Dementia Flashcards
what is the commonest cause of dememtia?
alzheimer’s disease
what is dementia?
- fatal, neurogenerative disorder characterised by progressive cognitive, social and functional impairment
what is the current treatment for dementia?
- no current cure
- acetylcholinesterase inhibitors have modest symptomatic benefit at early stages
what is the age group for switch from young onset and late onset dementia?
- age cut of at 65 between young onset and late onset dementia
- most prevalent >65 is Alzheimer’s
what is the continuum of dementia?
the diesase follows heterogenous course
in old age presentation is multiple co-morbidities
what are the causes of dementia?
- fAD- familial autosomal dominant
- AD- Alzheimer’s disease
- VaD- vascular dementia
- DLB/PD- parkinsons/ dementia with Lewy bodies
- FTD- frontotemporal dementia
- Alcohol or other
how can dementia be identified in elderly?
- As progresses lack insight so much ask family/carers – History most important in identifying dementia
what is the brain pathology of dementia?
- High Beta-amyloid antibody presence identified in immunochemistry post-mortem or PET scans in-vivo correspond with high liklihood of Alzheimer’s disease
what happens to the brain on dementia progression?
- As disease progresses get narrow gyri, widened sulci and ventricles dilated and enlarged, mediotemporal volume loss bilaterally, hippocampal volume loss and replaced with CSF
what can be used to assess a patient for dementia?
- MMSE (mini mental state exsamination)
- Head turning sign- when ask patient direct question, turn head to partner as either don’t know answer or cant be sure, need verification
- ACE (addenbrooks cognitive assessment)
- Episodic memory usually affected (profound impairment, particularly in relatin to recently learned material)
- Episodic memory= memory for particular episodes in life
- Dependant of medial temporal lobes inc hippocampus
what is the management for demetia?
- Acetylcholinesterase inhibitors
- Watch and wait (deterioration over 6months)
- Treating behavioural/ psychological symptoms
- Specialist therapy/ occupational therapy/ social services
how is Alzheimer’s diagnosed?
- subtle, insidious amnesic/ non amnesic presentation
- presence amyloid + tau + neurodegeneration for diagnosis Alzheimers
- can measure amyloid via PET or CSF, Tau via CSF
- CSF amyloid alzheimers = lower than normal
- CSF Tau alzheimers= higher than normal
what are the features of vascular dementia?
- reletated to cerebrovascular disease with classival step-wise deterioration + multiple infarcts
what are the features of dementia with lewy bodies?
cognitive impairment before/ within 1 year of parkinsonian symptoms, visual hallucinations and fluctuating cognition
- May be aware of recent events with no evidence of altered behaviour
- Memory not specifically an issue
- REM sleep disorder
- fluctuating cognition
- visual hallucinations can be improved with cholinesterase inhibitor (rivastigmine)
- high risk falls
what are the variants of frontotemporal dementia?
- variants: behavioural variant FTD, sematic dementia, progressive non-fluent aphasia
what are the inital features of Alzheimer’s disease?
- Typically involves initial episodic memory deficits secondary to dysfunction of medial temporal lobe structure (entorhinal cortex and hippocampus)
what are the differences seen in imaging in dementia with lewy bodies?
- Preserved hippocampal and meditemporal volume on MRI
- Caudate and putamen decreased dopamine transmission in imaging
how are lewy bodies formed?
what are the features of frontotemporal dementia?
- Memory issues
- Issues with speech, using wrong words, agrammatical speech and difficulty understanding speech
- Recognise fragmented letters and objects
- Angry and frustrated when not understood, become rude and obsessive
- Decreased personal hygiene
- Symmetrical and plantars withdrawn
what are the effects seen in MRI for frontotemporal dementia?
MRI volume loss in temporal lobes and frontal opercula
typically asymmetric
what testing is possible in frontotemporal dementia for diagnosis aid?
genetic testing
