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Year 3 > Dementias (EL) > Flashcards

Dementias (EL) Flashcards

1
Q

Define dementia.

A

Acquired disorder of cognitive function

Progressive cognitive decline of sufficient magnitude to interfere with normal social or occupational functions/usual daily activities

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2
Q

What are the most common causes of dementia in the UK in order?

A

Alzheimer’s disease > vascular dementia > Lewy Body dementia > frontotemporal dementia

(These conditions may co-exist)

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3
Q

Define Alzheimer’s disease.

A

Chronic, progressive neurodegenerative disorder characterised by a global, non-reversible impairment in cerebral functioning

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4
Q

What happens in Alzheimer’s disease?

A
  • degeneration of the cerebral cortex, with cortical atrophy and reduction in acetylcholine production
  • build-up of APP (amyloid precursor proteins) - due to beta and gamma secretase
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5
Q

Describe the histopathology of Alzheimer’s disease.

A

Characterised by senile plaques, neurofibrillary tangles, and neuronal loss

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6
Q

Define vascular dementia.

A

Chronic progressive disease of the brain causing multifaceted impairment of cognitive function

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7
Q

What happens in vascular dementia?

A

Brain damage due to several incidents of cerebrovascular disease e.g. strokes/TIAs/infarction/small vessel changes/haemorrhage/leukoaraiosis –> loss of brain parenchyma

Affects planning more than memory, motor and mood changes seen early

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8
Q

Define dementia with Lewy bodies.

A

Neurodegenerative disorder with parkinsonism, progressive cognitive decline, prominent executive dysfunction, behavioural and sleep disturbances, and visuospatial impairment

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9
Q

What happens in dementia with Lewy bodies?

A

Deposition of abnormal proteins (Lewy bodies) within the brainstem and neocortex

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10
Q

Define frontotemporal dementia.

A

FTD manifests primarily as disruption in personality and social conduct, or as a primary language disorder

Almost 50% display parkinsonism, a smaller subset may have motor neuron disease

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11
Q

What happens in frontotemporal dementia?

A

Specific degeneration of frontal and temporal lobes - thought to be caused by pick bodies

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12
Q

What are the main two clinical features of dementia?

A
  • memory impairment
  • cognitive impairment
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13
Q

What are the hallmark signs for Alzheimer’s?

A

Slowly progressive, episodic impairment of memory, insidious onset

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14
Q

What are the hallmark signs of vascular dementia?

A

Abrupt cognitive decline and stepwise deterioration

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15
Q

What are the hallmark signs of dementia with Lewy bodies? (4)

A
  • steady decline
  • fluctuating cognition / consciousness
  • recurrent visual hallucinations
  • parkinsonian motor disorders
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16
Q

What are the hallmark signs of frontotemporal dementia? (3)

A
  • early changes in personality (e.g. impulsivity, aggressiveness)
  • often has Fx
  • earlier age of onset around 45-65 years, peak prevalence in 7th decade
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17
Q

What are the key diagnostic factors of Alzheimer’s?

A
  • memory loss
  • disorientation
  • nominal dysphasia
  • misplacing items/getting lost
  • apathy
  • decline in ADLs
  • personality change
  • unremarkable initial physical examination
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18
Q

What are some risk factors for Alzheimer’s?

A
  • advanced age
  • family history
  • genetics
  • Down’s syndrome
  • cerebrovascular disease
  • lifestyle factors and medications
  • less than secondary school education
19
Q

What are the key diagnostic factors for vascular dementia?

A
  • history of stroke
  • difficulty solving problems
  • apathy
  • disinhibition
  • slowed processing of information
  • poor attention
  • retrieval memory deficit
  • frontal release reflexes
20
Q

What are some risk factors for vascular dementia?

A
  • age >60 years
  • obesity
  • hypertension
  • cigarette smoking
21
Q

What are some key diagnostic factors for dementia with Lewy bodies?

A
  • fluctuations (cognition, attention, arousal)
  • visual hallucinations
  • motor symptoms (parkinsonian)
  • REM sleep behavioural disturbance
22
Q

What are some risk factors for dementia with Lewy bodies?

A
  • older age
  • (familial occurrence - weak)
23
Q

What are some key diagnostic factors for frontotemporal dementia?

