Dementia and Memory Clinic Flashcards
What are the four different parts of memory clinic?
- History and Collateral History
- Physical and Mental State Examination inc Risk Assessment
- Cognitive Assessment e.g ACE-III, MOCA
- Investigations
What are some questions to ask in the history in the memory clinic?
- What is the course of symptoms over time?
- Any impact on day to day life?
- Why have they come now?
- Any changes in general health?
What physical exams may you consider at memory clinic?
- Neurological
- CVS
What investigations may you do at memory clinic?
- Bloods
- ECG (look for contraindications)
- CT head/MRI brain to assist dementia subtype
What cognitive assesments can you do for a patient in hopsital with suspected dementia?
ACE-III gold standard
AMT-10
6-CIT
MOCA
MMSE
Generally patients in hospital are difficult to assess so ask GP to see in 6-8 weeks when illness has settled and refer to memory clinic
Why is a blood screen done in new suspected dementia?
To look for reversible causes
What things do we need to risk assess in memory clinic?
- Self neglect
- Vulnerability e.g locking doors, finances
- Driving
- Medications
- Self harm and Suicide
- Falls
- Risk to others e.g irritable, aggressive
How would you describe dementia to a patient in clinic OR OSCE?
Umbrella term for damage to the brain. What causes the damage determines what type of dementia it is
Cannot get diagnosis from CT, can only get post-mortem by taking a brain sample, however CT can show patterns that point towards one disease process over the other
It is irreversible but we can do XYZ to support
We can also refer you to the.. (e.g OT, physio, social services) who can help you with these things
Assess carer strain
What MMSE score is suggestive of dementia?
24 or less out of 30
Alzheimer’s disease is the most common cause of dementia. How does it present?
Insidious onset with slow progression. Behavioural problems are common. Diagnosed on clinical history but brain imaging may show disproportionate hippocampal atrophy.
What are the risk factors of Alzheimer’s disease?
family history,
lack of aerobic physical activity,
smoking and alcohol,
obesity, htn, diabetes
Down’s syndrome,
depression,
hearing loss
What is the strongest genetic risk factor for Alzheimer’s disease?
apolipoprotein E (APOE) gene
What is the diagnostic criteria of Alzheimer’s disease?
causative AD genetic mutation or all of the following:
memory and learning decline plus one other cognitive domain,
steady gradual cognitive decline,
no evidence of mixed aetiology
Alzheimer’s disease causes widespread cerebral atrophy mainly involving…
the cortex and hippocampus
What are the microscopic pathological changes in Alzheimer’s disease?
cortical plaques due to the deposition of type A-beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
What non-pharmacological treatment options does NICE recommend in the management of Alzheimer’s disease?
group cognitive stimulation therapy for patients with mild and moderate dementia,
group reminiscence therapy,
cognitive rehabilitation
Outline the pharmacological management of Alzheimer’s disease
1st line for mild - moderate disease : donepezil, galantamine and rivastigmine (all ACh inhibitors)
2nd line for severe disease / where 1st line is contraindicated: memantine (an NMDA receptor antagonist)
When is donepezil (acetycholinesterase inhibtor used in Alzheimer’s disease) contraindicated?
bradycardia
Vascular dementia is the 2nd most common cause of dementia. Give its key features
Suggested by vascular risk factors e.g. hypertension. Imaging is suggestive of vascular disease. Often has a step wise progression.
What is the prevalence of vascular dementia?
20% of dementia cases are vascular
How do you manage vascular dementia?
lifestyle modification
medication to reduce cardiovascular risk e.g. statins and anti-hypertensives
How does frontotemporal dementia typically present?
Onset often early e.g. in a younger person with fam hx
often associated with complex behavioural problems, language dysfunction may occur
What are the macroscopic changes seen in frontotemporal dementia?
Atrophy of the frontal and temporal lobes
Which type of dementia is associated with MND?
frontotemporal
How does Lewy-Body dementia typically present?
Dementia, visual or auditory hallucinations, delusions and Parkinsonism
Fluctuating cognition
What is the prevalence of Lewy Body dementia?
10-15% of dementia cases
What are the risk factors for Lewy body dementia?
increasing age,
Parkinson’s disease.
REM sleep behaviour disorder
Outline the management of Lewy body dementia
promote exercise,
cognitive training,
cholinesterase inhibitors,
may benefit from levodopa introduced at low doses and increased slowly
What are the important differentials of dementia?
Pseudodementia- depression
Delirium
SOL
Hypothyroidism
Addison’s
B12/folate/thiamine deficiency
What is defined as young onset dementia?
Diagnosis under the age of 65
What investigations should you carry out if you suspect young onset dementia?
Cognition assessment
Baseline blood tests,
Neuroradiology,
OT functional assessment,
Genetic testing,
CSF testing to assess for Alzheimer’s
what are the autonomic features of dementia?
orthostatic dizziness,
syncope,
falls,
urinary tract symptoms,
constipation
What is BPSD?
Behavioural and psychological sxs of dementia e.g. agitation, aggression, mood disturbance, hallucinations
How can BPSD be managed?
Identify triggers
Engage in meaningful activities
Sleep hygeine
Watch and wait - if no improvement after 4 weeks consider risperidone
