Dementia Flashcards
what is cognition?
mental action of acquiring and understanding information
what is dementia?
un-doing of the mind
what is the biggest risk factor for dementia?
age
causes of acute cognitive decline
focal injuries such as viral encephalitis, head injury and stroke
acute cognitive disorder examples
- transient global amnesia
2. transient epileptic amnesia
what is transient global amnesia?
abrupt onset of antegrade amnesia with preserved knowledge of self
presentation of transient global amnesia
4-6 hours
antegrade amnesia
>50
triggered by change in temperature or emotion
what is transient epileptic amnesia?
associated with temporal lobe seizures causing forgetfulness
management of transient epileptic amnesia
AED response
causes of sub-acute cognitive disorders
toxins metabolic changes inflammation mood disorders infection (HIV, syphilis)
examples of sub-acute cognitive impairments
- functional/ subjective cognitive impairment
- Prion disease
- Limbic encephalitis
what is functional/ subjective cognitive impairment?
everyday forgetfulness impacting on function
fluctuation in symptoms
exclude mood disorder
what is prion disease?
CJD is a neurodegenerative proteinopathy with prion building up in the brain
examples of gradual onset disorders of cognition
Alzheimer's FTD vascular dementia dementia with LB PD dementia Huntington's disease
what is the most common form of dementia?
Alzheimer’s disease
what is Alzheimer’s disease?
neurodegenerative proteinopathy of amyloid which disrupts cholinergic pathways with synaptic loss due to extracellular amyloid plaques
what do intracellular neurofibrillary tangles in Alzheimer’s cause?
disruption to the cytoskeleton and cell death
presentation of Alzheimer’s
forgetfulness
apraxia primary progressive aphasia
diagnosis of Alzheimer’s
screening tests e.g. MOCA
MRI (atrophy in temporal and parietal lobes)
SPECT (reduced metabolism in temporal and parietal lobes)
CSF= low amyloid with high TAU
amyloid ligand imaging
management of Alzheimer’s
ACh boosting= cholinesterase inhibitors e.g. rivastigmine or NMDA blocker e.g. memantine
vascular RF
adverse of cholinesterase inhibitors such as rivastigmine
D&V HA cramps bradycardia worsen COPD/ asthma
what should be checked before prescribing cholinesterase inhibitors e.g. rivastigmine?
pulse and before any dose change
when should you not use cholinesterase inhibitors?
active peptic ulcer
severe asthma/ COPD
adverse of NMDA blocker e.g. memantine
hypertension sedation dizziness HA constipation
what should be checked before starting NMDA blockers e.g. memantine?
BP
what is FTD?
early onset dementia caused by neurodegenerative proteinopathy involving the TAU protein which aggregates and causes cell damage
presentation of FTD
personality/ behaviour change first, then dementia
primary progressive aphasia
frontal lobe symptoms
MND-FTD spectrum
what are some examples of frontal lobe symptoms?
disinhibition
apathy
empathy lost
compulsive behaviour
3 syndromes of FTD
- behavioural variant (frontal)
- primary progressive aphasia (temporal)
- semantic dementia (temporal)
behavioural variant of FTD
behaviour change executive dysfunction disinhibition impulsivity loss of social skills apathy obsessions change in diet
presentation of primary progressive aphasia
effortful non-fluent speech
speech errors
lack of grammar and words
presentation of semantic dementia in FTD
impaired understanding of meaning of words
fluent but empty speech
difficulty retrieving names
diagnosis of FTD
MRI shows atrophy of FT lobes
SPECT has reduced metabolism in FT lobes
CSF= high TAU and normal amyloid
check FH for MND spectrum
management of FTD
trial of trazadone/ antipsychotics to help behavioural features
safety management with controlled access to food, money, etc.
what is vascular dementia
late onset dementia >65 with the presence of cerebrovascular disease
presentation of vascular dementia
memory and personality change in someone with a history of cardiovascular disease
step-wise deterioration
small vessel disease= reduced attention, slowed processing
post-stroke dementia <3 months
dysphasia
dyscalculi
management of vascular dementia
vascular RF +/- cholinesterase inhibitors
what is dementia with lewy bodies?
late onset dementia due to neurodegenerative proteinopathy with alpha-synuclein protein
what does the alpha-synculein protein in DLB cause?
it is an insoluble protein that disrupts cholinergic and dopaminergic pathways leading to Parkinsonian features
presentation of DLB
fluctuating cognition vivid visual hallucinations normally of children and not threatening REM disturbance dementia <1 year TRAP features for <1 year
diagnosis of DLB
clinical
DaT
protein in CSF or ligand imaging
management of DLB
levodopa/ reduced ACh (cholinesterase inhibitors)
what is PD dementia?
late onset and have had PD for a number of years before cognitive decline
presentation of PD dementia
TRAP features
REM disturbance
dementia >1 year
management of PD dementia
levodopa/ reduced ACh (cholinesterase inhibitors)
what is Huntington’s disease dementia?
early onset 30-50 years due to expansion of CAG trinucleotide producing neurodegenerative protein (Huntingtin protein)
presentation of HD
dementia
associated changes in mood/ personality and chorea +/- psychosis
diagnosis of HD
genetics
MRI shows loss of caudate heads
management of HD
mood stabilisers
Rx for chorea
