Dementia in Younger People Flashcards
What is young onset dementia?
Onset under 65 years old
Under 65s vs older 65s dementia presentation, prognosis, impact and support
Types of dementia
APOE4 - increases risk
APOE2 - reduces risk
Presenelin 1/2 - 50% chance if have copy
Unique challenges of younger dementia places
- Driving
- Working age
- Stigma
- Role of carer to others
- Multiple losses
- Present to wide range of settings
History for ?dementia
- Timeline
- Enquire about memory - recent/remote, knowledge of recent events in news, soaps/sports
- Associated symptoms - language, vision, movement, continence
- Personality/impulsivity/social functioning
- MH - depression/psychosis
- Sleep - REM sleep disorder?
- Appetite - frontotemporal - sweet tooth
- Systemic - falls, motor symptoms, continence
MEMORY LANES
Available on app store
Has games that help those with dementia about different topics
Relaxes and stimulates conversations
Rest of history
- PMH
- Psychiatric history
- Current medication/allergies - including compliance
- SH - home situation, ADLs (eating, bathing, continence, finances), driving, occupation, support network
- Substance use - alcohol, cannabis, other substances
- FH - young onset dementia?
Assessment of risk
- Self harm/suicide
- Aggression to others
- Wandering
- Self neglect
- Medication compliance
- Meals?
- Falls
- Driving - judgement, spatial orientation and planning
- Carer strain
- Disinhibition - don’t to pay at shops etc
Examination of patient with ?dementia
- MSE
- Cognitive assessment - MMSE, GPCOG (primary care), 6CIT (primary care), MOCA, ACE-III, - allow to quantify
- Physical exam with focus on neurological symptoms
GPCOG/6CIT not valid for under 65s - interpret with caution
GPCOG
2 part test
Test for patient
Part for informant - collateral, move onto this if don’t do well on first one
What to take into consideration with cognitive assessment?
- Take into account baseline - may score well but how did they get there?
- Was it difficult for them?
Inv for ?dementia
- Baseline bloods - B12/folate, TFTs, FBC, CRP, U&E, LFT
- Neuroradiology - MRI brain (standard is CT in older patients)
- Can use FDG-PET if need functional imaging - what part of brain is using glucose and what isn’t
- Also used - neuropsychology (more detailed cognitive assessment), OT assessment (dementia is functional diagnosis), CSF (Alzheimers disease - amyloid proteins, Tau, more sensitive in younger people), EEG, genetic testing, ECG
Management of dementia in young people
- Explain diagnosis and prognosis
- Consider medication (AD and LBD - cholinesterase inhibitors +/- Memantine in Alz)
- Rivastigmine in PD
- Antipsychotic/antidepressant for BPSD - careful
- MDT - CMHT, OT, SALT, psychology, social
- Voluntary for post diagnostic support - Age UK, Alz Society, Young onset dementia group
- Drivability - assessment
- Legal - wills, POA - Age Uk can help
Dementia signs on MRI
Knife blade atrophy - frontotemporal or severe dementia
Cortical atrophy = Prominent sulci and thinner gyri
Hippocampal atrophy
How can posterior cortical atrophy Alzheimers present in young people?
- Cortical blindness - unaware of extent of visual disturbance (do not realise is blind)
- Problems with visual recognition, reading
- Light sensitivity
- Judging distances difficult
- Hallucinations
- Anxious and insight something is not right
- Normal ocular exam
Behavioural variant FTD
- 35-65 (or45-65)
- Language/behavioural symptoms
- Later affects movement and memory
- Main symptoms are apathy, loss empathy, disinhibition, overeating, poor judgement, deteriorate in executive function
- Often misdiagnosed as depressive illness
FTD umbrella
- MND
- Behavioural varient FTD
- Semantic variant - primary progressive aphasia - loss meaning of words
- non-fluent variant - primary progressive apahsia - loss flow of speech
- Logopenic - primary progressive aphasia - can’t find words, usually Alzheimers variant
- Corticobasal syndrome
- Progressive supranuclear palsy
PPA language variants
Management of FTD
- Explain diagnosis
- No medical management currently
- MDT - SALT, social, community mental health team, young onset group in Ulverscroft
Semantic variant PPA imaging
- Present with imaging changes at time of diagnosis
- Assymmetric temporal lobe atrophy - left more than right
- Assymetric hippocampal atrophy
Imitators of dementia
- Delirium
- Psychiatric illness
- Substance misuse
- Menopause –> brain fog
- Fibromyalgia
- Normal pressure hydrocephalus - gait wide based, incontinence, confusion
- Sensory deprivation
- Poorly controlled endocrine disorders - hypothyroid?
Rapidly progressing dementias
- Associated neurological symptoms - seizures, spiking temps, focal neuro signs
- Develop over weeks-months-years
- Could be infective cause eg encephalitis
Causes of RPD
VITAMINS
* Vascular
* Infection
* Toxic-Metabolic
* Autoimmune
* Mets/neoplasm
* Iatrogenic
* Neurodegenerative
* Systemic
Red flags for dementia presentation
- Under 50
- Recent head trauma
- Associated weight loss, headaches, motor sx, seizures, incont, raised ICP
- Positive FH
