Psychiatry: Dementia Flashcards
Alzheimers disease, Parkinson’s disease and Lewy body all types of what
Degenerative forms of dementia
What are the key features of Alzheimers (name the additional ones if you can)
Agnosia - difficulty recognising objects, people, sounds
Apraxia - difficulty using objects
Amnesia - memory loss, first short term memory of time
Aphasia - expressive (Brocas) or receptive (wernicke’s), lexical anomia (word finding difficulty)
Associated behaviours: labile mood, irritable, sexually disinhibited, incontinence, depression, disorientation, personality change
Also Hallucinations + Delusions
What are the early signs of Alzheimers disease
Forgetfulness
Disorientation in self
Change in behaviour e.g. wandering
What are the key features on an Alzheimers MRI
Cortical atrophy (parietal and temporal), B-amyloid plaques and NFT in cortex
What are the MMSE ranges for Alzheimers Disease
Mild = 21-16
Mod = 20-10
Severe < 10
What is the clinical course of Alzheimers
Gradual and progressive
How does early onset Alzheimer’s differ from normal
Early onset < 65yo
Rapid and severe detrioration in cognition with severe apraxia and agnosia
Poor prognosis
What are the 6 RF for poor prognosis in Alzheimer’s
Male Age < 65yo Parietal lobe damage Severe focal deficit e.g. apraxia Observed depression Prominent behavioural problems
What is the 1st line treatment for Alzheimers (mild-mod)
Mild-moderate
- ACHe-i (increase Ach in cortex)
- Donepazil, rivastigmine, galantamine
What is 2nd line for Alzheimers (mod-sev)
Mod-severe
2. NMDA receptor antagonist, Memantine
What are the three most common types of dementia
- Alzheimers
- Vascular
- Lewy Body
What is LB dementia
Degenerative, mixed-type dementia
- LB deposits within the basal ganglia of the midbrain a/w neuronal change (decrease in Ach transmission) and vascular changes (30%)
In what demographic does LB occur
50-83yo, M>F
What are the cardinal symptoms of LB dementia
What are the other symptoms
- Parkinsonism
- Fluctuating cognition and consciousness (mute and unresponsive for periods)
- Hallucinations and delusions
Depression, falls and syncope, Antipsychotic sensitivity
What are the main treatment options for LB
- ACHe-i = donepazil, rivastigmine, galantine
2. clonezapm = for sleeping difficulties
What should you be absolutely cautious with when treating LB dementia
DO NOT GIVE A/P drugs!! They will cause:
- Permanent parkinsonism
- Neuroleptic malignant syndrome
- increase risk of mortality
What should you be absolutely cautious with when treating LB dementia
DO NOT GIVE A/P drugs due to A/P sensitivity!! They will cause:
- Permanent parkinsonism
- Neuroleptic malignant syndrome
- increase risk of mortality
What are the causes
Thromboembolic events or infarcts of s/m cerebral vessels
Which demographic are at particular risk of Alzheimers
Down syndrome - chr.21 holds gene for B-amyloid plaques
What is the clinical course of LB dementia
Gradual and progressive with fluctuating cognition and consciousness
What are the three clinical syndromes of vascular dementia
- Cognitive impairment following single stroke
- Multiple infarct dementia (MID)
- Binswanger disease (progressive small vessel disease)
Explain the pathology and symptoms of MID
multiple strokes cause step-wise deterioration of cognition
Period between strokes are stable
What is the region of the brain associated with the highest risk of vascular dementia following a single stroke
Mid brain and thalamic region
Explain the pathology and symptoms of Binswanger disease
multiple micro-vascular infarcts perforate vessels in brain –> white matter changes and lacunae formation
Gradual and progressive deterioration in cognitive function, psychomotor retardation and motor dysfunction
