Dementia + Alzheimer's Flashcards
differentials for dementia - different dementias
1 - alzheimer’s
2 - vascular dementia
3 - lewy body dementia
4 - fronto-temporal dementia
differentials for dementia - non-dementia
delirium
drugs - medication, intoxication, withdrawal, alcohol-related
brain - infection, tumour, injury
neuro - huntington’s, parkinson’s
dementia - behaviour
restless, repetitive, purposeless activity
sexual + social disinhibition
rigid routine
no initiative
dementia - speech
speech errors
dysphasia
mutism
dementia - thoughts
slow, poor memory, muddled
delusions
no insight
dementia - perceptual abnormalities
illusions + hallucinations - often visual
dementia - mood
irritable
depressed
blunt affect
emotional incontinence eg of crying, laughing
vascular dementia - what is it? feature? investigations?
cumulative effects of many small strokes - sudden onset + stepwise deterioration
expressive aphasia (broca’s - stroke)
look for vascular pathology - BP, strokes, focal CNS signs
lewy body dementia - features, later features + management
fluctuating cognitive impairment
visual hallucinations
later - parkinsonism, falls, mobility problems
management - rivastigmine for behavioural symptoms
fronto-temporal dementia - features
behaviour + personality change
hyperorality + hyperphagia
early on, episodic memory + spatial orientation preserved
executive impairment
disinhibition + impulsivity
emotional unconcern/loss of sympathy
episodic memory
collection of past personal experiences that occurred at a particular time and place
dementia - history of memory/cognitive decline
2 re memory:
first thing noticed + timeline
hardest thing to remember
2 re out and about:
lost in familiar place?
ADL effects - shopping, tasks
2 re changes to normal traits:
mobility
aggression
dementia - symptoms to ask about in history
4 mood, behaviour + attitude: depression + anxiety aggression + agitation apathy drowsiness
4 dementia specific: repetitive speech hallucinations sleep disorder wandering
dementia - clinical tests
glucose
urine dip/CXR - infection
full bloods - FBC, U+E, LFT, calcium, TFT
B12 + folate - alcoholism
CT/MRI - vascular damage, tumour, subdural haematoma, NPH
volumetric MRI - subtype the dementia
volumetric MRI - how does each type of dementia look?
alzheimer’s - medial temporal + hippocampal atrophy
frontotemporal - inferior temporal atrophy; asymmetry
lewy body - medial temporal lobe fairly spared
drugs for alzheimer’s + lewy body dementia - types + examples
acetylcholinesterase inhibitors - slow disease progress:
donepezil, galantamine, rivastigmine
memantine (NMDA receptor blocker) - helps symptoms + slows disease
management of dementia - social
safety:
risk assess
e-tagging
mobility:
home adaptations - fire-safe, alarms, stairs, bathroom
walking frames
conservative medical:
catheters
nutritional supplements
legal:
LPA/advanced directive
DVLA
management of agitation in dementia
rule out pain + infection
music, muscle, massage (MMM)
risperidone oral if no response
beware benzos - falls risk
dementia - advice for relatives + carers
practical - lock unused rooms + important drawers
support - groups, helplines, alzheimer’s society - contact with others in same situ
specific - respite care, financial support
alzheimer’s dementia - presenting symptoms
global cognitive impairment (unlike in other dementias)
visuo-spatial impairment (gets lost)
speech problems
executive function (planning) problems
alzheimer’s dementia - later symptoms
mood - irritable, anxious, aggressive, depressed, elated wandering disinhibition hallucinations/delusions agnosia - doesn't recognise self/family reading/writing troubles tasks - forgets how to do
SEs of acetylcholinesterase inhibitors
headache + dizziness
insomnia
GI - tummy upset, appetite + weight loss
incontinence
acetylcholinesterase inhibitors - checks before starting + contraindications + cautions
caut - exacerbates PUD + heart block
CI - bradycardia, LBBB, prolonged QTc
ECG - HR, conduction abnormalities, QTc
memantine - class, SEs, preceding checks
antiglutamergic - NMDA receptor agonist
hallucinations + confusion
hypertonia
hypersexuality
dizziness
check U+Es - risk AKI
non-drug management of BPSDs
treat cause:
routine
orientation - clocks, calendars
activities:
music/dancing, massage
exercise
therapy:
CBT - may involve carers
reminiscence therapy, aromatherapy
animal-assisted therapy
non-drug management of BPSDs for when in hospital
familiar staff
red trays for food to alert help needed
individual rooms
safe space to wander
management of depression in dementia - which drug? what monitoring? what risks?
citalopram
monitor QTc
risks - falls, GI bleeding
trazodone - good for sleep regulation
lewy body vs frontotemporal
lewy - visual hallucinations + parkinsonism
frontotemporal - personality change + hyperorality
alzheimer’s - drug management (updated 2018)
mild-mod
1° - rivastigmine / donepezil / galantamine
2° - memantine
mod-severe - 1° + 2°
severe - monotherapy
antidepressants - only if mod-severe depression
antipsychotics - only if risk to self/others, or much distress
donepezil, galantamine, rivastigmine = AChE inhibitors
memantime = NMDA antagonist
