Dementia Flashcards
What is dementia?
Syndrome of generalised decline of memory, intellect and personality without impairment of consciousness, leading to functional impairment
What are the main types of dementia?
Alzheimer’s disease
Vascular
Fronto-temporal dementia
Dementia with Lewy bodies
What are irreversible causes of dementia?
Neurodegenerative - Alzheimer's Fronto-temporal - Dementia with Lewy bodies - Huntington's disease
Infections
Toxins
Vascular dementia
Traumatic head injury
What are the reversible causes for dementia?
Neurological
- normal pressure hydrocephalus
- intracranial tumours
Vitamin deficiencies
Cushing’s syndrome
Hypothyroidism
What are the ICD-10 criteria for dementia?
Evidence of
- decline in memory
- decline in other cognitive abilities characterised by deterioration in judgement and thinking
Preserved awress of environment long enough to show decline
A decline in emotional control or motivation or change in social behaviour shown by
- emotional lability
- irritability
- apathy
- coarsening of social behaviour
Present for at least 6 months
What is the pathophysiology of Alzheimer’s?
Degeneration of cholinergic neurons in nucleus basalis - deficiency of acetylcholine
What are the microscopic changes seen in Alzheimer’s?
Intracellular neurofibrillary tangles
Extracellular B-amyloid plaques
What are the macroscopic changes seen in Alzheimer’s?
Cortical atrophy
Widened sulci
Enlarged ventricles
What are risk factors for Alzheimer’s?
Increasing age Family history Genetics Down's syndrome Low IQ Cerebrovascular disease
Which genes are associated with Alzheimer’s?
Early onset
- Presenilin 1 (chromosome 14)
- Presenilin 2 (chromosome 2)
- Amyloid precursor protein (chromosome 21)
Late onset
- ApoE-4 (chromosome 19)
What are the features of early stages of Alzheimer’s?
Memory lapses
Difficulty finding words
Forgetting names
What are features of disease progression in Alzheimer’s?
Apraxia
Confusion
Language problems
Difficulty in executive thinking
What is exectutive thinking?
Problem solving Reasoning Decision making Visuospatial abilities Language skills
What are features of later stages of Alzheimer’s?
Disorientation to time/place Wandering Apathy Incontinence Eating problems Depression
What are the ICD-10 criteria for Alzheimer’s?
General criteria for dementia met
No evidence for any other cause
What are the ICD-10 criteria for early onset Alzheimer’s?
General criteria met + <65
At least one of
- rapid onset and progression
- aphasia
- agraphia
- alexia
- acalculia
- apraxia
What are the ICD-10 criteria for late onset Alzheimer’s?
General criteria met + >65
At least one of
- slow onset and progression
- memory impairment over intellectual impairment
What is aphasia?
Impairment of language
What is agraphia?
Decreased ability to communicate through writing
What is alexia?
Reduced ability to read
What is acalculia?
Decreased ability to do maths
What is apraxia?
Inability to carry out previously learned purposeful movements
What is the pathophysiology of vascular dementia?
Cerebrovascular disease
What is the progression of vascular dementia?
Stepwise
What are the features of vascular dementia?
Memory loss Emotional changes Personality changes Confusion Neurological signs
What is the pathophysiology of Lewy body dementia?
Abonormal deposition of Lewy bodies in neurons
What are the features of Lewy body dementia?
Day to day fluctuations in cognition Visual hallucinations Motor Parkinson's signs - tremor - rigidity - bradykinesia
How is Lewy body dementia differentiated from Parkinson’s with dementia?
Lewy body dementia = dementia + Parkinsonism within 12 months of each other
What is the pathophysiology of fronto-temporal dementia?
Atrophy of frontal and temporal lobes
What are the features of fronto-temporal dementia?
Disinhbition Apathy Loosening of social behaviour Repetitive behaviour Language problems
How is dementia managed?
Supportive treatment
Advance planning
Social support
Pharmacology
- acetylcholinesterase inhibitor
- treat low mood
