Dementia Flashcards
Define dementia
Dementia is a chronic, progressive, neurodegenerative syndrome characterised by a decline in cognitive function across multiple domains, sufficient to cause functional impairment.
What are signs and symptoms of dementia?
• Memory loss is often the first symptom
• Other domains affected include
○ Behaviour: restless, purposeless
○ Personality changes
○ Speech changes
○ Thinking: slow and muddled, no insight
○ Mood: irritable and depressed
What are irreversible types of dementia?
alzheimer’s
vascular
frontotemporal
lewy body
What are some reversible causes of dementia?
- Hypothyroidism
- Normal pressure hydrocephalus
- Drugs (opiates, sedatives, anticholinergics)
- Tumours e.g. meningioma
- Neurosyphilis
- Chronic subdural haematoma
- Whipple’s disease
- Nutritional e.g. B3 deficiency (Pellagra)
- Psychiatric disorders
What Ix in dementia?
Cognitive assessment tests
Bloods: looking for reversible causes e.g. TFTs, B3 deficiency, syphilis
Imaging: ruling out chronic subdural, tumours, stroke
What DDx for dementia?
- Normal ageing
- MCI
- Depression
- Delirium
- Stroke
What is management of dementia?
Assess functional and social needs
Treat reversible causes
acetylcholinesterase inhibitors donepezil, rivastigmine: for mild to mod Alzheimer’s
memantine: moderate to severe Alzheimer’s
What are risk factors for dementia?
CV risk factors
What is normal pressure hydrocephalus
Secondary to reduced CSF absorption at the arachnoid villi. These changes may be secondary to head injury, subarachnoid haemorrhage or meningitis. Causes reversible dementia
What are Sx of normal pressure hydrocephalus?
- urinary incontinence
- dementia and bradyphrenia
- gait abnormality (may be similar to Parkinson’s disease)
Ix in normal pressure hydrocephalus?
• hydrocephalus with an enlarged fourth ventricle
in addition to the ventriculomegaly there is typically an absence of substantial sulcal atrophy
How is normal pressure hydrocephalus managed?
Ventriculoperitoneal shunting
