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Integrative Care > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia?

A

The progressive decline in higher cortical function leading to global impairment of memory, intellect and personality which affects the person’s ability to cope with activities of daily living.

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2
Q

Is consciousness impaired in dementia?

A

No

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3
Q

What symptom is often first noted in dementia?

A

Memory loss

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4
Q

What types of irreversible dementia are there?

A 
Alzheimer’s (60%)
Vascular
Dementia with Lewy bodies 
Fronto-temporal dementia 
Creutzfeldt- Jacob disease
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5
Q

What are some examples of reversible causes of dementia?

A 
Depression 
Vitamin deficiency B12, folate, thiamine 
Alcohol 
Hypothyroid disorder 
Subdural haematoma
Syphilis 
Brain tumour
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6
Q

Describe the memory deficits associated with dementia

A

Short term memory loss

Struggle to learn new information

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7
Q

What behavioural changes are seen in dementia?

A 
Altered personality 
Disinhibition 
Labile emotions 
Wandering 
Restless
Repetitive and purposeless activity
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8
Q

What physical challenges can occur in association with dementia?

A

Incontinence
Reduced oral intake
Difficulty swallowing

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9
Q

What speech changes occur with dementia?

A

Anomic aphasia - difficultly with word retrieval

Difficulty understanding language

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10
Q

What perceptual changes can occur with dementia?

A

Visual hallucinations
Illusions
Visuospatial disorder

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11
Q

What is apraxia?

A

Difficulty with motor planning - inability to perform learned purposeful movements

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12
Q

What investigations should be done?

A 
Full history and collateral history 
MMSE
Neurological examination 
Bloods - FBC, B12, TFTs 
CT/MRI to exclude tumour, stroke, hydrocephalus, subdural 
Memory clinic
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13
Q

What can be see on a CT with dementia?

A

Dilation of ventricles

Generalised atrophy

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14
Q

In vascular dementia, how would you describe the decline in cognitive status?

A

Stepwise - an event causes a drop

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15
Q

How would you describe the cognitive decline in Alzheimer’s?

A

Progressive decline

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16
Q

How would you describe the cognitive decline in Lewy body dementia?

A

General trend downwards, may have periods of time when they improve

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17
Q

Describe the macroscopic pathology seen in Alzheimer’s disease

A

Loss of cortical and subcortical white matter causing gyral atrophy and wide sulci.

Ventricular dilatation reflecting loss of white matter.

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18
Q

Describe the microscopic pathology of Alzheimer’s disease

A

The break down of amyloid precursor protein forms beta amyloid, which builds up and clumps together into plaques between neurons and disrupts cell functioning. The enzyme that cuts APP is not very precise - resulting in large beta amyloid strands that do not easily dissolve.

Inside cells, tau proteins detach from microtubules and stick to other tau molecules and eventually form tangles inside the cell. This disrupts the microtubule transport system inside the nerve cell. Can lead to cell apoptosis

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19
Q

What are the early stages of Alzheimer’s disease?

A

Loss of memory of recent events, forgetting names of places and objects, ask questions repetitively, poor judgement or harder to make decisions, less flexible and hesitant to try new things

Subtle changes in mood and behaviour- increasing anxiety or agitation, loss of interest and motivation

Does not majorly intrude into daily life ie can live on the whole independently
Insight maintained to a degree

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20
Q

Describe moderate Alzheimer’s disease

A

Memory problems more prominent and other cognitive difficulties start to emerge
Increasing confusion and disorientation
Difficulty expressing themselves, confusing words
Changes in behaviour e.g repetitive actions like tissue shredding
Changes to personality
Changes in sleep pattern
Complex activities difficult
Hallucinations

Reduced insight into disease

21
Q

Describe late stage Alzheimer’s disease

A

Severe and pervasive memory problems - may not recognise themselves
Marked changes in behaviour and personality (may become violent, demanding, suspicious)
Difficulty communicating
Inability to control movement
Incontinence
Difficulty swallowing
Weight loss
Need extensive help with activities of daily living

22
Q

In dementia with Lewy bodies, where are the Lewy bodies found in the brain?

A

Substantia nigra
Cortex

In Parkinson’s LBs found only in SN

23
Q

What are some key clinical features of dementia with Lewy bodies?

