Dementia Flashcards
define dementia
an acquired progressive impairment of cognition without clouding of consciousness that has been present for at least 6 months
state the 6 domains that cognition is assessed in
language movement visuospatial memory executive functioning behaviour
for a dementia to be present there must be how many cognitive domains affected
2
outline some general features of cognitive decline
memory loss slow, muddled thinking disorientated in space and time restlessness reduced attention and concentration loss of insight repetitive actions odd and disorganised behaviour
outline some primary causes of dementia
Alzheimers
Lewy body
Pick’s disease
outline some secondary causes of dementia
vascular dementia due to CVS disease
CJD or infection
huntingtons and Parkinson’s causing secondary dementia
alcohol abuse or head injury
what is the most common cause of dementia
Alzheimers disease
what gene has a defect in Alzheimers
ApoE gene
what are the macroscopic features of Alzheimers
cortical atrophy with thinning of gyri and sulci - occipital lobe spared
compensatory ventricular enlargement
what protein is there depositions of in Alzheimers disease
B-amyloid proteins
what are neurofibrillary tangles in Alzheimers and what protein are they formed from
filament bundles between the neurones - formed from tau protein
what is the effect on ACh neurotransmission in Alzheimers
reduced ACh in the nucleus Basilis of meynet
what is the initial symptom seen in Alzheimers
progressive memory loss, initially short term then followed by long term memory
describe the speech disorder in Alzheimers
dysphasia, trouble getting words out and understanding speech
describe some of the behavioural changes in Alzheimers
restlessness, agitation, aggressive outburst
associated with low mood and poor sleep
what are the findings on MRI in Alzheimers
usually normal, may have medial temporal lobe atrophy
usually imaging not required in suspected Alzheimers
who is at risk of developing vascular dementia
more common in men
those with increased CVS risks such as hypertension, hyperlipidaemia etc
what causes vascular dementia
develops as a result of small vessel infarcts within the white matter, grey nuclei and thalamus
what is the initial presentation in vascular dementia
functional deficits such as gait disturbance and urinary incontinence before memory problems
how does vascular dementia progress
in a stepwise progression, disease worsens then remains the same before getting worse even more
what are the emotional changes seen in vascular dementia
mood disturbances and disorders are very common
who is most likely to develop Lewy body dementia
men more commonly affected
>50 years
what causes Lewy body dementia
degeneration of substantiated Nigra and cortex
microscopically shows levy body deposition in substantial Nigra and cortex
what domains are affected first in Lewy body dementia
defects in executive functioning and visuospatial skills rather than memory loss
how does Lewy body dementia present
visual hallucinations
Parkinsonism
fluctuating cognitive ability
REM sleep disorders
how can you differentiate between Lewy body dementia and Parkinsons with secondary dementia
Lewy body the cognitive decline is seen before or at the same time as the onset of Parkinsonism
Parkinsons the cognitive decline will be at least a year after the onset of Parkinsonism
what is the pathophysiology of frontotemporal dementia
atrophy of the frontotemporal lobes
deposition of abnormal tau proteins
what is a specific type of frontotemporal dementia
Pick’s disease
what is the initial presentation of frontotemporal dementia
general change in premorbid personality
describe the behavioural changes seen in frontotemporal dementia
altered emotional responsiveness apathy disinhibition impulsivity reduced interpersonal skills diet change
describe the changes with speech seen in frontotemporal dementia
either wernickes or brocas aphasia
list some secondary causes of dementia
Huntingtons disease
normal pressure hydrocephalus
mad cow disease - CJD
what causes CJD
Prion disease
describe the presentation of CJD
presents in <50s
memory lapses and mood disturbances, evolves into unsteadiness and clumsiness in a few weeks
stiffness, jerking, incontinence and aphasia
what is the prognosis of CJD
not great, usually dead 6 months after presentation
what aids the diagnosis of a cognitive impairment
cognitive tests
what is the first cognitive test usually done to assess a patient with suspected dementia
mini mental state examination
an MMSE score of less than what is suggestive of cognitive impairment
less than 24
MMSE is out of 30
what are the more in-depth assessments for cognition
MOCA and ACE III
outline the non-pharmacological treatment of dementia
MDT input, possibly from Alzheimer’s Scotland too
care services
incontinence pads
house assessment by OT, dose boxes and dementia clock
community alarm
what is the first line drug used in dementia
cholinesterase inhibitors
what are examples of cholinesterase inhibitors
donepezil
rivastigmine
galantamine
rivastigmine is particularly useful in which dementia
Lewy body dementia
how do cholinesterase inhibitors work
increase cholinergic transmission in the brain delaying cognitive decline
what are the side effects of cholinesterase inhibitors
GI upset
headache
muscle cramping
contraindicated in asthma, COPD and active peptic ulcer disease
which drug is indicated in severe Alzheimers for when cholinesterase inhibitors have failed to work
NMDA antagonists such as memantine
are anti-psychotics useful for agitation in dementia
should be avoided due to s/e, particularly in Lewy body dementia
