Dementia Flashcards
How do you diagnose dementia
Cognitive decline from a previously higher level of functioning with impaired memory and at least one other cognitive domain, from:
- aphasia (language)
- apraxia (purposeful actions)
- agnosia (recognition)
- Executive function (goal-directed planning, decision making)
What do you need to rule out in a dementia diagnosis
Other neurological diseases like delirium
vascular risk factors for dementia
Atherosclerosis
Diabetes
genetics
Hypertension
Degeneritive/inherited risk factors for dementia
Down syndrome
Genetic
What is the most common cause of dementia
Alzheimer’s disease
What is the presentation of Alzheimer’s
Atrophic brain:
- cerebral cortex
- hippocampus
What tangles and plaques are there in Alzheimers
neurofibrillary tangles in neurones (bundles of aggregated and twisted tau protein)
Plaques of amyloid protein between neurones
How do plaques and tangles affect brain
Disrupt neurotransmission and cause nerve cell death
What does brain of an Alzheimer’s patient look like
Narrowed gyro
Increased Sylvian fissure
Global shrinkage
Widened sulcal margins
Subtypes of vascular dementia
Lacunar disease, microangiography
Multi-infarct disease (recurrent strokes)
Diffuse white matter disease
Vascular Parkinsonism (basal ganglia)
Risk factors for vascular dementia
Diabetes Hypertension Smoking Other vascular pathology Previous strokes
Presentations of vascular dementia
Patchy cognitive impairment
Frontal lobe, extrapyramidal, pseudobulbar features
Emotional liabiility
Urinary incontinence and falls
Apathy and depression (if predominantly subcortical)
Vascular dementia vs Alzheimer’s disease
Onset is gradual in Alzheimers vs sudden is more prevalent in vascular dementia
Abrupt change in cognition in vascular dementia
Motor/sensory deficits, gait disturbance, incontinence, speech deficits in vascular dementia. Normal functioning until late stage and speech deficits in Alzheimer’s
What is dementia and Parkinsonism
Dementia with Lewy bodies
Parkinson’s disease with dementia
Presentations of dementia with Lewy bodies
Difficulty sleeping, loss of smell and visual hallucinations can precede movement and other problems by as long as 10 years. Can be unrecognised or misdiagnosed until later stages
Dementia with Lewy bodies pathology
Lewy bodies are protein aggregates, balloon-like structures that form inside neurones
Neurones in the substantia nigra die or become impaired and cortex degenerates
Symptoms of Alzheimer’s like dementia with Lewy bodies
Memory loss,
poor judgment
Confusion
Symptoms of Parkinson’s like dementia
Difficulty with movement and posture, shuffling walk
Key presentations of Dementia with Lewy bodies
Visual hallucinations (animals, little children, not always distressing)
Fluctuations in attention and alertness
Persecutory delusions and other neuropsychiatric features
What are people with Parkinson’s disease at risk of developing
Dementia
Which Parkinson-plus syndromes increase risk of dementia
Multiple system atrophy
PSP
CBD
What are the triad symptoms of Normal Pressure Hydrocephalus
Gait disturbance
Cognitive Impairment
Urinary incontinence
Management of Normal Pressure Hydrocephalus
CT of head
Lumbar puncture
MMSE (or other cognitive test) before and after
Gait assessment before and after you take CSF
If removal of fluid for hydrocephalus is successful, what do you do
Refer to neurosurgery for shunt procedure
