Dementia overview Flashcards
Define
A syndrome of generalised decline in brain functions (memory, intellect, cognition, executive functioning and personality) without impairment of consciousness, leading to functional impairment
Reversible causes of dementia
- Neurological: normal pressure hydrocephalus, intracranial tumours, chronic subdural haematoma
- Vit deficiencies: B12, folic acid, thiamine, nicotinic acid
- Endocrine: Cushing’s syndrome, hypothyroidism
Irreversible causes of dementia
- Neurodegenerative: AD, FTD, Pick’s disease, DLB, PD w/ dementia, HD
- Infections: HIV, encephalitis, syphilis, CJD
- Toxins: Alcohol, barbiturates, BDZs
- Vascular: vascular dementia, multi-infarct dementia
- Traumatic head injury
Dementia mnemonic for causes
DEMENTIA (preventable/reversible causes)
• Drugs: barbiturates
• Eyes + Ears: visual/hearing impairment (confused w/ dementia)
• Metabolic: Cushing’s + hypothyroid
• Emotional (depressed can prevent as pseudodementia)
• Nutritional deficiencies/Normal pressure hydrocephalus
• Tumours/Trauma
• Infections (e.g. encephalitis, HIV)
• Alcoholism/Atherosclerosis (vascular)
What routine bloods are done
FBC* (infection, anaemia) CRP (infection, inflammation) U/Es (renal disease/sodium) calcium (hypercalcaemia) LFT (alcoholic liver disease) glucose (hypoglycaemia) vit B12 + folate (nutritional def.) TFTs (hypothyroid)
*remember do an FBC before blood culture (do blood culture if FBC indicates infection)
Ix
- Urine dipstick (UTI)
- CXR (pneumonia or lung tumour [SCLC → hyponatraemia])
- Syphilis serology + HIV testing (if risk or atypical features)
- Brain imaging
o CT scan → cortical atrophy + ventricular enlargement
o MRI → atrophy of grey matter (hippocampus, amygdala, medical temporal lobe)
o SPECT → differentiated AD, VD and FTD - ECG → CVD
- EEG → FTD or CJD
- LP → CJD
- Genetic testing → HD
- Cognitive assessment: MMSE, AMT…
ICD-10 classification of dementia
- Evidence of below:
a. Decline in memory
b. Decline in cognitive abilities (deterioration in judgement and thinking) - …
- Decline in emotional control or motivation, or a change in social behaviour manifested by 1 of:
a. emotional lability
b. Irritability
c. Apathy
d. Coarsening of social behaviour - (1) Needed for 6 months for confident Dx
DDx
- Normal ageing + mild cognitive impairment
- Delirium
- Trauma (stroke, traumatic brain injury)
- Depression (pseudodementia) → poor conc + impaired memory → need to identify whether poor memory or low mood came first
- Late onset schizophrenia
- Amnesic syndrome (memory disrupted w/ minimal cognitive deterioration)
- Learning disability
- Substance misuse
- Drug SE (opiates, BDZs)
Cortical dementia - which types are considered to be cortical and where in the brain do they affect
Pick’s disease (frontotemporal) and AD (posterior parietal)
Subcortical dementia - which types are considered to be sub cortical
Subcortical dementia: PD, HD, Wilson’s disease (Genetic: copper deposits → liver [cirrhosis] and basal ganglia → Rx: penicillamine), progressive supranuclear palsy (Parkinson plus disease), HIV dementia
Mixed dementia
vascular
Features cortical dementia
Memory loss: Severe Mood: Normal Speech and language: Early aphasia Personality changes: Indifferent??? Coordination: Normal Praxis: Apraxia (muscle disorder affecting speech production) Motor speed: Normal
Features subcortical dementia
Memory loss: Moderate Mood: Low Speech and language: Can be dysarthria Personality changes: Apathetic Coordination: Impaired Praxis: Normal Motor speed: Slow
Treatment
- MDT approach: OT, PT, COE doctor, GP, social worker…
- Pts must contact DVLA
- Early discussion for advanced planning (before deterioration) → advanced statements or directives, lasting power of attorney…etc
- Later in disease → Mental capacity act (assessment)
- Other non-pharmacological approaches: Social support (support groups), ^ assistance w/ ADLs, information + education, community dementia teams, home nursing + personal care, community services (e.g. meals on wheels, day centres, care homes…), non-cognitive symptoms (aromatherapy, massage, music therapy, animal assisted therapy)
Aims of treatment
Aims of Rx: promote independence, maintain function + treat symptoms (cognitive, non-cognitive [hallucinations, delusions, anxiety, agitation, aggression], behavioural and psychological)
