-Family history
– Lack of exercise
– unhealthy eating
– smoking
19
Q

Name some early cognitive symptoms of vascular dementia

A

– Problems with planning, organisation, making decisions and solving problems
– difficulties following a series of steps
– slower speed thought
– problems concentrating,

20
Q

Name some symptoms which may be present in a vascular dementia patient who has had a stroke

A

– Weakness of a limb/paralysis

– problems with speech/vision

21
Q

Name some symptoms which may affect a vascular dementia patient with sub cortical vascular dementia

A

– Early loss of bladder control
– weakness of a side of the body
– clumsiness, balance affected when walking/more prone to Falls
– lack of facial expressions/problems pronouncing words

22
Q

What is the onset of vascular dementia like in patients who have strokes

A

It is a stepwise progression.

There are times of stabilisation and deterioration following strokes

23
Q

In small vessel disease of vascular dementia, is that gradual decline in function

A

Yes

24
Q

How would you assess and investigate a patient with suspected vascular dementia?

A

– History and collateral history
– cognitive assessment, mental state examination, NINDS-AIREN CRITERIA
– blood tests: FBC, U+E
– Radiology: MRI (preferred), CT IF unavailable/contraindicated
– ECG

25
Q

Name some biological treatments for vascular dementia

A

– Treat reversible causes
– consider anticoagulants
– consider medication to modify risk factors (reduce hypertension, anticoagulants, lower cholesterol)

26
Q

Name some psychological treatments for vascular dementia

A

Emotional support
Cognitive rehabilitation
Group stimulation/reminiscence
Treatments for comorbid illnesses: anxiety

27
Q

Name some social care treatment for patients with vascular dementia

A 
– Care support
– occupational therapy
– social care interventions
– quit smoking
– healthy eating
– exercise
28
Q

Would you prescribe an antipsychotic for a patient with vascular dementia?
What would you want to do anyway before prescribing an antipsychotic?

A

No.
Antipsychotics have negative cardiovascular risk factors.
Therefore they should be avoided
Think of pinch me pneumonic
– pain, infection, constipation, hydration, medications, environment

29
Q

Would you ever consider prescribing and ACHE inhibitor in patients with vascular dementia?

A

Only consider if the patient has a mixed type of dementia.

Vascular dementia with comorbid Alzheimer’s/Parkinson is dementia/Lewy body dementia

30
Q

What is the prognosis for patient with vascular dementia?

A

Approximately 4 to 5 years after diagnosis.

Patient is most likely to die from a heart attack or a stroke

31
Q

Describe the epidemiology of Lewy body dementia

A

– 10–15% of all dementia

– linked with Parkinson’s disease

32
Q

Describe the neurochemical theory behind Lewy body dementia

A

Lewy bodies are tired deposit of proteins (alpha – synuclein)
These proteins deposit in nerve cells in the brain
– –
They are thought to be linked with two factors:
– ACh and dopamine are both low
– lots of connections between nerve cells which then die
– –
Associated with Parkinson’s disease
– if Parkinson’s disease is first, referred to as Parkinson’s disease dementia
– If dementia precedes Parkinson is, referred to as Lewy body dementia

33
Q

What are the core features of Lewy body dementia?

A

– Fluctuating cognition (attention and alertness)
-Spontaneous motor features of parkinsonism – slow movement, stiffness, resting tremor
- Visual hallucinations
– –
According to Sarah, need to core features or one core feature and one additional symptom for diagnosis

34
Q

Name additional symptoms of Lewy body dementia other than parkinsonism, visual hallucinations and fluctuating cognition

A

– Sleep disorders, lashing out and sleep, acting out nightmares
– sleepiness during the day
– survey extrapyramidal symptoms
- PET changes – SPECT changes
– Recurrent falls, syncope, loss of consciousness, steeped posture, difficulty with balance
– problems seeing in 3D
– memory affected but less so in early stages as Alzheimer’s

35
Q

How would you assess for Lewy body dementia?

A

– History and collateral history
– exclude reversible causes
– cognitive testing: AMTS/specific for Lewy bodies
- CT head, with shows general atrophy
-Bloods: FBC, U + E, CK, PNS, MSK exam, neurological exam
– SPECT (DAT) scan: shows dopamine transporter uptake
-If cannot to SPECT, do you say I – MIBG cardiac scintigraphy (differentiates between Parkinson is dementia and lewy body dementia)

36
Q

What is the first biological treatment for lewy body dementia (Mild, moderate)

A

Rivastigmine, donepezil
– –
Only give galantamine if rivastigmine or donepezil are contra indicated

37
Q

If ACh esterase inhibitor is contraindicated, what would you prescribe instead for lewy body dementia?

A

Consider memantine

38
Q

Why would you not give an antipsychotic to a patient with lewy body dementia?

A

It’s further decreases the amount of dopamine.

This increases that parkinsonism traits which are experienced

39
Q

What psychological treatments can you give to patients with lewy body dementia?

A

– Memory aids

– memory cafés

40
Q

What social interventions would you want to provide patients with if they have lewy body dementia?

A 
– Physiotherapy
– occupational therapy
– exercise more
– 
Do you not nap during the day
41
Q

Name the three subtypes of fronto- temporal dementia

A
  1. Behavioural variant
  2. Progressive non fluent aphasia
  3. Semantic dementia
42
Q

How would you investigate for fronto-temporal dementia?

A

MRI: you would see fronto-temporal atrophy

43
Q

How would you treat fronto- temporal dementia ?

A
  • treat symptoms
  • DO NOT USE ACHEi
  • some evidence supports the use of SSRI’s

Psychiatry (13 decks)

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