Dementias Flashcards
What is Alzheimer’s disease?
Alzheimer’s disease is a progressive degenerative disease of the brain accounting for the majority of dementia seen in the UK.
What does NICE recommend for non-pharmacological management of Alzheimer’s disease?
NICE recommends offering a range of activities to promote wellbeing that are tailored to the person’s preference.
What type of therapy does NICE recommend for patients with mild and moderate dementia?
NICE recommends offering group cognitive stimulation therapy.
What are other non-pharmacological options for managing Alzheimer’s disease?
Other options include group reminiscence therapy and cognitive rehabilitation.
What did NICE update in 2018 regarding pharmacological management of Alzheimer’s disease?
NICE updated its dementia guidelines to include three acetylcholinesterase inhibitors: donepezil, galantamine, and rivastigmine for managing mild to moderate Alzheimer’s disease.
What is memantine and when is it recommended?
Memantine is an NMDA receptor antagonist recommended as a second-line treatment for moderate Alzheimer’s in specific situations: for patients intolerant of acetylcholinesterase inhibitors, as an add-on drug, or monotherapy in severe Alzheimer’s.
What does NICE say about managing non-cognitive symptoms in Alzheimer’s patients?
NICE does not recommend antidepressants for mild to moderate depression and advises that antipsychotics should only be used for patients at risk of harming themselves or others, or experiencing severe distress from agitation, hallucinations, or delusions.
What are the contraindications and adverse effects of Donepezil?
Donepezil is relatively contraindicated in patients with bradycardia, and its adverse effects include insomnia.
What is Alzheimer’s disease (AD)?
Alzheimer’s disease is a progressive degenerative disease of the brain accounting for the majority of dementia seen in the UK.
What are the risk factors for Alzheimer’s disease?
Risk factors include increasing age, family history of Alzheimer’s disease, and Caucasian ethnicity.
What percentage of Alzheimer’s cases are inherited as an autosomal dominant trait?
5% of cases are inherited as an autosomal dominant trait.
Which genes are associated with the inherited form of Alzheimer’s disease?
Mutations in the amyloid precursor protein (chromosome 21), presenilin 1 (chromosome 14), and presenilin 2 (chromosome 1) genes are thought to cause the inherited form.
What is the role of the apoprotein E allele E4 in Alzheimer’s disease?
The apoprotein E allele E4 encodes a cholesterol transport protein.
What are the macroscopic pathological changes in Alzheimer’s disease?
Widespread cerebral atrophy, particularly involving the cortex and hippocampus.
What are the microscopic pathological changes in Alzheimer’s disease?
Cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein.
What biochemical change is associated with Alzheimer’s disease?
There is a deficit of acetylcholine from damage to an ascending forebrain projection.
What are neurofibrillary tangles made from?
Paired helical filaments are partly made from a protein called tau.
What is the function of tau protein?
Tau interacts with tubulin to stabilize microtubules and promote tubulin assembly into microtubules.
How is tau protein affected in Alzheimer’s disease?
In Alzheimer’s disease, tau proteins are excessively phosphorylated, impairing its function.
What is dementia?
Dementia is a condition that affects over 700,000 people in the UK and accounts for significant health and social care spending.
What is the most common cause of dementia in the UK?
The most common cause of dementia in the UK is Alzheimer’s disease, followed by vascular and Lewy body dementia.
What are some features of dementia diagnosis?
Diagnosis can be difficult and is often delayed.
What assessment tools are recommended by NICE for non-specialist settings?
Recommended tools include the 10-point cognitive screener (10-CS) and the 6-Item cognitive impairment test (6CIT).
What assessment tools are not recommended by NICE for non-specialist settings?
Tools not recommended include the abbreviated mental test score (AMTS), General practitioner assessment of cognition (GPCOG), and the mini-mental state examination (MMSE).
A MMSE score of 24 or less out of 30 suggests dementia.
What is the initial management approach for dementia in primary care?
A blood screen is usually sent to exclude reversible causes, such as hypothyroidism.
What tests does NICE recommend for dementia management in primary care?
NICE recommends tests including FBC, U&E, LFTs, calcium, glucose, ESR/CRP, TFTs, vitamin B12, and folate levels.
What is the role of old-age psychiatrists in dementia management?
Patients are commonly referred to old-age psychiatrists, sometimes working in ‘memory clinics’.
What is performed in secondary care for dementia?
Neuroimaging is performed to exclude other reversible conditions and provide information on aetiology to guide prognosis and management.
What did the 2011 NICE guidelines state about structural imaging?
The 2011 NICE guidelines stated that structural imaging was essential in the investigation of dementia.
What is frontotemporal lobar degeneration (FTLD)?
FTLD is the third most common type of cortical dementia after Alzheimer’s and Lewy body dementia.
What are the three recognised types of FTLD?
- Frontotemporal dementia (Pick’s disease)
- Progressive non fluent aphasia (chronic progressive aphasia, CPA)
- Semantic dementia
What are common features of frontotemporal lobar dementias?
