Dementia & Delirium Flashcards
The most common cause of dementia in the UK is
Alzheimer’s disease
Vascular dementia makes up ___% of dementia cases in the UK?
20%
Lewy Body dementia makes up __% of dementias in the UK?
10-15%
Alzheimer’s makes up __% of dementias in the UK?
60-70%
MMSE stands for
mini-mental state examination
A MMSE score of ____ or less out of 30 suggests dementia
24
GPCOG test for cognition stands for
General practitioner assessment of cognition
AMTS test for dementia stand for
abbreviated mental test score
The AMT-4 test for dementia stands for
Abbreviated Mental Test- 4 questions
The 6CIT test for cognition stands for
Six-item Cognitive Impairment Test (6CIT)
The IQCODE test for dementia stands for
Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)
Blood screen tests in primary care to rule out reversible causes of dementia
NICE recommend the following tests:
* FBC,
* U&E,
* LFTs,
* calcium,
* glucose,
* ESR/CRP,
* TFTs,
* vitamin B12 and folate levels. Patients are now commonly also referred on to old-age psychiatrists (sometimes working in ‘memory clinics’).
Reversible causes of dementia
- Alcohol (thiamine def)
- Drug abuse (barbituates)
- Vitamin B12/ folate deficiency
- Hypothyroidism
- Addison’s
- Infections such as HIV, Syphillis and UTIs
- Tumors or haematomas that place pressure on the brain
- Depression
In secondary care, it is essential to carry out _____ to rule out any other causes of reversible dementia and provide information of aetiology
Neuroimaging
Reversible causes of dementia that may be picked up on neuroimaging
- Subdural haematoma,
- normal pressure hydrocephalus
- Tumour
Multi-infarct dementia is that which is caused by
Cerebrovascular disease (stroke)
Dementia secondary to stroke makes up ____% of strokes
10-20%
Rare causes of dementia (5%)
- Huntington’s
- CJD
- Pick’s disease (atrophy of frontal and temporal lobes)
- HIV (50% of AIDS patients)
Frontotemporal dementia is also known as
Pick’s disease
Risk factors for Alzheimer’s Disease
- Increasing age
- family history
- Caucasian ethnicity
Down’s syndrome - 5% of cases are inherited as an autosomal dominant trait
mutations in the amyloid precursor protein (chromosome 21), presenilin 1 (chromosome 14) and presenilin 2 (chromosome 1) genes are thought to cause the inherited form - apoprotein E allele E4 - encodes a cholesterol transport protein
Macroscopic changes in Alzheimer’s (physical visual brain changes)
widespread cerebral atrophy, particularly involving the cortex and hippocampus
Microscopic changes in Alzheimer’s
- Cortical plaques due to deposition of type A-Beta-amyloid protein and
- **intraneuronal neurofibrillary tangles ** caused by abnormal aggregation of the tau protein
hyperphosphorylation of the tau protein has been linked to AD
Biochemical changes in Alzheimer’s
there is a deficit of acetylcholine from damage to an ascending forebrain projection
Describe what neurofibrillary tangles are:
They are paired helical filaments are partly made from a protein called tau
tau is a protein that interacts with tubulin to stabilize microtubules and promote tubulin assembly into microtubules
in AD are tau proteins are excessively phosphorylated, impairing its function
Non-Pharmacological management of Alzheimer’s
- NICE recommend offering ‘a range of activities to promote wellbeing that are tailored to the person’s preference’
- NICE recommend offering group cognitive stimulation therapy for patients with mild and moderate dementia
- other options to consider include group reminiscence therapy and cognitive rehabilitation
1st line pharmacological management of Alzheimer’s
the three acetylcholinesterase inhibitors :
donepezil
galantamine and rivastigmine
to managing mild to moderate Alzheimer’s disease
2nd line pharmacological management of Alzheimer’s
**memantine (an NMDA receptor antagonist) **
Memantine, the 2nd line treatment of Alzheimer’s is recommended by NICE to be used in which circumstances?
- moderate Alzheimer’s who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors
- as an add-on drug to acetylcholinesterase inhibitors for patients with moderate or severe Alzheimer’s
- monotherapy in severe Alzheimer’s
NICE does not recommend ___
for mild to moderate depression in patients with dementia
Antidepressants
antipsychotics should only be used for dementias patients when:
They are at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress
Donezepil is contraindicated in
- bradycardia
Adverse effect of Donezepil
Insomnia
____ is the third most common type of cortical dementia after Alzheimer’s and Lewy body dementia.
Frontotemporal lobar degeneration (FTLD)