Dementia Flashcards
What is Alzheimer’s?
Fatal, neurodegenerative disorder characterised by progressive cognitive, social and functional impairment
What are the common causes of dementia?
Alzheimer’s
Vascular dementia
Frontotemporal dementia
Dementia with Lewy Bodies
What are the potentially reversible causes of dementia?
Depression Alcohol related brain damage Endocrine Vitamin B deficiencies Benign Tumors
Why is hard to diagnose dementia?
Follows a heterogenous course
In old age the disease presentation is of multiple co-morbidities
Lots of mixed/uncertain pictures
What is on the checklist when testing for dementia?
Memory Language Numerical skills Executive skills Visuospatial skills Neglect phenomena Visual perception Rout finding and landmark identification Personality and social conduct Sexual behaviour Eating Mood Motivation/Apathy Anxiety Delusions/Hallucinations Activities of daily living
What is dementia?
Severe loss of memory and other cognitive abilities which leads to impaired daily function (regardless of the underlying cause)
What investigations might you carry out?
Neuropshychology
Bloods
MRI
PET
What Blood test might you carry out?
FBS Inflammatory markers Thyroid function Renal function Glucose B12 and folate Clotting
What infections might you screen for?
Syphilis serology
HIV
Caeruloplasmin
What is a sMRI?
Structural MRI
Coronal T1
What do you see on an sMRI in Alzheimer’s?
Narrow gyro Widened sulk Ventricles dilate Medial temporal volume loss Hippocampus volume loss
How do you manage dementia?
Acetylchloinsterase inhbitors Watch and wait Treat behavioural symotoms Anti-depressants Social Services
What must you do when diagnosing dementia?
Rule in and rule out other conditions
e.g. delirium or depression
How does Alzheimer’s present?
Subtle
Insidious amnestic or non-amnestic presentations
How does vascular dementia present?
Related to cerebrovascular disease with a classical step-wise deterioration +/- multiples infarcts
How does dementia with multiple Lewy bodies present?
Cognitive impairment before/within 1 year of parkinsonian symptoms, visual hallucinations and fluctuating cognition
How does frontotemporal dementia present?
Behavioural variant
Semantic dementia
Progressive non-fluent aphasia
What is really important when taking a dementia history?
What family/carers say
What is the MMSE?
Mini mental state examination
What is ACE?
Addenbrooks cognitive assessment
What is episodic memory?
Memory for a particular episodes in life
Dependent on the medial temporal lobes including the hippocampus
How can diagnosis be made in vivo?
Amyloid PET
CSF taken by lumbar puncture (tau will be higher in Alzheimer’s)
How does dementia with Lewy bodies look different on an MRI?
Preserved hippocampal volume
What is the purpose of the mock up of the MoCa?
So that those with dementia are able somewhat experience what it is like to take it
‘the impossible MoCA
What section of the Addenbrooke’s cognitive examination would someone with Alzheimer’s struggle with?
Name and address
Acute memory
Inability to lay down new memories
What must be taken into account when conducting the ACE?
The context of the individual
Socio-economic situation
Educational background
Political awareness and social interaction
What metrics in the ACE would people with visuospatial issues struggle with?
Drawing
Identifying partial letters
Look at diagrams and count the spots without pointing
What is the underlying issue with dementia care?
Contact
Primary care consultations are online
Would be difficult to administer cognitive tests online
No non-verbal queues to guide clinical observation
People become even more isolated
