Dementias Flashcards
Definition
Acquired and persistent generalised disturbance of higher cortical functions in an otherwise fully alert person
Dementia is reversible. True or false?
False
- irreversible
Neuropathology
Progressive loss of neurones
What is the biggest risk factor?
Age
Clinical features
Forgetfulness Memory loss Confusion Poor reasoning and logic Personality changes Poor judgement
What tests are used to diagnose dementia
MMSE Addenbrookes cognitive assessment MoCA Frontal assessment battery Detailed neuropsychological testing
Addenbrookes cognitive assessment - what are the 5 domains
Memory
Fluency
Language
Visuospatial functioning
MOCA - when is it used
Rapid screening
When would detailed neuropsychological testing be used
If the patient has a particularly low or high IQ to decide whether their current mental state is related to underlying disease
What is the standard imaging investigation?
CT scan
When would an MRI scan be used to investigate?
If the patient is younger
If there is fast progression
If there are other atypical features
Which type of dementia is SPECT most useful for?
Fronto-temporal dementia
What scan is used if query levy body dementia?
DAT scan (dopamine active transport scan)
CSF findings
Elevated CSF tau and phospho-tau hypo-metabolism
Management - non-pharmacologial
Advance planning should be arranged whilst patients have the capacity to make their own decisions
Management - medications for dementia can cure it. True or false?
False
Management - first line pharmacological agent
Cholinesterase inhibitor
- donepezil
- rivastigmine
This slows cognitive decline
Cholinesterase inhibitor - MOA
Inhibits acetyl cholinesterASE so that it doesn’t get rid of ACh. This means that more ACh is available in the synapse and thus cholinergic transmission is boosted
Cholinesterase inhibitor - side effects
Nausea
Diarrhoea
Headache
Bradycardia
Do not use cholinesterase inhibitor if patient is ______
Bradycardic
- check pulse before administering medication
Cholinesterase inhibitor - name 3 contraindications
Active peptic ulcer
Severe asthma
Severe COPD
Advanced dementia with behavioural disturbance is managed with
Memantine
Dementia and driving
Must be reported to DVLA
Doctor makes decision if patient can still drive whilst investigations are ongoing
Name 4 types of dementia
Alzheimers disease
Vascular dementia
Fronto temporal dementia
Dementia with lewy bodies
What is the most common cause of dementia in elderly?
Alzheimers disease
Alzheimers disease - usually presents after the age of?
60
Alzheimers disease - more common in males/females
Females
There is increased/decreased incidence of Alzheimers disease in a patient with trisomy 21. Why?
Increased incidence due to amyloid precursor protein
Alzheimers disease - neuropathology
Cortical atrophy Dilation of ventricles Formation of amyloid plaques Neurofibrillary tangles Widening of sulci Narrowing of gyri
Alzheimers disease - neurofibrillary tangles
Found especially in the hippocampus
Tau protein is hyper-phosphorylated and causes the tangles
Alzheimers disease - amyloid angiopathy. What does it stain with?
Congo red
Alzheimers disease - clinical features
Short term memory dysfunction - learning new things is difficult Can still remember things that happened a long time ago Dysphasia Dyspraxia Agnosia
Is it possible to diagnose a patient without scanning them?
Yes
Alzheimers disease - management
Cholinesterase inhibitor
Memantine
Alzheimers disease - when would you give memantine over cholinesterase inhibitor?
If patient has bradycardia
Vascular dementia - cause
Brought around by cerebrovascular ischaemia
Vascular dementia - clinical features
Dysphasia
Dyscalculia
Frontal lobe symptoms
Focal neurological signs
Vascular dementia - investigations
CT/MRI scan
- moderate small vessel disease
- multiple white areas around the brain
Fronto temporal dementia - what is it otherwise known aa?
Pick’s disease
FTD - definition
Progressive changes in character and social deterioration leading to impairment of intellect, memory and language
FTD - common in elderly. True or false?
False
- common in middle age (50-60)
FTD - which lobes are affected (and in which order)?
Frontal lobe - first
Temporal lobe
Alzheimers disease - which lobe is NOT affected
Occipital lobe
FTD - Neuropathology
Cortical atrophy
Pick’s cells (swollen neurones)
FTD - clinical features
Personality and behavioural change
Speech and communication problems
Reduced attention span
FTD - what are the 3 different syndromes
Behavioural variant
Primary progressive aphasia
Semantic dementia
FTD - behavioural variant
Behaviour changes Disinhibition Impulsivity Loss of social skills Obsessions
FTD - primary progressive aphasia
Does great on OT assessment
However, can’t communicate well
Lack of words
Non-fluent speech
FTD - semantic dementia
Impaired understanding of meaning of words
Fluent but empty speech
FTD - what investigation is best for diagnosing this condition?
SPECT
- fronto-temportal reduction in tracer uptake
Lewy body dementia - what condition is it associated with?
Parkinson’s disease
Lewy body dementia - definition
Parkinsonism + cognitive impairment
Lewy body dementia - clinical features
Two of the following must be present:
- visual hallucinations
- fluctuating cognition
- parkinsonism features
- REM sleep behaviour disorder
Lewy body dementia - parkinsonism clinical features must be present when?
At onset or within 1 year of symptoms
Lewy body dementia - investigations
DAT scan
SPECT - look for occipital changes
Lewy body dementia - neuropathology
Abnormal clumps of lewy bodies
Degeneration of the substantial nigra
Dementia in parkinson disease is common. True or false?
True
Dementia in parkinson disease usually develops _____ years after diagnosis of parkinson disease?
15-20
Pseudo dementia - definition
Lack of neurodegenerative dementia
Pseudo dementia - clinical features
Fluctuating loss of memory
Consistently depressed mood
Not progressive
Which type of dementia typically has a quick decline?
- Alzheimers disease
- Vascular dementia
- Fronto temporal dementia
- Dementia with lewy bodies
Fronto temporal dementia
Which type of dementia has fluctuating severity on a daily basis?
- Alzheimers disease
- Vascular dementia
- Fronto temporal dementia
- Dementia with lewy bodies
Lewy body dementia
Which type of dementia has a stepwise decline?
- Alzheimers disease
- Vascular dementia
- Fronto temporal dementia
- Dementia with lewy bodies
Vascular dementia
- accumulation of multiple infarcts
In which type of dementia do memory problems present before other signs and symptoms?
Alzheimers
