Dementia Flashcards
Define
Decline of mental functioning characterised by memory problems and personality and behavioural changes.
Pathophysiology:
Alzheimer’s Disease:
- What builds up - 2
Vascular dementia - define?
LBD:
- What accumulates?
- Where?
Frontotemporal dementia:
- What happens?
- What other neurological disease may it also be a part of?
- What makes this different from the others?
- What is Pick’s disease?
Cumulative effects of many small strokes.
——
Aggregations of Lewy bodies in substancia nigra
—–
Atrophy of frontal and temporal lobes
MND
Younger onset (45-70)
Frontal lobe dementia
What sex is it commoner in?
Women
Presentation - Alzheimer’s:
The pattern? - 2
The 4 A’s - what do they mean for Alzheimer’s:
- Amnesia
- Aphasia
- Agnosia
- Apraxia
What do visuospatial problems increase the risk of?
What else may be reduced? - think in psych
Insidious onset
Progressive and global cognitive deterioration
AMNESIA:
- Recall is impaired first, with recognition initially intact
- Short-term affected before long term
- Therefore, difficulty learning new things
Aphasia:
- Expressive first
- With word-finding difficulty
Agnosia:
- Difficulty naming objects in hand with eyes closed
Apraxia:
- Impaired motor planning skills (e.g. dressing apraxia)
-------------------------- Get lost easily ------------------------ Affective and psychotic symptoms Reduced executive function Apathy
Presentation - Vascular dementia:
How does the decline happen?
How may it fluctuate?
What other signs may you find with strokes being the main cause?
What 2 things tend to be preserved?
A stepwise, rapid decline
You can get partial recovery after the strokes
Focal neurological signs
Preserved personality and insight
Presentation - LBD:
How does cognition change?
How often does it change?
Why might they get depressed?
What type of hallucinations do they have?
What other neuro disease is associated?
You get fluctuating changes in cognition
Day to day - cycles get progressively shorter (e.g. hours)
They might have lucid periods where they have good insight.
Visual - vivid and often frightening - children, animals etc.
Parkinsonism including falls
Presentation - FTD:
What tends to be affected more in this one? - 2
Personality and speech problems
Risks to those with dementia:
- Physical
- Behavioural
- What might they overdose on?
Falls
Flood or fires in the house
Self-neglect
Financial exploitation
Wandering
Aggression towards others
Medication - Often accidental - forget they’ve taken them
History:
Q’s to explore the function
“Is there anything you used to do which you are no longer able to do and why?”
ADLs - washing, dressing, cooking, cleaning, shopping etc.
History:
Q’s for specific symptoms
Q’s for LBD dementia?
What is sundowning? How might you explore this?
Any trouble with memory or concentration?
Find yourself somewhere and you don’t know why/why?
Hard to focus/follow on TV/books?
Difficulty using new things (e.g. remote control)?
LBD:
- Any falls
- Any hallucinations
- Any tremors
A symptom of Alzheimer’s disease and other forms of dementia. It’s also known as “late-day confusion.” If someone you care for has dementia, their confusion and agitation may get worse in the late afternoon and evening. In comparison, their symptoms may be less pronounced earlier in the day.
“Any things worse in the evening”
History:
What else needs to be asked about as it is common in dementia?
How can the rate of progression be determined?
Depression - ask about mood
‘What was the first thing you noticed. When?’
Risk factors for Alzheimer’s?
FH
Specific mutations - ApoE
Down’s
Vascular risk factors
Limited intellectual activity or stimulation
Depression
Traumatic brain injury, especially in later in life.
Risk factors for vascular dementia?
IHD and its risk factors
DM
DDx:
Reversible dementias:
- Thyroid
- Electrolyte imbalance
- Lack of which vitamin
- Blood
- What is normal pressure hydrocephalus? What is the classic triad for this?
Hypothyroidism
Hyponatraemia
Vit B12 deficiency
Anaemia
An abnormal buildup of cerebrospinal fluid (CSF) in the brain’s ventricles, or cavities. It occurs if the normal flow of CSF throughout the brain and spinal cord is blocked in some way.
Dementia, urinary incontinence, and gait ataxia - wet, wacky, and wobbly”
DDx:
A genetic disease that causes non-reversible dementia?
Depression:
- When does the depression seem to be worse?
What is mild cognitive impairment?
Huntington’s Disease
The morning, whereas Alzheimer’s is worse in the evening.
Mild memory loss but no functional impairment
