Neurology - Memory Impairment Flashcards
Most common cause of dementia in the UK.
- Alzheimer’s disease
- Vascular dementia
- Lewy body dementia
Assessment tools recommended by NICE for dementia screening.
- 10 point cognitive screener (10-CS)
- 6-item cognitive impairment test (6-CIT)
- Mini-Cog
6-CIT test for dementia screening.
An MMSE score of __ out of 30 suggests dementia.
<24
Reversible causes of memory decline.
- hypothyroidism (TFTs)
- anaemia & infection (FBC)
- U&Es (uraemia, AKI)
- hypercalcaemia (calcium)
- hypoglycaemia (glucose)
- hyperbillirubinaemia (LFTs)
- B12 / folate deficiency
Risk factors for Alzheimer’s disease.
- increasing age
- family history of Alzheimer’s disease
- Down’s syndrome
Macroscopic changes seen in Alzheimer’s disease.
Widespread cerebral atrophy, particularly involving the cortex and hippocampus.
Microscopic changes seen in Alzheimer’s disease.
Hyperphosphorylation of tau protein results in deposition of beta-amyloid plaques and neurofibrillary tangles.
Biochemical changes seen in Alzheimer’s disease.
Deficit of acetylcholine.
Non-pharmacological management of Alzheimer’s disease.
Say you will write to patient’s GP and get social prescriber involved.
- NICE recommend offering ‘a range of activities to promote wellbeing that are tailored to the person’s preference’
- NICE recommend offering group cognitive stimulation therapy for patients with mild and moderate dementia
- other options to consider include group reminiscence therapy and cognitive rehabilitation
First line treatment for Alzheimer’s disease.
Acetylcholinesterase inhibitors.
Donepezil; Galantamine; Rivastigmine
Second line treatment for Alzheimer’s disease.
Memantine (NMDA receptor antagonist) used instead of or in adjunct to acetylcholinesterase inhibitors.
Should you prescribe antidepressants for moderate depression in patients with dementia?
No - NICE do not recommend.
Should you prescribe antipsychotics in Alzheimer’s dementia?
Only use when patients are at high risk of harming themselves or others.
Or where distress is severe.
Contraindications of donepezil.
Bradycardia
Adverse effects of donepizil.
Insomnia
Subtypes of vascular dementia.
- stroke related BD (multi-infarct)
- subcortical VD (small vessel disease)
- mixed dementia (VD + alzheimers)
Risk factors for vascular dementia.
- history of stroke / TIA
- atrial fibrillation
- hypertension
- diabetes mellitus
- hyperlipidaemia
- smoking
- obesity
- coronary heart disease
- family history of stroke / cardiovascular disease
Presentation of VD.
Several months of years of a history of sudden or stepwise deterioration of cognitive function:
- visual disturbance, sensory or motor symptoms
- difficulty with attention / concentration
- seizures
- memory disturbance
- gait disturbance
- speech disturbance
- emotional disturbance
Non-pharmacological management of VD.
Tailored to the individual
Include: cognitive stimulation programmes, multisensory stimulation, music and art therapy, animal-assisted therapy
Managing challenging behaviours e.g. address pain, avoid overcrowding, clear communication
Pharmacological management of VD.
No specific pharmacological management of VD - no evidence aspirin is effective.
Only consider AChE inhibitors or memantine for people with VD + comorbid dementia.
Pathophysiology of Lewy-Body dementia.
Lewy body deposition in:
- substantia nigra
- paralimbic areas
- neocortical areas
Features of Lewy body dementia (LBD).
- progressive cognitive impairment
- fluctuating cognition
- parkinsonism
- visual hallucinations