Dementia, Delirium and Cognitive Impairment Tools Flashcards
Give 4 risk factors for Alzheimer’s Disease?
Increased age 1st degree Family History CV disease Vascular risk factors- smoking, hypertension, hypercholesterolaemia, diabetes, obesity Depression Loneliness Down's Syndrome Severe head injury
What is the pathophysiology of Alzheimer’s Disease?
Accumulation of beta-amyloid peptide (which forms amyloid plaques) and accumulation of tau protein (which forms neurofibrillary tangles). Results in progressive neuronal damage and loss of acetylcholine
Give 4 clinical features of early stage Alzheimer’s Disease
Forget recent events Forget names of objects Misplace items Increased anxiety Ask questions repeatedly Show poor judgement Hesitant to try new things Periods of confusion
Give 4 clinical features of middle stage Alzheimer’s Disease
Increased disorientation Repetitive behaviour Disturbed sleep Difficulty judging distance Delusions Aphasia Frequent mood swings Hallucinations
Give 4 clinical features of late stage Alzheimer’s Disease
Dysphagia Incontinence Weight loss Increased severity of pervious symptoms Violent behaviour Loss of speech Poor mobility
How is Alzheimer’s disease managed?
Memory assessment
CT/MRI Head
Rule out depression
Acetylcholinesterase inhibitors- Donepezil, Rivastigmine, Galantamine
Antiglutamatergic drugs- Memantine (NMDA antagonist)
Vitamin E supplements
What is the pathophysiology of vascular dementia and some of the subtypes?
A cognitive impairment due to reduced blood supply to the brain due to diseased vessels
Causes/Types:
- Stroke
- Post-stroke = symptoms appear 6 month after a major stroke
- Single-infarct= 1 small infarct
- Multi-infarct = several small infarcts
- Subcortical
- Mixed= both vascular and Alzheimer’s dementia
Give 4 clinical features of early stage Vascular dementia
Difficulty planning Difficulty following instructions Slower speed of thoughts Visual Spatial issues Poor concentration Mild memory issues Less fluent speech Rapid mood swings
Give 4 clinical features of late stage Vascular Dementia
Severe confusion Loss of independent ADLs Social inhibition Aggressive/irritable Delusions/hallucinations
How is the progression of Vascular dementia often described?
Stepwise decline –> sudden decrease in cognitive function followed by period of plateau followed by another sudden decrease in cognitive function thought to be due to when additional mini strokes occur in the brain.
What is subcortical vascular dementia?
Small vessel disease of blood vessels deep in the brain . Can also damage white matter nerve fibres in the brain.
How does subcortical vascular dementia present?
Not stepwise! Gradual decline as more white matter is damaged.
- Early loss of bladder control
- Mild unilateral weakness so more prone to falls
- Clumsiness
- Lack of facial expression
- Problems pronouncing words
Give 4 predisposing factors for vascular dementia
Hypercholesterolaemia Hypertension Family history Obesity Diabetes Depression CV disease Stroke/TIA Sleep apnoea
How is vascular dementia investigated?
Full Hx and Examination
CT/MRI head
Memory testing
How is vascular dementia managed?
Control of CV risk factors Stop smoking CBT- psychological help with coming to terms with diagnosis Regular routine Pill box Stay active
What is the pathophysiology of Lewy Body dementia?
Lewy bodies are eosinophilic intracytoplasmic inclusion bodies which are very small deposits of the protein alpha-synuclein. When they build up it results in less ACh and dopamine and a loss of connections between nerve cells. The LEwy bodies are found in the brainstem and neocortex so movement and cognitive abilities are affected
