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SPM- Elderly Medicine > LO2- Dementia > Flashcards

LO2- Dementia Flashcards

1
Q

What is dementia?

A

Dementia is a global decline in cognitive function without impairment in consciousness.

It is chronic and progressive.

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2
Q

What differs dementia from mild cognitive impairment?

A

It begins to interfere with everyday functioning

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3
Q

What is the most common cause of dementia?

A

Alzheimer’s disease (also cerebrovascular disease)

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4
Q

What can be used to screen for cognitive impairment?

A

Abbreviated mental test score

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5
Q

What are some risk factors for dementia?

A 
Age
Female gender
Head trauma
Low level education
Vascular risk factors- HTN, smoking, diabetes
Apolipoprotein E
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6
Q

How does dementia present?

A

Progressive declines in cognitive function- reduced memory, and difficulty learning
Inability to keep up with everyday functioning
Confusion
Inappropriate behaviour
Often have no insight into their problems

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7
Q

What are some protective factors for dementia?

A 
Education- higher education
Exercise
Wine, coffee, turmeric, med diet
Brain training
Living with others
Bilingualism
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8
Q

What is the most common cause of dementia?

A

Alzheimer’s disease

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9
Q

What are the pathological findings in Alzheimer’s disease?

A

Amyloid plaques
Neurofibrillary tangles

There is reduced turnover of amyloid which causes beta amyloid plaques. They begin to disrupt neuronal function.

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10
Q

What gene inheritance can cause familial AD?

A

Amyloid precursor protein gene mutations leading to increased formation of amyloid plaques
Presenilin 1 and 2 genes too

Familial AD has autosomal dominant inheritance and causes earlier onset of alzheimer’s

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11
Q

What is the inheritance of familial alzheimer’s disease?

A

Autosomal Dominant

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12
Q

What might the work-up be for someone presenting with AD?

A

Bloods- FBC, U&Es, LFTs, Calcium, Glucose, TFTs, B12 and Folate
Neuroimaging may be done to rule out structural causes such as tumour, subdural haematoma etc.

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13
Q

Where are patients with dementia often referred to?

A

Old age psychiatrists or memory clinics

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14
Q

What is the management for alzheimer’s disease?

A

Non-Pharmacological
Activities to promote wellbeing, CBT, group reminiscence therapy, cognitive rehab, input from OTs

Pharmacological-
ACh esterase inhibitors e.g. donepezil, galantamine, rivastigmine for mild to moderate disease
Memantine- NMDA antagonist (if intolerant to ACh esterase inhibitors, or in combination for moderate or severe disease, or as a monotherapy)

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15
Q

What might be included in the pharmacological management of Alzheimer’s disease?

A

ACh esterase inhibitors- Donepezil, Galantamine, Rivastigmine
NMDA Antagonists

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16
Q

Name three ACh esterase inhibitors

A

Donepezil
Rivastigmine
Galantamine

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17
Q

Name an NMDA receptor antagonist used in the management of AD?

A

Memantine

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18
Q

What is a contraindication to donepezil?

A

Relative CI is bradycardia

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19
Q

What is pathological change is seen in lewy body dementia?

A

Lewy body formation in neurons which begin to reduce neuronal functioning

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20
Q

How do patients with Lewy body dementia usually present?

A

Poor memory
Visual hallucinations
Fluctuating cognitive impairment
Depression

Parkinson’s disease- substantia nigra affected but usually midler than full PD
Sleep disturbance

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21
Q

How do patients with Lewy body dementia usually present?

A

Poor memory
Visual hallucinations (normally indicates it’s Lewy Body)
Fluctuating cognitive impairment
Depression

Parkinson’s disease- substantia nigra affected but usually midler than full PD
Sleep disturbance

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22
Q

What can be used in the management of Lewy body dementia?

A

Acetylcholinesterase inhibitors- Donepezil, rivastigmine
MDMA Antagonists- Memantine

Manage PD according to its own guidance- Dopamine agonists, L-Dopa, Decarboxylase Inhibitor, MAO-B Inhibitors

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23
Q

What features are seen in Frontotemporal dementia?

A

Usually affects younger people <65
Behavioural change
Personality change
Progresses rapidly

Relatively preserved memory

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24
Q

What is Pick’s disease?

A

One of the causes of frontotemporal dementia that is due to Pick bodies

25
Q

What are Pick bodies?

A

Aggregates of Tau protein- it’s a Tauopathy

Amyloid plaques and neurofibrillary tangles are seen in AD

26
Q

Where is affected in frontotemporal dementia?

