Dementia Flashcards
What is dementia?
A neurodegenerative syndrome with progressive decline in several cognitive domains.
The initial presentation is usually memory loss.
How is a diagnosis of dementia made?
History from the patient. It is important to exclude any illness causing temporary confusion!
Ask about the timeline of decline and the domains affected, there might be non-cognitive symptoms such as agitation, aggression or apathy. These indicate late disease.
Do cognitive testing.
Examination to identify a physical cause, risk factors such as for vascular dementia and parkinsonism.
Do a medication review to see if any drugs might ellicit symptoms.
Explain cognitive testing in dementia.
Dementia screen such as AMTS.
+
Short tests of executive function and language.
Carry out a mental state exmination to identify anxiety, depression or hallucinations
Explain the AMTS.
Abbreviated Mental Test Score
1 - 42 west street
2 - Age
3 - Time
4 - Year
5 - Date of birth
6 - Date of 1st/2nd world war
7 - Queen
8 - Where are you?
9 - Recognise 2 people
10 - Count backwards 20-1
Investigations of dementia.
Look for reversible causes such as;
TFT, B12, Folate, Thiamine, Ca2+ def.
Check MSU, FBC, ESR, U&Es, LFTs, Glucose.
MRI to identify reversible pathologies.
Functional imaging - FDG, PET, SPECT
Consider EEG
Check antibodies for syphilis, HIV, CJD or other rare causes if indicated.
When should you consider EEG in dementia?
Suspected delirium
Frontotemporal Dementia
CJD
Seizure disorder
Subtypes of dementia
Alzheimer’s disease (most common)
Vascular dementia (25%)
Lewy Body’s dementia (15-25%)
Fronto-temporal dementia
Pick’s disease
HIV related dementia
Other causes of dementia.
Alcohol and drug abuse
Repeated head trauma
Pellagra
Whipple’s disease
Huntington’s
CJD
Parkinson’s
HIV
Cryptococcis
Familial autosomal dominant AD
CADASIL
Explain Vascualr dementia.
Cumulative effect of many small strokes. There is sudden onset and stepwise deterioration.
Look for any evidence of arteriopathy such as increased BP, past strokes and focal CNS signs.
Management of vascular dementia.
Treat any underlying cause such as strokes, hyperlipidaemia, HTN etc…
Haloperidol can be used if patient is agitated.
Alzheimer’s disease medicines, such as donepezil (Aricept), galantamine (Reminyl), rivastigmine (Exelon) or memantine are not used to treat vascular dementia, but may be used in people who have a combination of vascular dementia and Alzheimer’s disease.
What is Lewy body dementia?
Fluctuating cognitive impairment, detailed visual hallucinations and later parkinsonism.
Histology is characterised by Lewy Bodies in brainstem and neocortex.
Treatment of Lewy Body dementia.
Acetylcholinesterase (AChE) inhibitors, such as donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl), may help improve hallucinations, confusion and sleepiness in some people.
Memantine - NMDA antagonist
Levodopa can be given, it may make it worse as well.
Avoid antipsychotics in Lewy Body Dementia. It can lead to neuroleptic malignant syndrome.
Explain fronto-temporal dementia.
Front and temporal atrophy with loss of over 70% of spindle neurons.
Patients display executive impairment, behavioural and personality cahnges, disinhibtion, hyperorality, sterotype behaviour and emotional unconcern.
Episodic memory and spatial orentation are preserved until later stages.
Other considerations to make in dementia.
Depression can mimic dementia.
Try and SSRI or if severe mirtazapine.
CBT can help as well.
Cause of AD.
Environmental and genetic factors both play roles.
Accumulation of beta-amyloid peptide - a degradation product of amyloid precursor protein results in progressive neuronal damage. Neurofibrillary tnagles and increased number of amyloid plaques and loss of the neurotransmitter acetylcholine.
Neuronal loss is selective . the hippocampus, amygdala, temporal neocortex and subcortical nuclei are most vulnerable.
Vascular effects are also important as 95% of AD patients show evidence of vascular dementia as well.
