Dementia: subtypes, Mx and prognosis Flashcards
the frontal lobe does
personality, behaviour, executive function, impulse control, language fluency, memory, selective attention, smell
the temporal lobe does
memory, understanding and producing speech, naming, language, recognising and processing sound
the parietal lobe does
sensory (touch, temperature, pain), construction, spatial skills and attention, ideomotor praxis
the occipital lobe does
visual information, shapes and colours
which lobe does personality
frontal
which lobe produces speech
temporal
which lobe does spacial skills
parietal
anterograde memory
new learning
retrograde memory
memory of past events
which type of memory is affected first
anterograde - new learning
bilingual individuals in dementia
will revert back to a primary language
language in different types of dementia
alzheimers - occurs later
fronto temporal - occurs early
vascular - may occur at any stage
dyspraxia is
parietal motor coordination system deficit
difficulty using day to day items e.g toothbrush or fork
individuals need help with ADLs
dyspraxia occurs when
late in Alzheimer’s dementia
occur when memory problems and intellectual challenges are more severe
pathophysiology of alzeimers
beta-amyloid plaques outside cells
neurofibrillary tangles made of tau inside cells
brain cells eventually die and brain volume shrinks
in alzheimers disease, neurofibrillary tangles are made of
tau
factors increasing risk of alzheimers disease
sedentary lifestyle
less mentally active
vascular risk factors (HTN, smoking, obesity, cholesterol)
mood disorders
role of inflammation
main signs of vascular dementia
early gait disturbance with falls
memory impairment not the first or most dominant feature
evidence of vascular change on CT/MRI
pt will have vascular risk factors
vascular dementia with cortical vascular damage
cortical deficits such as aphasia, apraxia, agnosia
vascular dementia with subcortical vascular damage
subcortical frontal areas linking frontal cortex to related areas in the basal ganglia and thalamus
problems with attention, processing speed
usually accompanied by motor signs: suffering walk, brradykinesia, tremor and incontinence
symptoms of dementia with levy bodies
fluctuating cognition
Parkinsonism
prominent visual hallucinations
visuospatial difficulties
REM sleep disorder
what are levy bodies
intracellular spherical inclusion bodies (alphasynuclean) found diffusely through cerebral cortex
dementia with levy bodies responds to
cholinesterase inhibitor
symptoms of frontal temporal dementia
spectrum of presentations
predominantly frontal: mainly behaviour and personality
predominantly temporal: speech and language disturbance
little insight, disinhibition
primitive reflexes, early urinary incontinence
age of onset of front temporal dementia
younger age than alzheimers
things that foreshadow development of fronto-temporal dementia
mood and emotional disorders
depression/anxiety prominent
parkinsons dementia presentation
similar features to levy body dementia but cognitive decline occurs >12 months after clinical features of PD have developed
what can be used to medicate in alzheimers dementia
cholinesterase inhibitors
how do cholinesterase inhibitors help in Alzheimer’s dementia
target deficiency in cerebral cholinergic transmission in alzheimers disease
reduces breakdown of acetyl choline by acetyl cholinesterase
increasing amount of acetyl choline in synapse
how effective is cholinesterase inhibitors in alzheimers dementia
not disease modifying
temporary improvements in cognition
can improve ADLs in mild-moderate disease
not all patients respond
side effects of cholinesterase inhibitors
nausea, vomiting, diarrhoea, fatigue.
may cause bradycardia
Memantine
(Ebixa)
NMDA-receptor antagonist
may be disease modifying in alzheimers dementia by protecting neurons
can be used in combination with cholinesterase inhibitor
side effects uncommon and mild
BPSD
behavioural and psychological symptoms of dementia
non-cognitive symptoms of dementia
tends to occur late in course of disease
common, distressing
typical behaviours of BPSD
agitation, aggression, delusions, shouting, wandering, insomnia, pacing etc.
mainstay of treatment of BPSD
non-pharmacological
optimise environment
when non-pharmacological treatment of BPSD fails
drugs are second line
antipsychotic drugs should not be used as first line as they have significant side effects including increased risk of cardiovascular events and stroke.
antipsychotics have only moderate benefit
types of symptoms that respond to antipsychotics
aggression, agitation, psychotic
types of symptoms that do not respond to antipsychotics
wandering, withdrawal, touching, shouting, insomnia, pacing
preferred antipsychotic for Parkinson’s dementia and dementia with lewy body
quetiapine
