LO2- Dementia Flashcards
What is dementia?
Dementia is a global decline in cognitive function without impairment in consciousness.
It is chronic and progressive.
What differs dementia from mild cognitive impairment?
It begins to interfere with everyday functioning
What is the most common cause of dementia?
Alzheimer’s disease (also cerebrovascular disease)
What can be used to screen for cognitive impairment?
Abbreviated mental test score
What are some risk factors for dementia?
Age Female gender Head trauma Low level education Vascular risk factors- HTN, smoking, diabetes Apolipoprotein E
How does dementia present?
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
What are some protective factors for dementia?
Education- higher education Exercise Wine, coffee, turmeric, med diet Brain training Living with others Bilingualism
What is the most common cause of dementia?
Alzheimer’s disease
What are the pathological findings in Alzheimer’s disease?
Amyloid plaques
Neurofibrillary tangles
There is reduced turnover of amyloid which causes beta amyloid plaques. They begin to disrupt neuronal function.
What gene inheritance can cause familial AD?
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
What is the inheritance of familial alzheimer’s disease?
Autosomal Dominant
What might the work-up be for someone presenting with AD?
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.
Where are patients with dementia often referred to?
Old age psychiatrists or memory clinics
What is the management for alzheimer’s disease?
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)
What might be included in the pharmacological management of Alzheimer’s disease?
ACh esterase inhibitors- Donepezil, Galantamine, Rivastigmine
NMDA Antagonists
Name three ACh esterase inhibitors
Donepezil
Rivastigmine
Galantamine
Name an NMDA receptor antagonist used in the management of AD?
Memantine
What is a contraindication to donepezil?
Relative CI is bradycardia
What is pathological change is seen in lewy body dementia?
Lewy body formation in neurons which begin to reduce neuronal functioning
How do patients with Lewy body dementia usually present?
Poor memory
Visual hallucinations
Fluctuating cognitive impairment
Depression
Parkinson’s disease- substantia nigra affected but usually midler than full PD
Sleep disturbance
How do patients with Lewy body dementia usually present?
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
What can be used in the management of Lewy body dementia?
Acetylcholinesterase inhibitors- Donepezil, rivastigmine
MDMA Antagonists- Memantine
Manage PD according to its own guidance- Dopamine agonists, L-Dopa, Decarboxylase Inhibitor, MAO-B Inhibitors
What features are seen in Frontotemporal dementia?
Usually affects younger people <65
Behavioural change
Personality change
Progresses rapidly
Relatively preserved memory
What is Pick’s disease?
One of the causes of frontotemporal dementia that is due to Pick bodies
