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
What are some possible management options after the diagnosis?
Acetylcholinesterase inhibitors for alzheimer's Watch adn wait if unsure about diagnosis Treating behavioural symptoms Anti-psychotics Anti-depressants Refer to therapy Occupational therapy
How can conditions be ruled in or out? What are some common presentations?
Delirium - Depression - Alzheimer's - Vascular - Dementia with Lewy bodies - Frontotemporal - Rapidly progressing -
Delirium - usually acute, organic (physical) cause
Depression - mood
Alzheimer’s - subtle, insidious amnestic / non-amnestic presentation
Vascular - related to cerebrovascular diseases with step wise deterioration with or without multiple infarcts
Dementia with Lewy bodies - cognitive impairment within 1 year of Parkinsonian symptoms, visual hallucinations, fluctuating cognition
Frontotemporal - behaviour variant FTD, semantic dementia, progressive non-fluent aphasia
Rapidly progressing - dementia progresses fast
How does Alzheimer’s present clinically?
Patient often feel’s there is nothing wrong, thinks they are aging
Short term memory loss - forggeting things they have done or watched, asking the same questions again and again
Forgetting medications
Forgetting common routes e.g. to shops, children’s homes, etc.
Episodic memory loss
Irritable
What are the biomarker patterns in Alzheimer’s?
Amyloid plaques for first, then Tau mediated neuronal injury and dysfunction
This causes changes in brain structure leading to decrease in cognitive function
How does B-amyloid in CSF fluid compare in normal people to Alzheimer’s patients?
How does CSF Tau compare in normal people to Alzheimer’s patients?
Significantly lower CSF Beta-amyloid in Alzheimer’s patients than in normal control group
Significantly higher CSF Tau in Alzheimer’s patients than in normal control group
How does dementia with Lewy bodies normally present?
Associated with fluctuating cognition
Different cognitive profile to Alzheimer’s
Often visual hallucinations
REM sleep disorder - restless at night, shouting etc.
Development of symptoms associated with Parkinson’s
High risk of falls
What is the biochemical cause for dementia with Lewy bodies?
Aggregation of alpha-Synuclein leading to deposition of lewy bodies and so symptoms
How do MRIs and PET scans show differences between alzheimer’s and dementia with lewy bodies?
Alzheimer’s = medial temporal lobe and hippocampal atrophy
Dementia with lewy bodies = preserved hippocampal atrophy
What is a DATscan, how is it conducted, and what are the differences in imaging between Alzheimer’s and dementia with lewy body patients?
DATscan = brain imaging
Uses 123-Iodine tracer = images dopamine transporter
Alzheimer’s = dopamine transporters in caudate putamen
Dementia with Lewy body = decreased dopamine transporter in caudate putamen
How does frontotemporal dementia (FTD) present clinically?
Aphasia - using the wrong words, agrammatical
Significant anomia
Difficulty understanding speech
Angry, irritable, frustrated when misunderstood
Rude on number of occasions
Obsessive with routine
Lesser personal hygiene
Spontaneous conversation limited and dysfluent
How does FTD show up on blood tests and MRIs?
Blood tests usually normal
MRIs often show significant volume loss in the temporal lobes and frontal opercula (more so on the right)
