Intro to dementia Flashcards
What is dementia
- Cognitive failure
- deterioration in day to day function
- Evidence of long term progression
What are the symptoms of dementia
- Cognitive failure
- forgetting things
- difficulties with day to day function
- Hallucinations (dementia lewy bodies)
What are the different types of dementia
- Alzheimer’s
- Dementia with Lewy bodies
- Mixed dementia (mixed alzheimer’s/vascular)
- Vascular dementia
- Fronto-temporal dementia
What happens to memroy and neurological structure in normal ageing?
- occasional memory lapse
- Word finding difficulty
- Planning intact
- Degree of brain atrophy: the ventricles increase in size; the gyri are much thinner in the older brain; the sulci are much deeper and more prominent in the older brain
- Degree of brain pathology
Outline the cognitive domains that could be affected in dementia
- Memory
- Thinking
- Orientation
- Calculation
- Learning
- Language
- Judgement
What is perception
- recognition of sensory info
- representation of sensory info
Outline cognitive failure in dementia
- Pattern of cognitive failure is linked to distribution of brain& neurotransmitter dysfunction in early stages
- Regional and global brain atrophy occurs in later stages
Outline memory deficit(amnesia) in dementia
- Recent events
- New info
- Recall impaired
- Long term better
- Motor memory may remain intact until advanced disease (piano playing/artistic skills preserved to the very late stages as it’s a different kind of memory that is lost)
Outline aphasia in dementia
- Language deficit
- Simplified use of language
- Less use of abstract and descriptive terms
- Word finding problems
- Naming difficulties
- Receptive problems
- Complete loss of communication
Outline higher motor function (apraxia) in dementia
-Inability to perform acts of ones own will despite intact motor and sensory systems
-Dressing
-Eating
-Constructional (drawing)
-Ideomotor (wave goodbye)
(in dementia you don’t get involvement of the primary motor/sensory cortex)
Outline perceptual deficit (agnosia) in dementia
- Inability to understand the significance of sensory stimuli
- Misidentification of object by feel
- Misidentification of faces (propsoagnosia)
- R-L disorientation
- Unable to recognise own body parts
What is a key clinical hallmark of dementia with Lewy bodies
-Visual hallucinations
Outline the tests of global cognition
- )MMSE( Mini-Mental State Examination)
- 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment - )ACE-R (Addenbrooke’s Cognitive Examination)
What can dementia cause beyond cognition?
- Neuropsychiatric symptoms
- Behavioural and psychological symptoms of dementia (BPSD)
Outline the neuropsychiatric symptoms of dementia
- Hallucinations (particularly dementia with lewy bodies)
- Delusions
- Depression
- Anxiety
- Apathy
- Behavioural disturbance-shouting,pacing
- Eating preference
- Sexual disinhibition
- Sleep behaviours
Define hallucination in the context of dementia
- VISUAL hallucinations= Hallmark of dementia with Lewy bodies
- Seeing, hearing or smelling something that isn’t there
- Visual most common in dementia (People and animals)
What is a delusion in the context of dementia ?
- False belief
- Typically of theft( things misplaced are thought stolen)
- Rarely misidentification delusions (family member replaced by imposter(capgras); house is not their home))
What is Capgras syndrome
- Psychological condition.
- AKA “imposter syndrome” or “Capgras delusion.” -People who experience this syndrome will have an irrational belief that someone they know or recognize has been replaced by an imposter
Outline the areas of personal activities of daily living that dementia can interfere with
- Washing
- Dressing
- Eating
- Continence
- Finances
- Navigation
How is the prodromal period of dementia defined
- MILD cognitive impairment
- preclinical stage precedes this stage
How can we distinguish dementia and delirium ?
- Dementia = CHRONIC brain failure
- Delirium= ACUTE brain failure
1. )Onset: dementia= slow | delirium=rapid
2. )Duration: dementia=months to years | delirium= hours to weeks
3. )Attention: dementia=preserved | delirium=fluctuates
4. )Alertness: dementia= usually normal | delirium= hyper vigilant or reduced vigilance
5. Sleep-wake cycle: dementia=fragmented sleep | delirium= frequent disruption (eg day and night reversal)
What is the most common type of dementia?
AD
Outline the clinical presentation of AD
- Gradual onset
- Memory involved early
- Progressive cognitive decline
Outline the clinical presentation of vascular dementia
- Stepwise deterioration in cognitive function
- Often coexists with AD
- Vascular risk factors
- Neurological symptoms (mild/subtle)
Outline the clinical presentation of dementia with Lewy bodies
- Day to day fluctuation in cognition
- Visual hallucinations***
- Distubances of consciousness
- Parkinsonism(NB: antipsychotic sensitivity)
- Falls/syncope
What is anti-psychotic sensitivity ?
Up to 50% of patients with LBD who are treated with any antipsychotic medication may experience severe neuroleptic sensitivity, such as worsening cognition, heavy sedation, increased or possibly irreversible parkinsonism, or symptoms resembling neuroleptic malignant syndrome (NMS), which can be fatal.
Outline the clinical presentation of frontotemporal dementia
- Early decline in social/personal conduct
- Different variants affecting: behaviour; language
- Memory preserved in early stages
Which clinical specialties are involved in diagnosis of dementia?
- Old age psychiatry (memory clinics)
- Geriatrics(memory clinics)
- Neurology(younger onset)
Which clinical specialties are involved in long term follow-up of dementia
- Primary care
- Old age psychiatry
- Geriatrics
Outline the general principles of treatment in dementia
- Treat associated disorders eg chest infections, UTIs
- Address functional problems (Occupational therapy involvement)
- Carer supprot ad advice
- Manage risk factors eg vascular dementia
Outline safeguarding in dementia
A person with dementia may have problems:
- Preparing food and drink
- wandering
- self care
- ability to deal with finances
- Exploitation from others
Outline treatment of dementia
Disease modifiers
- ) Acetylcholinesterase( AChE) inhibitors
- Donepezil
- Galantamine
- Rivastigmine - )Currently no disease reversing medication for dementia
Outline treatment of symptoms of dementia
- Non pharmacological approaches( eg reminiscence therapy)
- Medication for specific symptoms (eg depression, hallucinations, agitation, sleep disturbance)
Outline the care settings of treatment in dementia
- Carer
- Home with social services support
- Care home~£1000/ week (payment by social care of pt depending on financial resources)
- NHS continuing care (no cost to patient)