A

The frontal lobes- causing personality change

The temporal lobes

27
Q

Can AChE inhibitors (e.g. Donepezil) or memantine (NMDA antagonist) be used in the management of frontal lobe dementia?

A

It is not recommended by NICE

28
Q

What causes vascular dementia?

A

Small vessel ischaemia or multiple discrete infarcts

It’s due to long term ischaemic changes

29
Q

What features are seen in patients with vascular dementia?

A

Declines in memory
Reduced cognitive function
Gait abnormalities
Focal neurological deficits in areas of infarction

30
Q

What are some other causes of dementia or dementia like disease?

A 
Depression
Parkinson's Disease
Huntington's Disease 
CJD- causes a very progressive dementia with myoclonus
Wernicke's -Korsakoff's
Chronic head trauma 
Wilson's disease
31
Q

What is important for the management of vascular dementia?

A 
Manage the risk factors for vascular disease
Stop smoking services
HTN
Glycaemic control
Statins
Diet and lifestyle
32
Q

What proportion of people in hospital have dementia?

A

1 in 4

33
Q

What proportion of people living with dementia have received a formal diagnosis?

A

2/3

34
Q

What features can help to indicate vascular dementia?

A

Presence of vascular risk factors

Abnormal gait

35
Q

What medication should be avoided in patients with Lewy Body dementia?

A

Antipsychotics- don’t use haloperidol for sedation

36
Q

What blood tests should be done for patients with dementia?

A 
FBC
U&amp;Es
TFTs
B12 Folate
HIV
Calcium
37
Q

What condition is the triad of normal pressure hydrocephalus?

A

Dementia
Incontinence
Gait dyspraxia

38
Q

Why might brain imaging be done in dementia?

A

To exclude structural causes of the dementia

Space occupying lesions
Abscess
Vascular damage
Hydrocephalus

39
Q

What is important to discuss with patients diagnosed with dementia regarding changes in capacity?

A

Advance care planning
Lasting power of attorney
Advanced decision to refuse treatment
DNAR

40
Q

What psychiatric condition is common in dementia patients?

A

Depression- manage accordingly

41
Q

What needs to be done before starting a patient on AChE inhibitors?

A

ECG as they can exacerbate heart block

May also exaggerate peptic ulcer disease so ask about this

42
Q

How might dementia present in hospital?

A 
Dementia crisis
Decompensation
Falls at home
Frailty
Co-existing with other medical conditions
43
Q

What features can help to differentiate between depression and dementia?

A

Depression favoured if:
More rapid onset
Sx of weight loss, anhedonia, sleep disturbance
Patient is worried about their memory (lack of insight is often seen in AD)
Global memory loss where AD is more likely to me short term memory loss

44
Q

What are some reversible causes of dementia?

A 
Alcohol dependence
Hypothyroidism
B12 and Folate deficiency
Syphilis- Neurosyphilis
Normal pressure hydrocephalus (dementia, incontinence and gait abnormalities)
45
Q

What are some non reversible causes of dementia?

A

Alzheimer’s disease
Lewy body dementia
Frontotemporal dementia
Vascular dementia

46
Q

What kind of memory is generally impaired initially in AD?

A

Short term memory

Memories from childhood often remain until very late stages

47
Q

What is the only investigation that can truly diagnose the type of alzheimer’s?

A

Brain biopsy- not done till after death

48
Q

What are three AChE inhibitors?

A

Donepezil
Rivastigmine
Galantamine

49
Q

What are some side effects of AChE Inhibitors?

A

Donepezil, Rivastigmine, Galantamine

Side effects include nausea, vomiting, heart block (do ECG), syncope, diarrhoea

50
Q

What NMDA antagonist might be used in AD?

A

Memantine

51
Q

What can be used to manage depression in AD?

A

CBT
Psychosocial interventions
SSRI

52
Q

Which type of dementia tends to occur in younger people?

A

Frontotemporal dementia

Pick’s disease

53
Q

What is a key feature of frontotemporal dementia?

A

Behavioural change

54
Q

How do you differentiate between Lewy Body Dementia and Parkinson’s dementia?

A

Order of the events
PD- Movement disorder then dementia
LBD- Dementia then movement disorder

LBD is associated with hallucinations and deficits in attention and alertness (can present as recurrent episodes of delirium)

55
Q

What should not be given to patients with LBD?

A

Haloperidol and other antipsychotics

56
Q

What could cause a rapidly progressive dementia?

A

CJD

57
Q

What can cause dementia in boxers?

A

Recurrent head trauma causes chronic traumatic encephalopathy

58
Q

Which STDs can cause dementia?

A

HIV

Syphilis

SPM- Elderly Medicine (6 decks)

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