Memory problems Flashcards
What is anterograde amnesia?
What is retrograde amnesia?
Anterograde amnesia; difficulty in remembering new information since the onset of the illness
Retrograde amnesia; difficulty in remembering past information from prior to the onset of the illness
List some of the reversible causes of memory loss
Depressive pseudodementia
Wernicke-Korsakoff syndrome
Normal pressure hydrocephalus
Delirium
PTSD
When would you do MoCA and when would you do an Addenbrookes?
MoCA is quicker so done by a GP or if the patient is too anxious or unable to complete a longer test
Addenbrookes is the test commonly done in old age psychiatry
*Both look at memory and cognitive function
What is dementia?
Progressive global cognitive decline which is irreversible
What are the 4 primary dementias?
Alzheimer’s
Lewy body dementia
FTD
Huntington’s disease
What are examples of secondary dementias?
Vascular dementia
Infection
Trauma
Metabolic
What are some of the risk factors for dementia?
Age
Alcohol
Diet
Concussions
What cognitive tests can be done to assess a patient with dementia?
MMSE
MoCA
Addenbrooke’s
Frontal assessment battery (FAB)
Neuropsychological testing
Why should bloods be part of the routine investigation for dementia?
To rule out other causes of the presentation such as; syphilis, thyroid problems and vitamin deficiencies
What is the best imaging investigation to do in a patient with suspected dementia?
CT
Less distressing for a patient than MRI an cheaper
When should an MRI be done in a patient presenting with memory problems?
Young patients, atypical presentation, unclear diagnoses
What medications can be used in the management of Alzheimer’s disease?
Acetylcholinesterase inhibitors
Memantine
What are the contraindications to the use of acetylcholinesterase inhibitors in patients with alzheimer’s disease?
Asthma and COPD
Causes bradycardia - so must check pulse
When should a patient be started on memantine?
In moderate cases of Alzheimer’s or when acetylcholinesterase inhibitors are contraindicated or have not worked for the patient
What is mild cognitive impairment?
Noticeable cognitive impairment with little deterioration in function
What is the most common form of dementia in the elderly?
Alzheimer’s
What condition is associated with an increased risk of developing Alzheimer’s later in life?
Down’s syndrome
Which is affected first in patients with alzheimer’s; memory or behaviour?
Memory first, behaviour later
Which type of memory is affected first in patients with Alzheimer’s?
Short - term
atrophy of the hippocampus
What is agnosia, a symptom of Alzheimer’s?
Difficulty in recognising familiar faces and objects
What is anosognosia, a feature of Alzheimer’s disease?
Lack of insight
Visuo-spatial issues can occur in Alzheimer’s if what part of the brain is atrophied?
Posterior cortical
What is capgras syndrome?
A type of delusion which occurs in Alzheimer’s
The patient has the irrational belief that someone they know or recognise has been replaced by an imposter
What are fregoli delusions?
A type of delusion which occurs in Alzheimer’s
Irrational belief that multiple people are in fact the same person who changes appearance or is in disguise
What causes Alzheimer’s?
Accumulation of the degradation products of the amyloid precursor protein
Describe the macroscopic pathology in Alzheimer’s disease
Widening of sulci and narrowing of gyri
Compensatory dilatation of the ventricles
What are some of the microscopic features of Alzheimer’s dementia?
Neuronal loss with associated astrocyte proliferation
Neuritic plaques
Amyloid angiopathy
Neurofibrillary tangles
What is the 2nd most common cause of dementia?
Vascular dementia (multi-infarct dementia)
Which is affected first in vascular dementia; behaviour or memory?
Behaviour is affected first, memory is affected later
Describe the progress of vascular dementia
Sudden onset with stepwise progression
What would you be likely to see on CT/MRI in a patient with vascular dementia?
Multiple lacunar infarcts
What is the 3rd most common form of dementia?
Lewy Body Dementia
Which type of dementia is one of the Parkinson + syndromes?
Lewy Body Dementia
Describe the progress of Lewy Body dementia
Fluctuating levels of attention and cognition on a day-to-day basis
Lewy Body dementia can be similar in its presentation to delirium. What things could you ask about to differentiate the two?
Parkinsonism symptoms
History of falls
What are some of the clinical signs and symptoms of Lewy Body Dementia?
Visual hallucinations
REM sleep disorders
Parkinsonism and falls
Dementia
What drug should not be given to patients with Lewy Body dementia?
Haloperidol
How can Parkinson’s dementia be differentiated from Lewy Body dementia?
Lewy body dementia; parkinsonism and dementia occur at roughly the same, or if parkinsonism appears first, symptoms must have been present for <1 year before the onset of dementia
Parkinson’s dementia; parkinson’s first, dementia years later
What is the function of the frontal lobe of the brain?
What is the function of the temporal lobe of the brain?
Frontal; Structured thinking and behaviour
Temporal; Making memories
Describe the progression in FTD
Rapid progression
What part of the brain is the first to be affected in patients with FTD?
Frontal lobe
(behaviour first)
These patients can often therefore perform well on cognitive testing
What 3 syndromes can occur in FTD?
Behavioural
Semantic
Primary progressive aphasia
Describe behavioural FTD
Personality and behaviour changes, disinhibition, impulsivity, changes in eating habits and loss of social skills
Describe semantic FTD
Speech and communication problems
Patient may become mute with time
Describe primary progressive aphasia FTD
Effortful non-fluent speech with articulation errors
What are the triad of symptoms in Huntington’s disease?
Triad of emotional, cognitive and motor disturbance
Where are the most common areas of missed pain and distress in patients with dementia?
Teeth, back and feet
