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Year 4: Medicine for Elderly > Dementia > Flashcards

Dementia Flashcards

1
Q

what is dementia

A

gradual global cognitive decline characterised by memory problems and personality/behavioural changes

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2
Q

normal MMSE score

A

>27 out of 30

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3
Q

MMSE score indicative of dementia

A

<24 out of 30

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4
Q

what score in the addenbrooke’s cognitive examination (ACE) is indicative of dementia

A

<82 out of 100

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5
Q

routine blood tests for patient with symptoms of dementia

A

FBC U+E LFTs calcium glucose TFTs Vitamin B12 Folate

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6
Q

what radiological investigation is first line for cognitive decline

A

CT HEAD

  • to look for vascular disease and rule out SOLs
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7
Q

most common type of dementia

A

Alzheimers

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8
Q

pathophysiology of Alzheimers

A

beta amyloid plaque deposition neurofibrillary tangles of Tau protein

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9
Q

where in brain does Alzheimers first affect

A

nucleus basalis of Meynert

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10
Q

why is nucleus basal of Meynert important in pathophysiology of alzheimers

A

it is the main source of acetylcholine for the cortex - beta amyloid plaques prevent synapses from transmitting acetyl choline

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11
Q

presentation of alzheimers

A

4 As

Amnesia: recall is impaired first. Short term affected before long term- difficulty learning new things.

Aphasia: expressive first, word finding difficulties common.

Agnosia: e.g. difficulty naming an object in hand with eyes closed

Apraxia: impaired motor planning skills e.g. dressing self

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12
Q

genetic condition that increases alzheimers risk

A

Downs syndrome

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13
Q

Risk factors for alzheimers

A

family history

traumatic brain injury

Depression

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14
Q

what may be seen on CT alzheimers

A

temporal lobe atrophy

(affects temporal + partietal lobes the most)

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15
Q

what other imaging modality may be used in Alzheimers

A

perfusion SPECT

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16
Q

1st line treatment alzheimers

A

cholinesterase inhibitors

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17
Q

examples of cholinesterase inhibitors

A

donepezil

galantamine

rivastigmine

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18
Q

what needs to be done before a patient is started on an cholinesterase inhibitor

A

ECG

  • 2nd degree heart block is a contraindication
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19
Q

what is important to monitor whilst a patient is taking an cholinesterase inhibitor

A

Pulse - side effect of bradycardia

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20
Q

side effects of donepezil, rivastigmine, galantamine

(cholinesterase inhibitors)

A

bradycardia

GI upset

insomnia

headache, dizziness

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21
Q

2nd line treatment of alzheimers

A

memantine

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22
Q

mode of action memantine

A

NMDA antagonist

23
Q

when is memantine used in alzheimers management

A

patients who are intolerant/contraindicated to cholinesterase inhibitors

add on drug in mod-severe disease

monotherapy in severe alzheimers

24
Q

when are symptoms of alzheimers typically worse

A

in the evening

25
Q

what scoring system can be used to differentiate between alzheimers and vascular dementia

A

Hachinski score

26
Q

hachinski score <4

what type of dementia?

A

alzheimers

27
Q

hachinski score >7

what type of dementia

A

vascular

28
Q

pathophysiology of vascular dementia

A

cumulative effects of many small strokes

  • vascular changes
29
Q

vascular dementia risk factors

A

>60 years old

obesity

hypertension

smoking

vascular disease

diabetes

30
Q

SPECT scan of vascular dementia

A

patchy uptake througout

31
Q

management of vascular dementia

A

maintain BP in normal range

antiplatelet therapy - aspirin/clopidogrel

statin

32
Q

what are lewy bodies

A

eosinophilic alpha synuclein protein cytoplasmic inclusions

33
Q

how can lewy bodies be detected

A

immunochemical staining for ubiquitin protein

34
Q

most common site for lewy bodies to aggregate in lewy body dementia

A

substantia nigra

35
Q

presentation of lewy body dementia

A

fluctuating changes in cognition

visual hallucinations

parkinsonism- gait changes, balance problems ect

36
Q

sleep disorder seen in lewy body dementia

A

REM sleep disorder

37
Q

difference between lewy body dementia and dementia in parkinsons disease

A

Lewy body: cognitive impairment occurs arround same time as movement disorder

Dementia in parkinsons: movement disorder is present before onset of cognitive decline

38
Q

drug management of lewy body dementia

A

same as alzheimers

donepezil/rivastigmine/galantamine

memantine

39
Q

pathophysiology of frontotemporal dementia

A

atrophy of frontal and temporal lobes

40
Q

what is frontotemporal dementia also known as

A

picks disease

41
Q

what are pick cells

A

swollen neurones

42
Q

what are picks bodies

A

intracytoplasmic filamentous inclusions

43
Q

presentation of picks disease

A

slow progression, changes in personality + social deterioration, loss of inhibitions, impaired memory + language

44
Q

triad of dementia, urinary incontinence and gait ataxia

A

normal pressure hydrocephalus

45
Q

triad of confusion, ataxia, opthalmoplegia

A

wernicke’s encephalopathy

46
Q

what is wernicke’s encephalopathy

A

acute presentation of thiamine deficiency (B1)

47
Q

what is korsakoff syndrome

A

chronic manifestation of thiamine deficiency

48
Q

presentation of korsakoff syndrome

A

confabulation- false memories believed to be true

anterograde amnesia - cant form new memories

retrograde amnesia - cant remember past

49
Q

what can cause thiamine deficiency

A

alcohol misuse - poor nutrition + impaired GI absorption

50
Q

treatment of wernicke’s/korsakoffs

A

thiamine replacement

  • IM/IV initially
  • oral long term
51
Q

definition of apraxia

A

cant perform purposeful actions

52
Q

definition of aphasia

A

inability to understand speech = receptive aphasia (wernicke’s area)

produce speech = expessive aphasia (Broca’s area)

53
Q

definition of agnosia

A

inability to interpret sensations

Year 4: Medicine for Elderly (8 decks)

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