Introduction to Dementia Flashcards
What is dementia?
Describing a number of different conditions that affect the brain (different types of dementia)
Can be thought of as a::
-Progressive…
-Global impairment…
-Of cognition (memory, intellectual ability, personality)…
-Of significant severity such as to affect daily functioning
Prevalence of dementia in UK?
> 850,000 people living with
Symptoms of dementia?
-Short term memory loss
-Later more long term memory loss
But not just memory loss:
-Difficulties concentrating
-Problems planning and thinking things through
-Struggling with familiar daily tasks
-Issues with language and communication (following conversations, word finding)
-Problems judging distances (even though eyesight is fine)
-Mood changes & difficulties controlling emotions.
Types of dementia?
-Alzheimer’s disease
-Vascular dementia
-Frontotemporal dementia - a type of this is Progressive supranuclear palsy
-Mixed dementia
-Lewy body dementia/Parkinson’s disease dementia
-Alcohol related brain damage
-Posterior cortical atrophy
-Huntington’s disease
-Corticobasal degeneration
-Normal pressure hydrocephalus
-(Mild cognitive impairment) = more likely to develop dementia
How to diagnose dementia?
-Take patient’s history
-Clinical – History, informant/collateral history
-Examination – Mental State, Physical (Neuro),
-Cognitive testing – GPCOG, MMSE, Addenbrooke’s cognitive examination & are mental state examinations too
-Imaging and investigations – CT head, MRI head, SPECT, DAT, bloods
-Scans etc to rule out anything else causing dementia-like symptoms
What investigations are done to rule out anything before diagnose dementia?
-Full blood count
-Urea, creatinine, and electrolytes (including calcium)
-Liver function tests
-Thyroid function tests
-Vitamin B12 & folate
-Blood Glucose or HbA1c
-CT/MRI scan of head
What are the 2 types of brain imaging?
-Structural neuroimaging = shape & size
-Functional neuroimaging = how brain is functioning
Risk factors of dementia - that can’t be changed?
-Age
-Genetic inheritance
-Gender
Risk factors of dementia - that can be changed?
-Lifestyle – regular exercise, smoking, alcohol, diet
-Managing comorbid health conditions e.g., hypertension, diabetes, cardiovascular disease
-Treating depression
How to prevent dementia/reduce risk?
-Manage blood pressure & comorbid health conditions
-Encourage use of hearing aids for hearing loss & reduce hearing loss
-Reduce exposure to air pollution & second-hand tobacco smoke
-Prevent head injury
-Limit or reduce alcohol intake
-Stop smoking
-Education
-Be physically active
-Reduce obesity, good diet
What brain changes are associated with Alzheimer’s disease?
-Tau protein – neurofibrillary tangles
-Amyloid deposits
-Loss of tissue (atrophy) in medial temporal lobes (includes: hippocampus, amygdala & parahippocampal regions)
-Image shows normal brain on left & brain of someone with Alzheimer’s on right - as is increased ventricular space
What are the early/progressing signs of dementia?
-Repetitive
-Forgetful
-Speech problems
-Trouble completing daily tasks
-Personality change
-Beocoming more reliant on others
-Increasing disorientation
-Neglecting social conventions
What are the late signs of dementia?
-Fragmented thinking
-Speech more disordered, even mute
-Swallowing difficulties
-Frailty
-Reliant on others for all care
What are some behavioural & psychological symptom of dementia?
-Agitation
-Aggression
-Hallucinations
-Delusions
-Repetitive - non-goal orientated activity
-Mood disturbances
-Anxiety
-Disinhibited behaviours
What are some pharmacological treatments for dementia?
-Acetylcholinesterase inhibitors – 1st line, e.g. Donepezil
-NMDA receptor antagonist (Memantine)
-Cognitive enhancers - can help with cognitive deficits
–> can slow time to full time care - BUT don’t affect disease progression itself - don’t reverse, slow down or cure dementia
