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Dementia > Overview and Types of Dementia > Flashcards

Overview and Types of Dementia Flashcards

1
Q

Define dementia.

A

It is a broad term for organic brain disorders that are characterised as being chronic, progressive and degenerative with a decline in cognitive function.

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2
Q

Provide an overview of symptoms in dementia.

A

Impaired memory and poor cognitive function
Impaired thinking with slow, impoverished, incoherent and rigid ideas with the inability to abstract new ideas (link to capacity to consent)
Behavioural changes
Lack of insight
Poverty of speech - very vague and empty
Low mood

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3
Q

What are some of the symptoms of memory loss and cognitive decline in patients with dementia?

A

Forgetfulness
Poor attention span
Becoming disorientated with the time and place
Agnosia - inability of the patient to recognise people, objects, themselves
Suffering from dysphasia - impairment to the production of speech
Suffering from dyspraxia - difficulty performing co-ordinated movement

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4
Q

What are some of the behavioural symptoms of dementia?

A

Disorganisation
Inappropriateness
Distracted
Restless
Anti-social

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5
Q

What is the prevalence of dementia?

A

850,000 currently diagnosed in the UK
however with an aging population it is projected to reach 2 million in the UK by 2051.

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6
Q

What is the prevalence of dementia from 40 to 80 year olds?

A

1 in 1400 people are affected aged between 40-64 years
1 in 100 people are affected aged between 65-69 years
1 in 25 people are affected aged between 70-79 years
1 in 6 people are affected aged over 80 years

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7
Q

What are some of the statistics regarding Dementia?

A

Dementia patients consist of 2/3 patients within a care home
2/3 of all patients with dementia live in the community
Dementia patients occupy 1/4 hospital beds
They cost £26.3 billion to the taxpayer each year, higher than the cost of CVD and Cancer. This would be higher if it wasn’t for carers.

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8
Q

What are the risk factors for dementia?

A

Older age
Poor cognitive performance/lower IQ
Low BMI or being overweight especially in middle age
Slow physical performance
Not having a high consumption of vegetables within the diet
Lack of alcohol consumption
Diabetes melluitis
Depression/Bipolar
apoE4
Having an MRI that shows white matter disease
Ventricular enlargement
Carotid artery thickening
History of bypass surgery

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9
Q

Which specific risk factors from the above are associated with Alzheimer’s dementia?

A

Not having a high consumption of vegetables within the diet
Lack of alcohol consumption
Diabetes melluitis

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10
Q

In which specific demographics is dementia more prevalent?

A

-In those with learning difficulties such as Down syndrome patients where there is premature aging
-Parkinson’s patients have a higher risk
- In Black and Minority Ethnic groups contribute about 25,000 cases of dementia, with 6.1% having early onset compared to 2.2% of the rest of the UK population.

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11
Q

Why might BME have a higher prevalence of dementia compared to other ethnicities?

A

ApoE is not protective in BME compared to Caucasian population.

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12
Q

What is the incidence of mortality in patients with dementia?

A

In 2017 903 per 100,00 of the population
Patients usually live with dementia for 5-8 years.

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13
Q

How many different types of dementia is there?

A

Over 400 different types

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14
Q

What are the most common types of dementia?

A

Alzheimer’s (50-60%)
Vascular disease (20-25%)
Lewy body disease (15-20%)
Frontal temporal lobar degeneration (7%)

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15
Q

What are some other types of dementia?

A

HIV
Parkinson’s
Huntingdon’s
Traumatic brain injury
Prion disease
Substance/medication induced

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16
Q

What is the characteristic presentation of Alzheimer’s disease?

A

There is a gradual onset with continual decline of symptoms/clinical presentation
Aphasias - language and speech
Apraxia - movements on command (responding to speech)
Agnosia - loss of recognition of face/objects etc
Disturbance of executive function

Other symptoms include depression, psychosis, behavioural and personality changes

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17
Q

What symptoms may a patient with Alzheimer’s in the early stages demonstrate?

