Dementia Flashcards
what assessment tools do NICE recommend using in primary care in a patient with suspected dementia ?
6 point cognitive impairment test (6-CIT)
10 point cognitive screener (10-CS)
describe how you would approach a patient in GP who presented with suspected dementia ?
history + collateral history functional impairment (ADL) assessment - 10 point cognitive screener - 6 point cognitive identification test
carry out blood tests to exclude reversible causes;
- FBC, U&E, LFT, TFT, glucose, vitamin B12, folate, calcium
1st line medication for mild-moderate alzheimers ?
acetylcholinesterase inhibitors e.g. donepezil, rivastigmine, galantamine
1st line medication for moderate - severe alzheimers ?
memantine (NMDA antagonist)
pathophysiology of alzheimer’s ?
build up of amyloid proteins
main neurotransmitter affected is acetylcholine
pathophysiology of lewy body dementia ?
build up of protein - alpha synuclein
key features of alzheimer ‘s ?
early memory loss
preservation of personality and visuospatial awareness until late stages
progressive decline
key features of lewy body dementia ?
hallucinations
fluctuations
Parkinsonism
key features of frontotemporal dementia ?
early personality change and loss of visuospatial awareness
memory spared until late stages
aphasia
key features of vascular dementia ?
step wise decline
vascular risk factors
affect component (blunting, depression etc)
‘reversible’ differentials of dementia ?
normal pressure hydrocephalus neurosyphilis / HIV brain tumour subdural haematoma vitamin B12 deficiency / folate hypothyroidism
side effects of acetylcholinesterase inhibitors i.e. Donepezil ?
nausea, vomiting diarrhoea fatigue insomnia muscle cramps syncope breathing problems
if patient cannot tolerate acetylcholinesterase inhibitor for the treatment of alzheimers, what should be given first line ?
memantine (NMDA antagonist)
