Dementia Flashcards
What is dementia?
A chronic syndrome with cognitive and behavioural symptoms
What are the cognitive symptoms of dementia?
Memory impairment
Loss of orientation
Reduced learning capacity
Loss of judgement
What are behavioural symptoms of dementia?
Agitation
Aggression
Wandering
Sexual disinhibition
What are other symptoms of dementia?
Depression + anxiety
Insomnia
Hallucinations
How is a diagnosis of dementia made?
Cognitive decline \+ Impairment of activities of daily living \+ Clear consciousness
What diagnoses is it important to exclude?
Hypothyroidism
Hypercalcaemia
Vitamin B12 deficiency
Normal pressure hydrocephalus
What are the main types of dementia?
Alzheimer’s disease
Vascular dementia
Lewy body dementia
Frontotemporal dementia
What are the macroscopic changes in alzheimers?
Global atrophy
Sulcal widening
Enlarged 3rd + 4th ventricles
What are microscopic changes in alzhemiers?
Senile plaques
- amyloid precursor protein broken down to Aβ protein
Neurofibrillary tangles
- Tau proteins
What is vascular dementia?
Cognitive impairment caused by ischaemia or haemorrhage
What are risk factors for vascular dementia?
Stroke Hypertension Hypercholesterolaemia Diabetes Smoking
How does vascular dementia present?
Focal neurological symptoms
Stepwise progression
What are lewy bodies?
Aggregations of α-synuclein protein
Where are lewy bodies deposited?
Substantia nigra
Temporal lobe
Frontal lobe
Cingulate gyrus
How does lewy body dementia present?
Fluctuating cognition + alertness
Vivid visual hallucinations
Parkinson’s features
What syndrome is dementia with lewy body sensitive to?
Neuroleptic malignant syndrome
What causes neuroleptic malignant syndrome?
Side effect to anti-psychotics
- sudden drop in dopamine
What are the features of neuroleptic malignant syndrome?
Fever Encephalopathy Vital signs instability Elevated creatinine phosphokinase Rigidity
What happens in frontotemporal dementias?
Atrophy of frontal and temporal lobes
What are the symptoms of frontotemporal dementia?
Loss of inhibition
Inappropriate social behaviour
Loss of motivation without depression
Non-fluent aphasia
What is the AIDS dementia complex?
HIV infected macrophages enter the brain -> HIV causes direct damage to neurones
What are the clinical features of the AIDS dementia complex?
Cognitive impairment Psychomotor retardation Tremor Ataxia Dysarthria Incontinence
How can dementia be managed pharmacologically?
Acetylcholinesterase inhibitors
NMDA antagonists
- reduce overstimulation of glutamate activity