A

This is usually within years 1-3:
Language difficulties
Depression - patients are usually screened for this during diagnosis
Losing direction when out and about
Recent memory impairment/forgetting names
Driving accidents
ADLs

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18
Q

What symptoms may a patient with Alzheimer’s in the mild stages demonstrate?

A

This is usually within years 2-7:
Aphasia
Amnesia - memory loss
Inability to bathe, eat, go to the toilet or dress without assistance
Inability to calculate solutions/problem solve
Behavioural or psychiatric changes

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19
Q

What symptoms may a patient with Alzheimer’s in the late stages demonstrate?

A

This is usually after 7 years:
Seizures become more likely
Short and long-term memory loss
Double incontinence
Mutism/non-sensical speech
Dependence upon others
Rigid posture

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20
Q

What are the subdivisions that the aetiology of Alzheimer’s can be put into?

A

Demographic
Genetic
Environmental/Medical

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21
Q

What are the demographic aetiologies of Alzheimer’s?

A

Increasing age
Down syndrome
Family history

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22
Q

What are the genetic aetiologies of Alzheimer’s?

A

Down syndrome
ApoE4

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23
Q

What are the environmental/medical aetiologies of Alzheimer’s?

A

CVA
Low IQ
Previous head injury
Depression
DM
Obesity

24
Q

How do symptoms present in vascular dementia?

A

Unlike Alzheimer’s they have a sudden onset with a progressive decline.

25
Q

At what age does vascular dementia usually occur?

A

Between late 60s and 70s

26
Q

What are the causes of vascular dementia?

A

Caused by an infarct and therefore at risk following a stroke, TIA or have high blood pressure.
10% of cases develop after a stroke and 1/3 after recurrent strokes

27
Q

What is the best treatment for vascular dementia?

A

Prevention and therefore managing and controlling:
DM
Hypertension
Ischaemic heart disease
Cholesterol

All conditions like to predispose infarct formation/strokes/TIAs

28
Q

What are the features of vascular dementia?

A

Emergence of emotional and personality changes including depression and memory impairment
Apraxia
Agnosia
Dysarthria (difficulty speaking due to weak muscles)
Dizziness

29
Q

What are some of the focal neurological disturbances in vascular dementia?

A

Gait disturbances - shuffling gait which differs from Parkinson’s/Parkinsonism’s where there is a broad base and preserved arm swinging
- Weakness of extremities
- Extensor plantar response
- Pseudobulbar palsy
- Exaggeration of deep tension reflexes

30
Q

What is the aetiology of vascular dementia?

A

Family history
Males
Hypertension
History of strokes and TIA
Diabetes melluitis
Smoking
Atrial fibrillation
Some studies similar to Alzheimer’s disease

31
Q

How do symptoms present in Lewy body dementia?

A

There is progressive cognitive decline in relation to attention and visuospatial ability

32
Q

Is Lewy body dementia more common in males or females?

A

As a derivative of Klezemers disease?, it is more common in men

33
Q

What are the main symptoms of Lewy body dementia?

A

Persistent/well formed visual and auditory hallucinations
Early gait disturbances
Parkinson’s type features
Other psychotic features

34
Q

What are some of the other symptoms of Lewy body dementia?

A

Repeated falls
Syncope - fainting
Transient loss of consciousness
Systematic delusions
Non-visual hallucinations
REM sleep behaviour disorders
Depression
Sensitive to side effects of anti-psychotics

35
Q

What is the underlying aetiology of Lewy body dementia?

A

Related to Parkinson’s - Synucleinopathies
Family history
No environmental risks

36
Q

What does synucleinopathies mean?

A

Synucleinopathies are a subgroup of neurodegenerative diseases, characterised by impairment of alpha-synuclein (αSyn) metabolism, producing abnormal intracellular deposits

37
Q

What is the characteristic appearance of Frontotemporal dementia?

A

Insidious in onset but has slow progression
There is an early loss of insight
Early signs of disinhibition
Patient appears distracted, impulsive

38
Q

What changes to language do patients with frontotemporal dementia experience?

A

Decreased speech output
Echolalia - repeating phases back
Preservation

39
Q

Which affective features do patients with frontotemporal dementia experience?

