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Dementia COPY Flashcards

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1
Q

What conditions must be met to qualify for a diagnosis of dementia?

A
  • functional impairment (impact ADL)

- symptoms for 6 months or more

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2
Q

Name some types of dementia

A
  • alzheimer’s dementia (most common)
  • levy body dementia
  • fronto temporal dementia
  • huntingtons dementia
  • HIV dementia
  • parkinsonian dementia (parkinson’s first then dementia)
  • vasuclar dementia
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3
Q

what are differentials for dementia (things you should rule out in history?

A 
D-drugs/alcohol 
E-ear/eye problems 
M-etabolic problems 
E-emotions/depression 
N- nutritional disorders
T-trauma, toxins, tumours 
I-infection 
A-alcohol, atherosclerosis

PMH
any problems with vision or hearing?
past medical history of depression?
past stroke/ heart attack?

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4
Q

what types of dementia are acetyl esterase inhibitors useful for?

A

ALZHEIMER’S DISEASE
-first line is MONOTHERAPY WITH ach-esterase-inhib
(RIVASTIGMINE, GALANTAMINE, DONEPEZIL)

  • second line is nmda receptor antagonist
  • AMANTINE or MEMANTINE
  • Good if patient has heart problems
  • can take both together

LEWY BODY DEMENTIA
-RIVASTIGMINE OR DONEPEZIL would be the best choice here (lewys a don but has a lot of stigma about his disease)

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5
Q

When should anti-psychotics be offered to dementia patients?

A

Anti-psychotics should ONLY BE OFFERED if the patient is at risk of hurting themselves or other or is experiencing delusions, hallucinations or agitation.

***there is an increased risk of stroke, falls and parkinson effects in elderly patients on anti-psychotics

If they are given they should be given at the LOWEST POSSIBLE DOSE and for the LEAST AMOUNT OF TIME with aREVIEW EVERY 6 WEEKS

Risperidone good for aggression

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6
Q

What assessment should you do for a patient with dementia

A
  • Always make sure they are involved in the decisions about their care
    ASSESS THEM
    ○ History
    ○ Collateral history
    ○ Physical examination
    ○ Cognitive assessment (MoCA or ACE-III or 6CIT in GP)
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7
Q

How do you treat depression in dementia

A

-Do not routinely offer anti-depressants but consider psychological therapies

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8
Q

How do you treat sleep problems in dementia

A

Do NOT offer melatonin, consider psychological interventions including sleep hygiene, exposure to daylight

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9
Q

What are the risk factors for Alzeimers disease

A

Genetics

  • 3 fold increase in risk of AD if first degree relative has it
  • ApoE (allele 4) although having 2 copies does not mean someone will definitely

EARLY ONSET/FAMILIAL
-downs syndrome
PSEN1 PSEN2

Environment

  • low SES
  • poor cognition
  • HRT protective

REDUCTION IN ACh - this is secondary to reduction in cholinergic neurons at the nucleus basalis

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10
Q

5 pathological findings in Alzheimers disease

A
  1. Beta amyloid plaques
    1. Neurofibrillary tangles
    2. Cerebral atrophy (can only see this one on scan- big ventricles, shrunk gyri and wide sulci)
    3. Senile plaques
      1. Ach depletion
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11
Q

5 As of alzheimer’s?

A
  1. APHASIA (trouble expressing themselves with words)
    1. AGNOSIA (trouble recognizing things/people)
    2. AMNESIA (trouble remembering things)
    3. APRAXIA (trouble moving)
      ASSOSIATED BEHAVIOURS
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12
Q

example of associated behaviours seen in all types of dementia?

A
  • Wandering
    - Aggressiveness (risperidone good for this)
    - Crying
    - Swearing
    - Disinhibition
    - Pacing
    - Psychosis (hallucinations/delusions)
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13
Q

Biological treatment of alzheimer’s

A 
FIRST LINE 
ACETYLCHOLINESTERASE INHIBITORS 
		○ Rivastigmine, Galantamine, Donepezil
		○ These drugs will improve symptoms and slow progression of disease 
		○ Not good if arrythmias

SECOND LINE- nmda receptor antagonist
○ Amantine and Memantine
○ Good if patient has heart problems

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14
Q

Psychological treatment of alzheimer’s?

A 
Psychological
	- emotional support groups 
	- Reminiscence therapies 
	- Cognitive rehabilitation
	- Treat comorbid conditions 
		○ CBT for anxiety
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15
Q

Social treatment of alzheimer’s?