A

Substantial fluctuations in the degree of cognitive impairment over time
In contrast to Alzheimer’s, early impairments in attention and executive function rather than just memory loss
Parkinson’s symptoms
Visual hallucinations
Frequent falls

24
Q

What are the types of vascular dementia?

A

Post stroke dementia - blood flow in a large vessel cut off - death of brain tissue. Approx 20% who have a stroke develop post stroke dementia

Single and multi infarct dementia - caused by one or more smaller strokes

Small vessel dementia / subcortical dementia- small vessels deep in brain thicken and become stiffer, so blood flow reduces. Can cause small infarcts near base of brain.

25
Q

What is the most common type of vascular dementia?

A

Small vessel/ subcortical dementia

26
Q

What are the names of the cholinesterase inhibitors used in dementia?

A

Donepezil
Rivastigmine
Galantamine

27
Q

How does Memantine work?

A

It is an NMDA receptor antagonist

28
Q

Alzheimer’s can be classified into sporadic and familial. What are some characteristics of sporadic disease?

A 
Late onset 
Genetic and environmental cause 
Accounts for vast majority of cases
Risk increases with age 
Inheriting the e4 allele of apoprotein E gene (less effective at breaking down beta amyloid)
29
Q

Describe the characteristics of familial Alzheimer’s disease

A

Cases where a dominant gene is inherited that speeds up progression of disease
5 to 10% of cases
Can be due to several gene mutations: PSEN-1 or PSEN-2 (change the way APP is cut) or trisomy 21 (Down syndrome) - the gene responsible for producing APP is located on this chromosome - increased expression of APP and therefore plaque build up.

30
Q

In those with Down syndrome, by what age does familial Alzheimer’s likely to have developed?

A

Aged 40

31
Q

Cholinesterase inhibitors are recommended for which stage of Alzheimer’s?

A

Mild to moderate disease

32
Q

What do cholinesterase inhibitors do?

A

Increase the level of acetylcholine in the brain

33
Q

What are some side effects of cholinesterase inhibitors?

A

Nausea
Diarrhoea
Trouble sleeping
Muscle cramps

Usually mild and temporary

34
Q

Memantine is usually used for which stage of Alzheimer’s disease?

A

Severe

Maybe moderate

35
Q

Can both cholinesterase inhibitors and memantine be used in the treatment of Lewy body dementia?

A

Yes

36
Q

What drugs should be avoided in Lewy body dementia?

A

Neuroleptics

Extremely sensitive to side effects and may develop irreversible Parkinsonism

37
Q

In Lewy body dementia what is the name of the protein that gets misfolded in the neurons?

A

Alpha synuclein - aggregates to form Lewy bodies

38
Q

In Lewy body dementia, do the motor symptoms occur early or late?

A

Late

39
Q

What symptoms are associated with vascular dementia?

A

Varies depending on region damaged
If stroke in temporal - difficulty with memory
Frontal - personality change

Appear suddenly and brain function decreases with each stroke

40
Q

How is vascular dementia diagnosed?

A

Symptoms
Tests to confirm loss of brain function e.g MMSE
Imaging - CT or MRI to show infarcts

41
Q

How is vascular dementia treated?

A

Focus on reducing repeated strokes

- manage BP, cholesterol, diabetes, stop smoking, diet and exercise improvements

42
Q

What are 3 types of frontotemporal dementias?

A

Frontotemporal lobar degeneration with tau pathology
Pick’s disease
Familial tauopathies

43
Q

What are the main symptoms seen in frontotemporal dementias?

A

Personality change and social conduct problems
Impaired judgement and insight
Speech output falls eventually to mutism
Insidious onset
Onset before 65
Relatively preserved memory and visuospatial skills

44
Q

What is the most common type of frontotemporal dementia?

A

Pick’s disease

45
Q

What are Pick bodies?

A

Spherical aggregations of tau protein

46
Q

Should cholinesterase inhibitors or memantine be used in frontotemporal dementia?

A

No

47
Q

Is a strong family link common in frontotemporal dementia?

A

Yes

48
Q

Is dementia more common in men or women?

A

Women

49
Q

What is the only way to make a definitive diagnosis of dementia?

A

Biopsy (post mortem)

Integrative Care (11 decks)

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