Dementia Flashcards
What is dementia?
Chronic progressive mental disorder that affects higher cortical functions including memory, thinking, orientation, comprehension, language, judgement
What is alzheimers
The most common form of dementia - represents 62% of all dementias - a degenerative cerebral disease. The onset is slow and steady over many years and results in progressive deterioration of cognition, function, behaviours
What are the 3 categories of symptoms?
- cognitive
- non-cognitive
- disability
Outline some cognitive symptoms
Memory loss, failing intellect, inability to learn new skills, poor concentration, language impairment, confusion
Outline some non-cognitive symptoms
Depression, delusion, anxiety, sleep disturbance, inhibition, aggression
Outline some disability symptoms
Difficulty with activities of daily living, self neglect, incontinence, BPSD (behavioural and psychiatric symptoms), may forget to eat e.g. malnourishment, forgetting to take medications
What is the pathology of dementia?
Neurodegenerative disorder which is a loss of brain tissue and nerve cells especially. in the cerebral cortex, and ventricles become enlarged to compensate for the loss of tissue.
- lose tissue in hippocampus
- Get amyloid beta plaques
- get tangles of tau protein
How is dementia diagnosed?
Symptoms, memory assessments, MRI and PET for biomarkers. (PET uses glucose to see neuron death, can see biomarkers e.g. tau proteins), CT/MRI looks at the brain shrinkage/atrophy
also mini mental state exams and clock drawing tests
What is the biggest risk factor for dementia?
age >65
What are the 2 genetic markers for dementia?
Trem2
ApoE4 which increases amyloid load
How does neuron death occur in dementia? i.e amyloid cascade hypothesis
APP mutations alter processing. Increased Amyloid beta production and decreased degradation leading to accumulation. This stimulates inflammaory response, microglial cells are dysfunctional and cannot clear amyloid. This leads to synapse loss, oxidative stress, increased ROS, increased calcium release and neuron death
What does dementia treatment focus on?
symptomatic modulation of neurotransmitters - no disease modifying therapy
What are the 2 broad treatment classes for dementia?
Cholinergic AChE inhibitors
NMDAR. inhibitors targeting glutamatergic signalling
What. treatment is. used. in mild-moderate dementia. and. its MOA?
AChE. inhibitors = donepazil, galantamine, rivastigmine.
Inhibit. acetylcholinesterase enzyme which breaks. down. ACh so it cannot break it down, increasing ACh to enhance the cholinergic transmission and improve cognitive function
What. treatment is. used. in moderate-severe dementia. and. its MOA?
Memantine - non-competitive antagonist of NMDARs so dampen down the glutamatergic signal and. improve cognitive function and reduce excitotoxicity
What is a non-pharmacological treatment for dementia?
Repetitive transcranial magnetic stimulation with cognitive training- NeuroAD (neuronix)
What is a limit to dementia treatment
Does not slow progression of disease so therapeutic effectiveness decreases with increasing neuronal damage
What are the side effects of AChE?
Nausea and vomiting
diarrhoea
Sludge effects - salivation, lacrimation, urination, defecation, GI, emesis
What can symptoms of dementia be confused with?
Infections vitamin defciencies thyroid problems depression,anxiety brain tumour diabetes
What are risk factors for dementia?
Age, drinking, smoking, diabetes, head injury, stroke history, hypoxia, genetics
What drug should you not give to someone who has dementia?
TCAs diphenhydramine chlorpehamine clozapine Due to anticholinergic properties increased Anticholinergic burden and doing the opposite
What are treatment options for non-cognitive symptoms of dementia
Depression SSRis - avoid TCA and MAOI
Sedatives IM lorazepam only if violence
Antipsychotics only if severe psychosis
