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Geriatrics > Lecture: Dementia Part 1 > Flashcards

Lecture: Dementia Part 1 Flashcards

1
Q

What is dementia?

A
  • Organ brain syndrome
  • Global impairment of cognition, social and occupational functioning
  • Affects ADLs
  • Clinical syndrome
  • Progressive, leading to dependency and death
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2
Q

How does mild cognitive impairment (MCI) differ from dementia?

A

MCI:
- Evidence of cognitive impairment
- Amnestic or non-amnestic
- DOES NOT affect activities of daily living
- Some will improve

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3
Q

What are the most common dementia subtypes?

A

60% Alzheimer’s
20% Vascular
10% Mixed
4% DLB
2% FTD
2% PDD
2% other

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4
Q

If a patient has a rapidly progressive dementia (occurs over months) what should you do?

A

Refer to a neurological service for LP/EEG to examine for rarer conditions like CJD

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5
Q

People <65 have a greater incidence of what type of dementia?

A

FTD

Less vascular dementia

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6
Q

What are the overall requirements for a diagnosis of dementia?

A
  • Clinical evaluation (history, examination, functional assessment)
  • Cognitive assessment
  • Basic laboratory evaluation
  • Structural imaging
  • Other Ix if indicated
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7
Q

What are the aims of dementia assessment?

A
  1. Establish if they have dementia
  2. Exclude other conditions
  3. Establish sub-type
  4. Evaluate the impact
  5. Evaluate family and social support
  6. Evaluate comorbidity
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8
Q

What are some common symptoms that may be clues someone has dementia?

A
  • Memory loss; losing things, missing appointments
  • Confusion
  • Repetitiveness
  • Becoming lost in a familiar area
  • Personality change (irritable, inappropriate, hoarding, indifference, rituals
  • Apathy and withdrawal
  • Apraxia (forgetting how to use things)
  • Agnosing (not recognising objects)
  • Impaired language skills
  • Loss of ability with iADLs
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9
Q

What are some common symptoms that may be clues someone has dementia?

A
  • Memory loss; losing things, missing appointments
  • Confusion
  • Repetitiveness
  • Becoming lost in a familiar area
  • Personality change (irritable, inappropriate, hoarding, indifference, rituals
  • Apathy and withdrawal
  • Apraxia (forgetting how to use things)
  • Agnosing (not recognising objects)
  • Impaired language skills
  • Loss of ability with iADLs
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10
Q

What are some potentially reversible causes of cognitive impairment?

A

Delirium
Depression/anxiety
Alcohol/substance use
Medication: BZD, narcotics, anti-epileptics
Neurological disease
Normal Pressure Hydrocephalus (NPH)
B12/folate deficiency
Hypothyroid
Hypercalcaemia
Neurosyphilis
Cerebral vasculitis

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11
Q

What are some aspects of the history from a patient with suspected dementia?

A
  • Symptoms (cognitive, mood, BPSD)
  • Collateral
  • Time course: onset + progression
  • PMHx, Meds, FamHx
  • Vascular RFs
  • Functional decline: ADLs, iADLS
  • RFs: alcohol, head injury, mood disorders
  • Driving
  • Safety
  • Living arrangements
  • Legal (will, EPA/EPG, advanced care planning)
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12
Q

What are ADLs?

A

Activities of Daily Living

Bathing
Toilet
Grooming
Dressing
Transferring
Feeding

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13
Q

What are IADLs?

A

Instrumental Activities of Daily Living

Home cleaning
Managing Finances
Shopping
Cooking
Managing medications
Using communication tools
Managing transportation

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14
Q

What is benign forgetfulness?

A
  • Slower learning, mental processing, minor forgetfulness with age
  • Not of severity to interfere with daily life
  • Subjective memory complaints
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15
Q

What is delirium?

A
  • Recent onset
  • Fluctuating course
  • Sleep-wake cycle altered
  • Perceptual disturbance
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16
Q

What is depression?

A
  • Can accompany or mimic dementia
  • Often a past history of mood disturbance
  • Decreased interest and attention
  • Persistent sadness or loss of pleasure in life
  • Poor sleep, poor appetite, lack of energy, difficulty concentrating
17
Q

Are cognitive screening tests ‘true’ screening tests?

A

No

Screening tests detect disease among healthy community members

They’re case finding: detection of cognitive impairment where there is a high probability of disease in a particular population or setting

18
Q

What are some limitations of cognitive screening tests?

A
  • Scores must be interpreted considering age, literacy and education achievement
  • Disability will affect the reading and writing parts
  • Don’t make a diagnosis of dementia
  • Detect cognitive impairment from any cause
  • A ‘normal’ score doesn’t exclude early cognitive decline
19
Q

What is the difference between the MMSE and the MOCA?

A

MMSE:
- Orientation, recall, language, attention and calculation
- Insensitive to early stages of dementia
- Well known for reliability and validity
- Culturally biased

MOCA:
- Assesses many of the same areas as the MMSE but is more in depth and includes the CDT and trail test
- More sensitive: can detect deficits the MMSE misses
- Better for detected of MCI
- Score >26 is normal

20
Q

When would you do neuropsychological testing?

A
  • Not required in all cases
  • When diagnosis is uncertain or there are atypical features
  • Especially when younger onset
  • If possibility of depression
21
Q

What is included in a typical dementia workup in terms of laboratory tests?

A

Basically just searching for reversible causes:

FBC
UEC
LFT
Glucose
Calcium
ESR
TFT
B12
Folate

22
Q

What neuroimaging is included in a dementia work-up?

A
  • Non-contrast CT or MRI is almost universally included as part of the work-up but the yield is low
  • Do when there are atypical features (fast progression, young) and to identify treatable conditions (NPH, subdural etc)
  • Identify characteristic changes that suggest AD or vascular disease or other causes of dementia
23
Q

What do you see on head CT of someone with AD?

A

Shrinkage in specific areas: hippocampus

24
Q

Where is the brain shrinkage in FTD?

A

Frontal and/or temporal lobes

Geriatrics (6 decks)

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