Dementia tutorial Flashcards
What is dementia?
Cognitive impairment AND impairment to the daily activities of living
What is the preceding state to dementia?
Mild cognitive impairment, may lead to dementia or may not
What are the 4 biggest types of dementia and how common are they?
Alzheimer’s=40-70% of cases
Vascular= 15-25%
Lewy body dementia= 2-20%
Fronto-temporal dementia= 2-4%
What are Alzheimers, front-temporal and Lewy’s body dementia caused by?
Proteinopathies- abnormal accumulation of proteins within the brain and CNS
What protein causes Alzheimer’s dementia?
Amyloid and Tau protein amyloid
What protein causes Lewy body dementia?
Alpha-synuclein
What protein causes frontal-temporal dementia?
Tau protein TDP 43
What is the basic anatomy of the brain?
Why is declarative memory affected in all dementias and how are they affected?
It does not localise, long term memories are stored across the whole neocortex. In dementias declarative memories fade slowly
What are declarative memories?
Same as explicit memories, which are those that are consciously recalled. This includes memories of events from your life as well as the memory of facts and other learned information
Where do the proteinopathies start for the different types of dementia?
Alzheimers starts at the back (of the unfolded brain), Lewy body in the middle and frontal-temporal at the front
What are the early signs of Alzheimers disease?
Starts at back of brain where object recognition and memory formation occur
Leads to anterograde amnesia (cannot form new memories) and difficulties recognising objects.
What is anterograde amnesia?
Anterograde amnesia is a type of memory loss that occurs when you can’t form new memories
What are the early signs of Lewy body dementia?
Occurs in the middle where working memory, praxis, primary visual processing and visuospatial skills are
Leads to hallucinations, fluctuant working memory and changes in visual spacial skills
What are the early signs of fronto-temporal dementia?
Based in the front- where attention, working memory, erasing, personality and social cognition are located
Causes changes in attention, reasoning and working memory, deranged personality and social cognition. Behaviour and preferences change.
What are some reversible causes of dementia?
Subdural hematoma is common
Intracranial tumours, empyema or abcess
CNS infection/inflammation
Metabolic conditions- brain does not have enough resources
Depression
Epilepsy
Why can epilepsy cause dementia?
There is a lot of glutamate toxicity in epilepsy that damages synapses
What is the stepped approach to diagnosing dementia
- History and examination
- Blood test (check organ functions)
- HIV and syphillis screening and check ESR and CRP
- Brain imaging
- Referral to secondary care for specialist assessment
Why do we test ESR and CRP in patients presenting with dementia?
Testing for inflammatory and vasculitic causes
What are the simple cognitive assessment tests that can be done?
Abbreviated mental test- AMT
Mini-mental state exam- MMSE
Quick, but pretty useless
What is ACE-III?
Addenbrooke’s cognitive exam, takes around 30 mins.
Tests aspects of attention, memory, fluency, language and visuospatial skills
Out of 100 points
What is the gold standard for cognitive tests?
Neuropsychological assessment- but takes over 90 mins
What should be assumed with capacity?
Mental capacity should be assumed unless proven otherwise for informed consent
What drugs are recommended by NICE to help symptoms of dementia?
Choline esterase inhibitors- not a cure
What is BPSD?
Behavioural and psychological symptoms of dementia
How is attention tested in ACE-III?
Attention is tested by asking patients about the date, season, location, asking them to repeat words and serial subtraction
How is memory tested in ACE-III?
Asking patients to recall words previously said, asking widely known historical facts and recalling a fictional name/address
How is fluency tested in ACE-III?
Asking patient to say as many words as they can in a category e.g. animals or starting with a letter
How is language tested in ACE-III?
Patients have to complete a series of commands and write two grammatically correct sentences
How is visuospacial skills tested in ACE-III?
Patient has to copy two diagrams, draw a clock with hands at specific time. and to recognise 4 fragmented letters
