Essential Dementia Flashcards
Neurocognitive Domains (CALM PLES)
Complex Attention.
Learning and Memory.
Perceptual-motor function.
Language.
Executive Function.
Social cognition.
Mild Neurocognitive
Modest cognitive decline.
Cognitive deficits are insufficient to interfere with independence.
Cognitive deficits does not occur exclusively in the context of a delirium.
Cognitive deficits are not primarily attributable to another mental disorder (e.g., major depressive disorder, schizophrenia).
Major neurocognitive disorder
Substantial cognitive decline.
Cognitive deficits are sufficient to interfere with independence.
Causes
Alzheimer’s disease.
Vascular disease.
Traumatic brain injury.
HIV infection.
Substance/medication use.
Frontotemporal lobar degeneration.
Lewy body disease.
Prion disease.
Parkinson’s disease
Huntington’s disease
Another medical condition.
Multiple aetiologies.
Unspecified.
Alzheimer’s Disease
60-70% of dementia over age of 60.
Characteristics of Alzheimer’s disease
Decreased short-term memory initially (later decreased long-term memory).
Gradual decline over several years.
Depression common early on.
Suspicion, persecutory accusations.
Personality changes or entrenches.
May require prompts/assistance.
Gross Neuropathology
Neuronal loss leads to: loss of synaptic connectivity and degeneration of cortical architecture.
Picture: severely enlarged ventricles, extreme shrinkage of cerebral cortex.
Alzheimer disease: Neuronal level
Plaque: Beta-amyloid proteins that builds up between nerve cells.
Neurofibrillary tangles: twisted fibres of Tau protein form inside dying nerve cells.
Alzheimer’s disease: Risk factors
Age, family history, Down’s syndrome/FH, Head injury (in males), FH Parkinson’s, Depression, Epilepsy, Encephalitis/meningitis, Herpes zoster/simplex.
Dementia assessment
History: including collateral.
Examination; mental state exam, Mini-mental state exam, and physical exam.
- Montreal cognitive assessment (MoCA)
Special investigations: depends on findings
Dementia Early Management
Discuss Dx.
Rx other illness (esp. depression).
Eliminate non-essential drugs.
Advise on non-essential drugs.
Monitor driving and household safety.
AD support group.
Discuss referral to specialized clinic.
Medication options.
Dementia later management
Help carers optimize preserved pt. functions.
Monitor/ Rx neuropsychiatric symptoms.
Arrange support/ respite.
Monitor health of carers
Plan transition to nursing home.
Medicine to treat NCD
Cholinesterase inhibitors: Donepezil (Aricept), Galantamine, Rivastigmine.
NMDA receptor antagonist: Memantine.
Where can the medication provide limited benefits?
Mild to moderately severe Alzheimer’s disease.
Dementia with Lewy bodies.
Vascular dementia.
Mixed dementia.
Features of Vascular Dementia
Dementia plus focal neurological deficits (Dysarthria, Dysphagia, Gait disturbance, Focal weakness, Hyperreflexia).
Personality often reserved.
May have step-wise deterioration.
