Dementia Flashcards
What is the most common cause of dementia?
Alzheimer’s disease - fatal neurodegenerative disorder characterised by progressive cognitive, social and functional impairment
Is there a cure or treatment?
No cure, treatment with acetylecholinesterase inhibitors having modest symptomatic benefit in the early stages
In what age group are rarer forms of dementia more prevalent?
Younger population = more prevalent rarer forms of dementia; for late onset dementia (i.e. >65) it is usually Alzheimer’s
Other than Alzheimer’s disease, what are some other types / causes of dementia?
Vascular dementia
Frontotemporal dementia
Dementia with Lewy bodies
What are some potentially reversible causes of dementia?
What are some rarer causes of dementia?
Potentially reversible = depression, alcohol related brain damage, endocrine (hypothyroidism, Addison’s, Cushing’s), B1/B12/B6 deficiency, benign tumours, infections etc.
Rare = progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration, Huntington’s disease, etc.
How does cognitive function compare between dementia and aging?
Dementia - curve for cognitive function decreases much faster than in aging
Why is cognition difficult to assess clinically?
Dependent on: quality of sleep, UTIs, taking sleeping tablets, diet, infections etc.
Why is it difficult to accurately diagnose dementia in the clinic?
Disease follows heterogenous course
In old age, the disease presents with multiple co-morbidities
Mixed and uncertain pictures (of the brain)
Clinical history, function of the patient and how they change is most important for diagnosis
How is dementia diagnosed clinically?
Usually referral to memory clinic Patient goes for clinical interview - take detailed history (most important) Examination Investigations Diagnosis Management
What is the checklist for the clinical interview for patients and their friend / partner / children etc.?
Memory Language Numerical skills e.g. manage their finances Executive skills Visuospatial skills Neglect phenomena Visual perception Route finding and landmark identification Personality and social conduct Sexual behaviour Eating Motivation / apathy Anxiety / agitation Delusions / hallucinations Activities of daily living Ask about mood - may be depressed, so medications e.g. SSRIs can reverse the declining cognitive function
How can the speed of deterioration point to the type of dementia a patient might have?
Slow deterioration = most likely Alzheimer’s
Fast deterioration = rarer causes, maybe vascular dementia
Define dementia:
Severe loss of memory and other cognitive abilities which leads to impaired daily function (regardless of underlying cause)
What examination is usually taken from the patient?
Neurological tests:
e.g. test CNs, upper limbs and lower limbs (gait), focused tests (e.g. frontal lobe), perception and cognition tests, mental state tests etc.
MMSE - Mini mental state examination
ACE - Addenbrook’s Cognitive Assessment
Head turning sign - patient turns to partner / friend and waits for them to answer as they either don’t know or is unsure of the answer
What sort of investigations take place?
How may these investigations show cognitive impairment?
Neuropsychology Bloods (look for cause of cognitive impairment- may be reversible) - full blood count, inflammatory markers, thyroid function, biochemistry and renal function, glucose, B12 and folate, clotting, syphilis serology, HIV, caeruloplasmin
MRIs - as disease progresses, narrow gyri and widened sulci, venticles dilated and englarged, volume loss of medial temporal lobe esp. hippocampus (CSF fills the space instead) - look at coronal T1 MRIs
PET scans - contrast on PET scans show in vivo amyloid plaque in brain and they correspond with amyloid plaque presence post-mortem (the more amyloid, the more progressed the dementia)
What are the common possible diagnoses after taking patient history, examining the patient and conducting further investigations?
Alzheimer's Vascular Lewy body STD Depression Delirium Nothing
