OPM - Dementia Flashcards
what is the prevalence of dementia
increases proportionally as you age. Doubling every 5 years
what are the 4 main cognitive symptoms of dementia
Amnesia: loss of memory
Aphasia: difficulty with language
Agnosia: inability to recognise objects or people
Apraxia: inability to carry out physical tasks
what are the different types of dementia (9 different types)
Alzheimer’s dementia
Vascular dementia
Dementia with Lewy Bodies
Frontotemporal dementia
Huntington disease dementia
CJD dementia
Parkinson’s disease dementia
Alcoholic dementia
Dementia pugilistica
who is more at risk of alzheimers
females
down syndrome
what genetic risk factors for alzheimers
Presenilin 1 &2, APOE ɛ4, APP
what are some of the main risk factors for alzheimers
age, premorbid IQ, female, lower education, hypertension, diabetes, obesity, hypercholesterolaemia, physical inactivity, smoking
Head trauma
what is the neuropathophysiological of Alzheimer’s
temporo-parietal lobe mainly affected, widening of sulci and narrowing of gyri, ventricular enlargement, senile (amyloid) plaques, neurofibrillary tangles (tau protein)
decrease acetylcholine, noradrenaline and serotonin
atrophy seen on medial temporal lobe
who is most at risk of vascular dementia
men
what are some fo the risk factors of vascular dementia
Hypertension, hypercholesterolaemia, diabetes
what is more common in vascular dementia than vascular dementia
depression and epileptic fits more frequent and common
what are the neuropathophysiology of vascular dementia
multiple large vessel disease-related stroke in critical areas
OR massive small vessel disease (more than ¼ of the total white matter)
OR multiple lacunes in the basal ganglia and frontal white matter, or bilateral thalamic lacunes
who is at risk of lewy body dementia
age 75+
F=M
sporadic and rarely familial - so anyone
what are some of the symptoms of lewy body dementia
parkinsons+
bilateral parkinsons with congitive impairment
what is the neuro pathology of lewy body dementia
lewy bodies in cerebral cortex/substantia nigra, senile plaques, no neurofibrillary tangles
who gets frontotemporal dementia
earlier age of onset 45-65
can be hereditary
memory preserved until late stage
what are some screening tools
Abbreviated Mental Test Score (AMTS)
Mini Mental State Examination (MMSE)
Montreal Cognitive Assessment (MOCA)
General Practitioner Assessment of Cognition (GPCOG)
Addenbrookes Cognitive Examination (ACE-iii)
Cambridge Cognition Examination (CAMCOG)
what are the 10 questions asked in the AMTS.
and at wat level suggests cognitive impairment
Age
Time to the nearest hour
An address to be repeated
Year
Name of hospital / home address
Recognition of two persons
Date of birth
Year WWI started
Name of present monarch
Count backwards from 20 to 1
<7 suggests impairment
what are the 6 areas being assessed in the MMSE and what are the levels for normal and dementia
Orientation
Registration
Attention and calculation
Recall
Language
Visuospatial
27/30: normal
24-26/30: mild impairment
18-24/30: mild dementia
12-18/30: moderate dementia
<12/30: severe dementia
what are the 5 areas being assessed in the ACE-ii and what is the cut-off value
Attention and orientation
Memory
Verbal fluency
Language
Visuospatial
Cut-off 82/100
who normally carries out a neuropsychological assessment
clinical psychologist
what do you need to make a diagnosis of dementia
history
mental state examination
Physical Examination
Cognitive Examination
what investigations can be done for dementia and what is the gold standard
Dementia bloods screen: FBC, U&Es, TFT, LFT, blood glucose, folate, vitamin B12, calcium
Urine MC&S
Neuroimaging: CT, MRI, DAT scan, SPECT
Neuropsychological testing
Gold standard is autopsy
what are the DVLA rules for driving with dementia
DVLA must be informed
early stages - can have a 1 year licence
Most cant drive
taxi/lorry - NO driving
which dementia drug has possible shown signs of treating the illness
risperidone
risperidone is what type of drug
antipsyhchotic
what class of drug teds to be given for mild-moderate AD
chiolinesterase inhibitors
what are 2 examples of cholinesterase inhibitors
Donepezil
Rivastigmine
Galantamine
what class of drug (and example) is given for moderate-severe AD
NMDA antagonist
memantine
what other (non treatment) drugs can be given for symptoms
Benzodiazepines
Anticonvulsants, antidepressants
what do cholinesterase inhibitors do
stop breakdown of acetylcholine
what are side effects of cholinesterase inhibitors
Nausea, vomiting, diarrhoea, dizziness, headache, muscle cramps
who needs to use cholinesterase inhibitors with caution
Use with caution in gastric ulcer, heart disease, COPD
how does memantine work
Blocks the pathological effects of abnormal glutamate release
what are the side effects of memantine
headaches and dizziness
who needs to avoid memantine
people with kidney disease and seizure disorders
how long can you take risperidone
12 week corses