A
  • coarsening of personality, social behaviour and habits
  • progressive loss of language fluency/comprehension
  • development of memory impairment, disorientation or apraxias
  • progressive self-neglect and abandonment of work, activities, and social contacts
24
Q

What are some risk factors for frontotemporal dementia?

A
  • mutations in MAPT gene
  • mutations in GRN gene
  • mutations in C9orf72 gene
  • (traumatic brain injury - weak)
25
Q

What cognitive assessment do we do for dementia?

A

Mini Mental State Exam (MMSE)

<24 = dementia

26
Q

What do the scores mean on the MMSE for dementia?

A
  • 0-17: severe cognitive impairment
  • 18-23: mild cognitive impairment
  • 24-30: no cognitive impairment
27
Q

What screen can we do in primary care for dementia?

A

Blood screen to exclude reversible causes i.e. FBC, U&E, LFTs, calcium, glucose, TFTs (hypothyroidism), vitamin B12 and folate levels

(Neuroimaging then done in secondary care)

28
Q

What imaging can we do for dementia?

A

Neuroimaging in secondary care i.e. CT/MRI/PET

29
Q

What are the 1st line investigations done for Alzheimer’s?

A
  • bedside cognitive testing (MMSE)
  • FBC
  • metabolic panel
  • serum TSH
  • serum vitamin B12
  • urine drug screen
  • CT
  • MRI
30
Q

What are the 1st line investigations done for vascular dementia?

A
  • FBC
  • ESR
  • BGC
  • renal and liver function tests
  • vitamin B12
  • folate
  • thyroid function
  • CT / MRI brain
  • ECG
31
Q

What are the 1st line investigations done for dementia with Lewy bodies?

A
  • SPECT (DATscan)
  • serum TSH
  • serum vitamin B12
  • CT head
  • MRI head
32
Q

What are the 1st line investigations done for frontotemporal dementia?

A
  • formal cognitive testing (MMSE)
  • brain MRI / CT
  • FBC
  • serum CRP
  • TSH & T4
  • metabolic panel
  • serum urea
  • serum creatinine
  • LFTs
  • B12 and folate
  • syphilis serology
  • HIV testng
  • serum enzyme-linked immunosorbent assay
33
Q

What would we see on neuroimaging in the different types of dementia?

A
  • Alzheimer’s: cortical and hippocampal atrophy
  • vascular: lacunar infarcts (white areas on MRI)
  • frontotemporal: atrophy in frontal and temporal lobes
34
Q

What would we see on neuroimaging in Alzheimer’s?

A

Cortical and hippocampal atrophy

35
Q

What would we see on neuroimaging in vascular dementia?

A

Lacunar infarcts (white areas on MRI)

36
Q

What would we see on neuroimaging in frontotemporal dementia?

A

Atrophy in frontal and temporal lobes

37
Q

What is the 1st line treatment for mild-moderate Alzheimer’s?

A
  • supportive treatment
  • PLUS environmental control measures
  • PLUS cholinesterase inhibitors (donepezil, rivastigmine if hallucinations, galantamine)
  • CONSIDER management of depression / dementia-related psychosis / insomnia / other behavioural and psychological symptoms
38
Q

What is the 2nd line treatment for Alzheimer’s (if cholinesterase inhibitors contraindicated/not tolerated/ineffective) OR 1st line for severe Alzheimer’s?

A

Switch to or add memantine (NMDA receptor antagonist, leading to decreased glutamate-induced excitotoxicity)

39
Q

What is a contraindication for cholinesterase inhibitors?

A

Prolonged QT interval

40
Q

What is the 1st line treatment for vascular dementia?

A
  • antiplatelet therapy (aspirin/clopidogrel)
  • PLUS lifestyle modification
  • PLUS supportive care
41
Q

What is the 1st line treatment for dementia with Lewy bodies?

A
  • supportive care
  • PLUS cholinesterase inhibitor (e.g. donepezil) or memantine
  • CONSIDER non-pharmacological and behavioural interventions
42
Q

What drug do we avoid in patients with Lewy body dementia?

A

Antipsychotics - may cause irreversible parkinsonism

43
Q

What is the 1st line treatment for patients with frontotemporal dementia?

A

Supportive care

44
Q

What non-pharmacological treatments are there for dementia?

A
  • cognitive stimulation therapy to improve memory and problem-solving skills
  • cognitive rehabilitation

Year 3 (22 decks)

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