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NMH: Module 2 > Differential diagnosis of dementia > Flashcards

Differential diagnosis of dementia Flashcards

1
Q

What is Charles Bonnet Syndrome (CBS)?

A

Complex visual hallucinations in indivduals w/ acquired visual loss with insight and without cognitive impairment (10-60%)

[high incidence of non reporting + diagnosis of exclusion]

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2
Q

Common characteristics of CBS?

A
  • Simple geometric shapes
  • Complex shapes with reconisable forms (faces, objects)
  • Tessellopsia (regular, overlapping patterns)
  • Prosometamorphopsia (facial distorsion)
  • Dendropsia (branching forms)
  • Hyperchromatopsia (all objects appear coloured)
  • Polyopia (multiple forms of one image)
  • Micropsia (objects appear smaller than normal)
  • Macropsia
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3
Q

General features of the nature of dementia presentation

A
  • no implied aetiology
  • insidious onset, progressive decline
  • clear consciousness
  • deficits in behaviour, attention, memory, language, visuospatial dys
  • reversible/irreversible; indolent/rapid progress; multiple def/isolated def
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4
Q

1st and 2nd most common dementia forms?

A
  1. AD
  2. DLB (and PDD)

[there is also vasc. dement and FTD)

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5
Q

How to definitively diagnose dementia?

A

Brain tissue required (biopsy)

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6
Q

Features that should be preserved w/ ageing?

A
  • Temporal Orientation
  • Immediate Attention
  • Vocabulary
  • Visuospatial skills
  • Judgement & Insight
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7
Q

Features that suffer mild decrements w/ ageing

A
  • Sustained Attention
  • Visual > Verbal recall
  • Naming
  • Response speed
  • Flexibility
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8
Q

What is Mild Cognitive Impairement (MCI)?

A

Cognitive impairment that is insufficient to reach criterion of “dementia”

Amnestic/non-amnestic

10-15% annually convert to dementia

NB: rule out psyc/drug/other

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9
Q

Features of Depressive Pseudodementia (DPD)?

A
  • apathy
  • social withdrawal
  • mutism
  • incontinence
  • lack of “sadness”

[depression is misdiagnosed as dementia in 8-15% of mentally declining pts]

NB: depression is present in 20-30% of demented pts

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10
Q

Clues of DPD?

A
  • FHx
  • subacute onset
  • agitation/pacing
  • precipitants
  • poor memory
  • poor effort
  • spared language + praxis
  • normal EEG/imaging
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11
Q

What is Balint’s syndrome

A

[focal lesion]

Unable to perceive visual field as a whole:

  • occulomotor apraxia
  • optic ataxia
  • visual stimultagnosia
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12
Q

What is Gerstmann’s syndrome?

A

[focal lesion]

  • dysgraphia/agraphia
  • acalculia
  • finger agnosia
  • unable to distinguish R/L side of body
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13
Q

Types of anatomical classification of dementia pathology?

A
  • subcortical

- cortical

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14
Q

Describe subcortical features of dementia?

A
  • slow, inefficient
  • apathy, mood, personality
  • motor signs

[e.g. PDD, huntingtons, PSP, MS, Wilson’s, HIV)

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15
Q

Describe cortical features of dementia?

A
  • language
  • praxis (visuospatial)
  • disinhibition
  • (memory)

[e.g. AD, FTD, DLC, CJD]

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16
Q

Describe feature of delirium?

A

Impaired stream of though and cognitive deficits

17
Q

Diagnose:

Insidious amnesia, language impairment (anomia, paraphrasias, poor comprehension): ?

Lack of hygiene, personality change, poor comportment & planning: ?

Fluctuation, agitation, hallucinations, visuospatial dysfunction, Parkinsonism, neuroleptic sensitivity: ?

A

AD

FTD

DLB

18
Q

Diagnose:

Memory loss, Ataxia, Incontinence: ?

Stepwise decline, focal/motor/gait signs: ?

Subacute or rapid decline,motor signs: ?

A

Normal Pressure Hydrocephalus (NPH)

Multi-Infarct Dementia (MID)

CJD/Autoimmune

19
Q

Potential differentials for dementia symptoms?

A
  • normal ageing
  • psych disease (depress-pseudo dem, depression)
  • drug
  • focal neuro syndromes (aphasia, anomia, amnesia etc)
  • acute confusional states (delirium)
  • MCI (amnestic vs non-amnestic)
  • MS
  • Charles Bonnet Syndrome
20
Q

Ddx of visual hallucinations?

A
  • neurological (PD, LBD, epilepsy)
  • psychiatric (schizophrenia)
  • drugs
  • sleep deprivation
21
Q

Investigations for dementia symptoms?

A
  • history
  • neuro exam (dementia is a clinical diagnosis)
  • biomarkers (CSF tau, CSF amyloid)
  • EEG (slow wave activity in dementia due to increased delta waves)
  • imaging (CT, MRI, PET, SPECT)
  • brain biopsy (definitive)
22
Q

Types of management for dementia?

A

Symptomatic treatment (no treatments that can halt progression)

23
Q

Categories of dementia

A
  • neurodegenerative
  • traumatic/structural
  • vascular
  • metabolic
  • toxic
  • psychiatric
24
Q

List some forms of neurodegenerative dementia?

A
  • AD
  • LBD
  • PDD
  • PSP/CBD
  • FTLD
25
Q

Forms of traumatic/structural dementia?

A
  • subdural haematoma
  • head injury (CTE, DAI, cerebral contusions)
  • NPH (normal pressure hydrocephalus)
  • neoplasm
26
Q

Forms of vascular dementia?

A
  • multi-infarct dementia
  • cerebral amyloid angiopathy
  • vasculitis (Wegner’s)
27
Q

Metabolic causes of dementia?

A
  • hypoxia/hypercapnia
  • uraemia
  • hepatic encephalopathy
  • thiamine/B12 deficiency
  • hypoglycaemia
28
Q

Toxic causes of dementia?

A
  • medication (Anticholinergic, valproate)
  • alcohol
  • carbon monoxide
29
Q

Psychiatric causes of dementia?

A
  • schizophrenia
  • depression (pseudodementia)
  • bipolar disorder
30
Q

How to differentiate normal ageing from dementia?

A

Normal ageing has:

  • preserved temporal orientation
  • preserved visuospatial skills
  • preserved judgement
  • can give immediate attention when asked

NMH: Module 2 (33 decks)

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