Dementia (lecture) Flashcards
What is confusion?
A disturbance in mental state affecting orientation, attention, and awareness. Can be acute or chronic.
A disturbance in mental state affecting orientation, attention, and awareness. Can be acute or chronic.
Delirium, Dementia, Brain injury, Substance misuse, Psychiatric illness.
What is dementia?
A syndrome caused by brain cell damage leading to progressive, irreversible decline in memory, thinking, and reasoning.
What are the subtypes of dementia?
Alzheimer’s, Vascular, Mixed, Lewy Body, Frontotemporal, Parkinson’s related, Other causes.
What characterises Alzheimer’s Disease?
Progressive brain degeneration, especially in hippocampus. Includes neurofibrillary tangles and amyloid plaques.
What is seen in an Alzheimer’s brain?
Brain shrinkage, especially in cortex and hippocampus, with enlarged ventricles.
What causes Vascular Dementia?
Reduced blood supply to the brain, often due to atherosclerosis or stroke.
What are the types of Vascular Dementia?
Multi-infarct, Subcortical vascular, and Post-stroke dementia.
How does Vascular Dementia typically progress?
Stepwise decline, with sudden drops after strokes or events.
What is Lewy Body Dementia?
Dementia caused by alpha-synuclein (Lewy bodies) disrupting neurotransmission in cortex and basal ganglia.
What are key features of Lewy Body Dementia?
Fluctuating cognition, early visual hallucinations, and Parkinsonian features.
What is the difference between LBD and Parkinson’s Disease Dementia?
LBD shows cognitive decline early; Parkinson’s dementia follows motor symptoms.
What is Frontotemporal Dementia?
Degeneration of frontal and temporal lobes. Early changes in behaviour, emotion, and language.
What causes Huntington’s Disease?
A genetic neurodegenerative disease with movement, psychiatric symptoms, and dementia.
What causes Alcohol-related dementia?
Chronic alcohol use, thiamine deficiency, and brain damage.
What is Progressive Supranuclear Palsy?
A rare disease with Parkinson-like features affecting movement, balance, and eye movements.
What is Creutzfeldt-Jakob Disease?
A rare, rapidly progressive dementia caused by prions.
What causes HIV-related cognitive impairment?
Advanced or untreated HIV, leading to subcortical dementia.
What is Normal Pressure Hydrocephalus?
CSF buildup in ventricles causing dementia, gait disturbance, and incontinence.
Why is history important in dementia assessment?
It helps identify dementia type and must include collateral history when possible.
What are common cognitive difficulties in dementia?
Losing objects, forgetting appointments, disorientation, dysphasia, agnosia.
What are the stages of dementia?
Early: memory loss, slow learning. Mid: ADL difficulty, behaviour changes. End: incontinence, swallowing issues.
What are basic cognitive screening tools?
AMTS, 6-CIT, GP COG.
What are formal cognitive assessments?
MMSE and MOCA (more sensitive for early changes).
What blood tests are used in dementia investigation?
FBC, B12, Folate, ESR, CRP, U&E, LFT, TFT, Glucose/HbA1c, Lipids.
What is the role of ECG in dementia investigation?
To assess cardiac risk, e.g. AF which may cause embolic stroke.
What is the preferred brain imaging in dementia?
Contrast MRI to rule out tumours, stroke, NPH, or atrophy.
What is the mnemonic for reversible causes of cognitive impairment?
DEMENTIA: Drugs, Emotional, Metabolic, Eyes/ears, NPH, Tumour, Infection, Anaemia.
What are key principles of dementia support?
No cure, person-centred care, communication, support networks, legal planning.
How are cognitive symptoms of dementia treated?
AChE inhibitors (Donepezil, Rivastigmine, Galantamine), Memantine for moderate–severe AD.
How is Vascular Dementia managed?
Manage vascular risk: HTN, DM, cholesterol, smoking, stroke prevention.
What are BPSD symptoms?
Wandering, aggression, agitation, anxiety, depression, hallucinations.
How is BPSD managed?
Non-pharmacological (first-line); Antipsychotics used cautiously if severe.
Which dementia subtype is most associated with early hallucinations and Parkinsonism?
Lewy Body Dementia
Which type of dementia is characterised by behavioural change before memory loss?
Frontotemporal Dementia
Which dementia has a stepwise progression often following strokes?
Vascular Dementia
What is the first-line imaging investigation in suspected dementia?
Contrast MRI
What cognitive screening tool uses 10 questions and is abnormal if score < 8?
AMTS (Abbreviated Mental Test Score)
What reversible cause of cognitive decline is linked to B12 deficiency?
Anaemia or nutritional deficiency
Which Alzheimer’s drug is an NMDA receptor antagonist?
Memantine
Name three Acetylcholinesterase inhibitors used in Alzheimer’s treatment.
Donepezil, Rivastigmine, Galantamine
Which dementia type is associated with alpha-synuclein deposits?
Lewy Body Dementia
What are the features of the classic triad in Normal Pressure Hydrocephalus?
Gait disturbance, urinary incontinence, dementia
Which condition must always be ruled out before diagnosing irreversible dementia?
Delirium
In a patient with dementia, when is it mandatory to inform the DVLA?
When dementia affects driving ability or diagnosis is confirmed
What does the acronym DEMENTIA stand for in reversible causes?
Drugs, Emotional, Metabolic, Eyes/ears, NPH, Tumour, Infection, Anaemia
What is the most common cause of dementia?
Alzheimer’s Disease
In which dementia is memory typically preserved early?
Frontotemporal Dementia