- Onset before 65
- Insidious onset
- Relatively preserved memory and visuospatial skills
- Personality change and social conduct problems
What characterises Pick’s disease?
Pick’s disease is characterised by personality change and impaired social conduct. Common features include hyperorality, disinhibition, increased appetite, and perseveration behaviours.
What is a characteristic macroscopic change seen in Pick’s disease?
Atrophy of the frontal and temporal lobes.
What are the microscopic changes in Pick’s disease?
- Pick bodies - spherical aggregations of tau protein (silver-staining)
- Gliosis
- Neurofibrillary tangles
- Senile plaques
What does NICE recommend for the management of frontotemporal dementia?
NICE do not recommend that AChE inhibitors or memantine are used in people with frontotemporal dementia.
What is the chief factor in progressive non fluent aphasia (CPA)?
The chief factor is non fluent speech, with short utterances that are agrammatic. Comprehension is relatively preserved.
What characterises semantic dementia?
In semantic dementia, the patient has a fluent progressive aphasia. The speech is fluent but empty and conveys little meaning. Unlike in Alzheimer’s, memory is better for recent rather than remote events.
What is Lewy body dementia?
Lewy body dementia is an increasingly recognised cause of dementia, accounting for up to 20% of cases.
What is the characteristic pathological feature of Lewy body dementia?
The characteristic pathological feature is alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas.
What is the relationship between Parkinson’s disease and Lewy body dementia?
The relationship is complicated, particularly as dementia is often seen in Parkinson’s disease. Up to 40% of patients with Alzheimer’s have Lewy bodies.
What are the features of Lewy body dementia?
Features include progressive cognitive impairment, parkinsonism, and visual hallucinations.
How does cognitive impairment typically present in Lewy body dementia?
Cognitive impairment typically occurs before parkinsonism, with both features usually occurring within a year of each other.
How does cognition in Lewy body dementia differ from other forms of dementia?
Cognition may be fluctuating, and early impairments are in attention and executive function rather than just memory loss.
What is the typical method of diagnosis for Lewy body dementia?
Diagnosis is usually clinical, with single-photon emission computed tomography (SPECT) increasingly used.
What is the sensitivity and specificity of SPECT in diagnosing Lewy body dementia?
The sensitivity is around 90% with a specificity of 100%.
What medications can be used in the management of Lewy body dementia?
Both acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine can be used.
What should be avoided in the management of Lewy body dementia?
Neuroleptics should be avoided as patients are extremely sensitive and may develop irreversible parkinsonism.
What is vascular dementia (VD)?
VD is the second most common form of dementia after Alzheimer’s disease, characterized by cognitive impairment due to mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease.
What is vascular cognitive impairment (VCI)?
Vascular dementia is increasingly recognized as the most severe form of the spectrum of deficits encompassed by VCI.
What is the prevalence of vascular dementia in the UK?
VD is thought to account for around 17% of dementia cases in the UK.
How does stroke affect the risk of developing dementia?
Overall, stroke doubles the risk of developing dementia.
What are the main subtypes of vascular dementia?
The main subtypes are stroke-related VD, subcortical VD, and mixed dementia.
What are common risk factors for vascular dementia?
Risk factors include history of stroke or TIA, atrial fibrillation, hypertension, diabetes mellitus, hyperlipidaemia, smoking, obesity, coronary heart disease, and family history of stroke or cardiovascular issues.
What is CADASIL?
CADASIL is a rare inherited form of vascular dementia characterized by cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.
How do patients with vascular dementia typically present?
Patients often present with several months or years of sudden or stepwise deterioration of cognitive function.
What are some symptoms of vascular dementia?
Symptoms may include focal neurological abnormalities, difficulty with attention and concentration, seizures, memory disturbance, gait disturbance, speech disturbance, and emotional disturbance.
What is involved in the diagnosis of vascular dementia?
Diagnosis includes a comprehensive history, physical examination, cognitive impairment screening, medical review, and MRI scan.
What criteria does NICE recommend for diagnosing vascular dementia?
NICE recommends using the NINDS-AIREN criteria, which includes cognitive decline interfering with daily activities, cerebrovascular disease, and a relationship between cognitive decline and cerebrovascular events.
What is the general management approach for vascular dementia?
Management is mainly symptomatic, addressing individual problems and supporting patients and carers while detecting and addressing cardiovascular risk factors.
What are some non-pharmacological management strategies for vascular dementia?
Non-pharmacological strategies include cognitive stimulation programs, multisensory stimulation, music and art therapy, and animal-assisted therapy.
What pharmacological treatments are available for vascular dementia?
There is no specific pharmacological treatment approved for cognitive symptoms, but AChE inhibitors or memantine may be considered for patients with suspected comorbid Alzheimer’s disease.
Is aspirin effective in treating vascular dementia?
There is no evidence that aspirin is effective in treating patients with a diagnosis of vascular dementia.
Have statins been evaluated for vascular dementia?
No randomized trials have found evaluating statins for vascular dementia.