A

Depression
Apathy
Emotional blunting

40
Q

Which genes may be linked to the underlying pathophysiology of frontotemporal dementia?

A

Progranulin (GRN)
TAU-linked to chromosome 17
TDP-43
C9ORF72

41
Q

Why is getting an early diagnosis of dementia so important?

A

Any reversible/treatable conditions such as pseudo-dementia is detected and reversed
For the patient and family to get as much time together to make memories with the awareness that there will come a time they are no longer able to
To sort out affairs such as Power of Attorney and personal affairs
Plan for future care
Join support groups
To start treatment to slow the progression of the disease

42
Q

What is involved in the diagnosis of dementia patients?

A

They will undergo medical, physical and mental state examinations
However any medications the patient may be taking causing anticholinergic side effects must be taken into consideration due to affecting cognition
DSM, ICD tests
Other psychometric tests
Neuroimaging - MRI/CAT to establish type and progression of disease

43
Q

Which investigations will be undertaken in primary care in the diagnosis of dementia?

A

FBC
U & E
LFT
CRP
Calcium and phosphate
Thyroid function
Vitamin B12 and folate
Urine dipstick
Blood glucose
Temperature

Helps to establish cause or any potential differential diagnosis

44
Q

What is the purpose of conducting FBC and urine dipstick in the diagnosis of Alzheimer’s disease?

A

Elderly are more prone to infections especially chest infections and UTIs, and this can often cause confusion, so it is effective in establishing a differential diagnosis.
CRP and temperature can also indicate infection.

45
Q

What is the purpose of measuring blood glucose in the diagnosis of Alzheimer’s?

A

Again as a differential diagnosis, hypoglycaemia can cause the presentation of a confused state.

46
Q

What is the purpose of measuring LFTs in the diagnosis of Alzheimer’s?

A

Explanation of confusion may be linked to hepatic encephalopathy or alcohol withdrawal. Changes in LFTs can link to chronic alcohol abuse.

47
Q

What is the purpose of measuring thyroid function in the diagnosis of Alzheimer’s disease?

A

Confusion could be precipitated by hypothyroidism.

48
Q

Which investigations may be undertaken in secondary care in the diagnosing dementia?

A

MRI/CAT
Urinalysis
HIV status
Neuropsychological assessment
EEG

49
Q

Which other type of dementia may be indicated upon conducting a CT scan?

A

Vascular dementia which demonstrates evidence of an infarct or haemorrhage

50
Q

List the four screening tools used in the diagnosis of dementia.

A

Mini-mental state examination
Abbreviated mental test score
Alzheimer’s disease assessment scale
Addenbrooke’s cognitive examination 3 (readily available)

51
Q

Benefits of using the abbreviated mental test score?

A

Used to measure the extent of cognitive decline
Quick to perform - under four minutes
A score of 7 or less suggests impairment

52
Q

What does the mini-mental state examination test?

A

Memory
Attention
Calculation
Orientation
Language
Ability to follow commands
Praxis (naming common objects)

Takes only 10-15 minutes

53
Q

What is the MMSE used to assess?

A

Cognitive function and cognitive decline
Used to determine severity of Alzheimer’s disease
It can be used to assess response to pharmacological treatment

54
Q

When is MMSE appropriate/inappropriate to use?

A

This can be defined in terms of sensitivity
MMSE is less sensitive in the early stages of dementia especially in those with higher intellect
And is not possible to use in the late stages of disease

However is sensitive to cholinergic drugs such as anticholinesterases

55
Q

Aside from sensitivities what other limitations does the MMSE have?

A

Relies on the prior ability of the patient (low IQ)
Patients may score lower if English isn’t their first language

56
Q

What is the format for the MMSE?

A

8 questions and patients receive an overall score out of 30

57
Q

How do scores of MMSE correlate to severity of dementia?

A

27-30 Normal
25-27 Mild impairment
21-26 Mild Alzheimer’s can commence treatment
10-20 Moderate Alzheimer’s
10-14 Moderate to Severe Alzheimer’s
<10 Severe Alzheimer’s

Dementia (3 decks)

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