A
  • Carer support (restbite for family)
    • OT input (for supported employment)
      ○ Timing on oven/toaster
      ○ No mirrors
      ○ Alarm bells
      ○ Trackers
      ○ Timed dosset boxes
    • Refer to Alzheimer’s society
    • Refer to social services
      -Day centre
      -Meals on wheels
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16
Q

what type of dementia can be linked to dominant gene on chromosome 19

A

vascular dementia

17
Q

risk factors for vascular dementia

A
  • HTN
    • High cholesterol
    • Smoking
    • FH of IHD of CVA
    • Obesity
    • Male
      • Diabetes
      • Coagulation (anti phosopholipid syndrome)
18
Q

Investigations for vascular dementia

A
  • FBC
    • Us and Es
    • LFT
    • TFT (hypothyroidism risk factor)
    • Calcium, magnesium, phosphate (Ca may be raised in vascular dementia)
    • Heamotinics- Iron. vitamin B12and folate
    • Glucose (risk factor)
    • Urine dip (to look for infectious cause)
    • ECG
      • Imaging - CT head might be useful for ?stroke patients
      • Clotting screen
      • Syphylis/HIV
19
Q

biological treatment for vascular dementia

A
  • Main thing is manage the risk factors
  • Give aspirin if clot (arterial thrombosis)
  • ACETYL-CHOLINESTERASE INHIBITORS ARE NOT USED IN VASCULAR DEMENTIA (Unless associated behaviors)
  • Instead, NMDA antagonists such a memantine can be used particularly if there is a mixed picture to the dementia
20
Q

what is the second most common type of dementia for under 65s?

A

FTD

21
Q

what are the three types of FTD?

A

BEHAVIOURAL VARIENT FTD
-change in personality/behaviour/interpersonal skills (colin)

PROGRESSIVE, NON FLUENT APHASIA (pnfa)

  • Loss of language skills (the mum in documentary)
  • Slow, hesitant, difficult speech

SEMENTIC DEMENTIA

  • loss of semantic memory (long term common knowledge e.g. colours)
  • loss of vocabulary, however fluency of speech maintained
22
Q

What is the brain scan of choice for Frontal temporal dementia?

A

On MRI scan there is evidence of BILATERAL ATROPHY OF THE FRONTAL AND TEMPORAL LOBES

MRI IS SCAN OF CHOICE

23
Q

Histologically there are three different types of FTD, what are they?

A
  • MICROVACUOLAR = 60%
    • PICK’S TYPE = 25%
      ○ Presence of Pick’s bodies. Intraneuronal masses of cytoskeletal elements
      COMBINED = 15%
24
Q

bio management of Frontal temporal dementia?

A

Given that the aetiology of FTD is less know this makes the management somewhat more complicated also.
- DO NOT USE ACHEis
- TREAT THE SYMPTOMS
SOME EVIDENCE FOR SSRIs

25
Q

What are the main clinical features of lewy body dementia

A
  1. Fluctuating cognition (in terms of attention and alertness)
  2. 70% of people will experience spontaneous Parkinsonian motor features (dementia happens prior/same time as Parkinsons features)
  3. 70% of people will also experience visual hallucinations
26
Q

Other symptoms (less common) in lewy body dementia

A
  • LOC/falls
  • sleep disturbances REM sleep
    • Systematised dellusions (a whole system of false belifs created with logical structure)
  • Changes in PET scans
  • depressive episodes
27
Q

what imaging should be used for lewy body dementia and what does it show

A
  • SPECT scan (specific proton emission CT)

- reduced striatal uptake of ligands across pre-synaptic dopamine transporters

28
Q

Whats the biological treatment of lewy body dementia

A
  • Ach-esterase inhibs
  • RIVASTIGMINE and Donepezil
  • PSYCHOLOGICAL INTERVENTIONS ARE VITAL
29
Q

what is the mirror sign and what does it mean

A

when patients talk to themselves in mirror -indicated dementia has got quite severe

30
Q

what is sundowning?

A

patients with dementia become aggressive around teatime - it will often settle as the evening progresses

31
Q

Possible causes of delirium/increased aggression of dementia patient

A
  • P - Pain
    • I - infection
    • N - nutritional depletion
    • C - Constipation
    • H - Hydration
    • M - Medication
      E - Environmental (changes to routine/glasses/hearing aids)
32
Q

side effects of acetyl choline esterase inhibitors?

A
  • HEART BLOCK- need ecg
  • may exacerbate peptic ulcer disease
  • reduced appetite
  • nausea/vomitting
  • heart
33
Q

what patients should we be careful of when prescribing acetyl choline esterase inhibitors?

A

Patients with Cardiovascular disease- can give nmda receptor antagonist (Amantine and Memantine) fo patients with alzheimer’s and heart problems

34
Q

What signs might you see with vascular dementia?

A

Signs for vascular dementia-make sense with causes

- Neuro signs (brisk reflexes/ akinesia/rigitiy) 
- Cardiovascular signs
35
Q

What the prognosis for vascular dementia?

A

5 years approx- because of comorbidities

36
Q

What are some ways that you can test frontal lobe function in ?dementia?

A

FRONTAL LOBE TESTING

Psych (22 decks)

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