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Year 4: Medicine for Elderly > Dementia > Flashcards

Dementia Flashcards

(53 cards)

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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

Study These Flashcards
A

NMDA antagonist

23
Q

when is memantine used in alzheimers management

Study These Flashcards
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

Study These Flashcards
A

in the evening

25
what scoring system can be used to differentiate between alzheimers and vascular dementia
Hachinski score
26
hachinski score \<4 what type of dementia?
alzheimers
27
hachinski score \>7 what type of dementia
vascular
28
pathophysiology of vascular dementia
cumulative effects of many small strokes - vascular changes
29
vascular dementia risk factors
\>60 years old obesity hypertension smoking vascular disease diabetes
30
SPECT scan of vascular dementia
patchy uptake througout
31
management of vascular dementia
maintain BP in normal range antiplatelet therapy - aspirin/clopidogrel statin
32
what are lewy bodies
eosinophilic alpha synuclein protein cytoplasmic inclusions
33
how can lewy bodies be detected
immunochemical staining for ubiquitin protein
34
most common site for lewy bodies to aggregate in lewy body dementia
substantia nigra
35
presentation of lewy body dementia
fluctuating changes in cognition visual hallucinations parkinsonism- gait changes, balance problems ect
36
sleep disorder seen in lewy body dementia
REM sleep disorder
37
difference between lewy body dementia and dementia in parkinsons disease
Lewy body: cognitive impairment occurs arround same time as movement disorder Dementia in parkinsons: movement disorder is present before onset of cognitive decline
38
drug management of lewy body dementia
same as alzheimers donepezil/rivastigmine/galantamine memantine
39
pathophysiology of frontotemporal dementia
atrophy of frontal and temporal lobes
40
what is frontotemporal dementia also known as
picks disease
41
what are pick cells
swollen neurones
42
what are picks bodies
intracytoplasmic filamentous inclusions
43
presentation of picks disease
slow progression, changes in _personality_ + social deterioration, loss of inhibitions, impaired memory + language
44
triad of dementia, urinary incontinence and gait ataxia
normal pressure hydrocephalus
45
triad of confusion, ataxia, opthalmoplegia
wernicke's encephalopathy
46
what is wernicke's encephalopathy
acute presentation of thiamine deficiency (B1)
47
what is korsakoff syndrome
chronic manifestation of thiamine deficiency
48
presentation of korsakoff syndrome
confabulation- false memories believed to be true anterograde amnesia - cant form new memories retrograde amnesia - cant remember past
49
what can cause thiamine deficiency
alcohol misuse - poor nutrition + impaired GI absorption
50
treatment of wernicke's/korsakoffs
thiamine replacement - IM/IV initially - oral long term
51
definition of apraxia
cant perform purposeful actions
52
definition of aphasia
inability to understand speech = receptive aphasia (wernicke's area) produce speech = expessive aphasia (Broca's area)
53
definition of agnosia
inability to interpret sensations

Year 4: Medicine for Elderly (8 decks)

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