Dementia and depression Flashcards
what is the definition of dementia?
an acquired decline in memory and other cognitive functions in an alert person that is sufficient to affect daily life
what are the main dementia syndromes?
Alzeheimers Vascular dementia Dementia with lewy bodies Parkinsons dementia frontotemporal dementia
What lobe controls executive function and how might deficits in executive function manifest in dementia?
frontal lobe - reasoning and complex task
Decreased safety awareness, inability to manage finances, poor decision making, poor planning
What lobe controls memory and how might deficits in this manifest in dementia?
Temporal lobe
Repetitive questions and conversation, misplaced belongings, forgetfulness, getting lost
what lobe controls visuospatial awareness and how might deficits show in dementia?
parietal lobe
Cant recognise faces, poor fine motor ability
what lobes control language and how might deficits manifest?
frontal and temporal lobe
Difficulty in thinking of normal words in conversation, hesitation and speech, spelling and writing errors
How is dementia diagnosed?
collateral Hx
Congitive exam - MMSE, addenbrookes, MOCA
Cranial nerve and motor exam - abnormal in VD
Psych assessment - depression can mimic
FBC, CRP, ESR, U&E’s, LFT, glucose
- ?underlying cause
Neuroimaging
What are the features of AD?
slow progression
Profound short term memory loss
Progression to global cognitive decline
Behavioural change and functional impairement
what is the pathophysiology of AD?
Beta amyloid deposited as amyloid plaques and abnormal aggregation of tau protein into neurofibillary tangles. cortical atrophy
what treatment options are available for AD?
Acetlycholinesterase inhibitors e.g doneprizil, galantamine and rivastigmine
NDMA receptor antagonist e.g memantine
Antidepressants and antipsychotics
What are the features of VD?
patchy cognitive impairment
problem solving difficulty
disinhibition, poor attention and memory
Focal neuro signs e.g hemiparesis, dysarthria and dysphagia
urinary incontinence and falls early
what can a physical exam show in VD?
focal neurology consistent with stroke or CVD i.e hyperreflexia, extensor plantars, abnormal gait
what may neuroimaging show in VD?
large vessel infarcts
single cortical infarct
microvascular disease
what treatements may be of use in VD?
anti-atherosclerosis meds e.g antiplatelet, statin, carotid angioplasty, stenting
BP control
what are the features of dementia with lewy bodies?
progressive dementia short term fluctuations in cognitive function Auditory and visual hallucinations mild parkinsonism REM sleep behaviour disorder
what may physical exam show in lewy body dementia?
Parkinsons signs
OH
autonomic dysfunction
what are the treatment options for LBD?
Benzos for behavioural issues
Atypical antipsychotics e.g risperidone
Clonazepam or melatonin for REM sleep behavioural disorder
why are atypical antipsychotics used for LBD instead of typical?
typical antipsychotics e.g haloperidol may worsen confusion and parkinsonism?
what are the features of frontotemporal dementia?
early age onset
behavioural and language problems predominate
insight lost early
FHx in 50%
disinhibtion, mental rigidity, inflexibility, impairment of executive function
why might MMSE be normal in frontotemporal dementia?
It does not assess frontal lobe dysfunction
what might a physical exam show in FTD?
ALS signs i.e progressive asymmetrical weakness of spinal or bulbal muscles and wasting
Parkinsonism signs
MND signs i.e fasiculations, atrophy, hyperreflexia
Glabellar, snout, sucking and grasp reflexes
Incontinence
what are management options for FTD?
Benzos
SSRI
Mitrazapine or trazodone for sleep
valproate semisodium - anticonvulsant that treats manias, irritability and agression
what are the clinical features of depression?
low mood anhedonia feelings of guilt, worthlessness, hopeless Anorexia and weight loss Sleep disturbance Behavioural disturbance congitive impairment suicidial ideation or self harm physical slowness
what investigations are useful in geriatric depression?
Geriatric depression scale
Cornell score for depression in dementia
MMSE - does it improve after treatment?
FBC - anaemia causing lethargy
ESR - malignancy or vasculitis
B12 and folate - deficitency can cause low mood
U&E’s - uraemia and dehydration
TFTs - hypothyroid?
Calcium - hypercalcaemia causes depression
what non-drug treatment is available for depression?
Supportive
Psychotherapy - CBT, IPT and PST
ECT
what drug therapy is available for depression?
SSRIs - sertraline, citalopram
TCA’s - amitriptyline
Serotonin and noradrenaline reuptake inhibitor - Venlafaxine
Serotonin agonist - Mitrazapine
MOAI’s - moclobemide, selegiline, hydrazine
