Dementia and Delirium: Clinical and Population Aspects Flashcards
What is the current clinical definition of dementia?
Deficit in >=2 cognitive domains
Sufficient to impact activities of daily living
What are the problems with the current clinical definition of dementia?
Cognitive domains subjective and ambiguous - not completely distinct
Activities of daily living subjective and vary between individuals
How does the incidence of dementia change after 65yrs old?
Doubles every 5yrs - exponential increase
How is the number of dementia sufferers in the population changing?
Increasing
How is the prevalence of dementia in the population changing and why?
Decreasing
As population size increasing - smaller proportion with dementia
What is the different between CFAS I and II?
CFAS II later but in same geographical region
What are CFAS I and II?
Population studies of dementia prevalence
Computerised assessment of whether criteria met in individual
What did a 2013 comparison of CFAS I and II find?
Decreased dementia prevalence of multiple old age groups in CFAS II
Which factors are thought to be key in explaining the result of the 2013 comparison of CFAS I and II?
Education
CV disease prevention and treatment
What are the 3 symptom stages of AD?
Mild episodic memory deficits
Moderate deficits in multiple domains
Global cognitive and functional impairment
Which staging system does tau pathology follow and what are the stages?
Braak stages
Entorhinal cortex -> hippocampus -> neocortex
Name the 4 main types of dementia
AD
Vascular
Lewy body
Frontotemporal
When does vascular dementia occur?
Post-stroke
What are the symptoms of vascular dementia?
Variable - depends on brain region affected
Prominent gait issues common
What is the pattern of the time-course of decline in vascular dementia?
In steps
What is the neuropathology of vascular dementia?
Lacunar infarcts
White matter damage
What are the symptoms of Lewy body dementia?
Attention and visuospatial disturbances
Fluctuations in consciousness
REM disorders
Hallucinations
What is the neuropathology of Lewy body dementia?
Alpha-synuclein and ubiquitin inclusions (Lewy bodies) - spread from SN to neocortex
What are the methodological challenges in dementia epidemiology?
Case ascertainment - dementia definition
Sample selection
Clinico-pathological correlations
Population neuropathology
How does stroke recurrence rate vary between a specialist clinic and the general population and what is the implication of this?
Higher in general population
Using secondary care for figures gives underestimate - those who did not survive to secondary care not included
How does the rate for MCI progression to dementia vary between the clinic and general population and what is the implication of this?
Higher in clinic
Using clinical sampling gives overestimate - clinic takes more severe cases
What is the overall problem with clinical sampling?
Underestimates rates of acute conditions
Overestimates rates of chronic conditions
What are the symptoms of delirium?
Disturbance of consciousness
Change in cognition
Is delirium acute or chronic?
Acute
What causes delirium?
Physiological precipitant and stress conditions - causes cognitive decompensation - causes temporary confusion
How does dementia affect the risk of delirium?
Increases
How does delirium affect the risk of dementia?
Increases
What did a long-term review of hospital cohorts with delirium find and what is a limitation of this study?
Delirium associated with 2x death risk, 13x dementia risk
Not all with delirium admitted to hospital - inaccurate figures - selection bias
How do the cognitive trajectories of AD patients vary with and without delirium?
With delirium - greater acceleration in cognitive decline after delirium episode
Without delirium - increased rate of cognitive decline over disease course - but slower than delirium-affected
What could the implication of the differing cognitive trajectories between AD patients with and without delirium be?
Delirium could accelerate effects on tau and AB pathology on cognition in AD patients
