Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia Flashcards
what are the 3 elements of the biological diagnosis of alzheimers disease
ATN
amyloid beta deposition
pathological Tau
Neurodegeneration
*premature to use in general medical practice
should you use amyloid or tau imaging to assess people without memory decline
no, not outside research setting (as presence of these factors is of uncertain significance)
what imaging technique is recommended to investigate VASCULAR cognitive impairment
MRI > CT
what tools are recommended for the diagnosis of vascular mild cognitive impairment and vascular dementia
use of STANDARDIZED criteria
i.e one of:
Vascular Behavioural and Cognitive Disorders Society criteria (VAS-COG)
DSM 5
Vascular Impairment of Cognition Classification Consensus Study
or American Heart Assoc consensus statement
why should you treat HTN
treatment of HTN may reduce the risk of dementia and thus clinicians should assess, diagnose and treat HTN according to HTN Canada guidelines
which patients should be treated with antihypertensives
those with cognitive disorders in which vascular contribution is known or suspected–> if avg. diastolic is at or above 90mmHG and /or systolic at or above 140mmHG
is the use of aspirin recommended for patients with MCI or dementia who have brain imaging evidence of covert white matter lesions of presumed vascular origin without history of stroke or infarcts
no
are cholinesterase inhibitors or memantine recommended for treatment of vascular cognitive impairment
may be considered in selected patients
is cognitive screening recommended in asymptomatic patients
no
list risk factors for cognitive disorders
- late onset depressive disorder or lifetime history of MDD
- untreated sleep apnea
- hx stroke or TIA
- unstable metabolic or CV morbidity
- a recent episode of delirium
- first major psychiatric episode at an advanced age (i.e psychosis, anxiety, depression)
- recent head injury
- parkinsons disease
what rapid, objective assessments of cognitive function are recommended by the guidelines
- Memory Impairment Screen (MIS) + clock drawing test
- the Mini-Cog
- the AD8
- the four item version of the MoCA
- GP Assessment of Cognition (GPCOG)
what are the four items included on the four item MoCA
clock drawing
tap at letter A
delayed recall
orientation
what is the most widely used cognitive assessment instrument
MMSE
has high sensitivity and specificity for separating moderate dementia from normal cognition
what is a weakness of the MMSE
lacks sensitivity for the diagnosis of mild dementia or MCI
why might you use the MoCA over the MMSE
more sensitive to MCI
use when MCI is suspected or when there is suspicion for cognitive impairment or concern about patients cognitive status but the MMSE score is within normal range
what is the normal range on the MMSE
24+/30
what are the more comprehensive psychometric screening tools listed in the guidelines
Modified Mini Mental State (3MS) exam
MMSE
Rowland University dementia assessment scale (RUDAS)
name an example of a longitudinal series cognitive assessment
QuoCo curves
what is a questionnaire a caregiver or informant could fill out about dementia in a patient
AD-8
IQCODE (informant questionnaire on cognitive decline)
what tools can be used to assess BPSD in a patient if a behavioural, personality or mood change has been observed
short version of the Neuropsychiatric Inventory (NPI-Q)
Mild Behavioural Impairment Checklist (MBI-C)
(or PHQ-9 if mood change)
what are 2 tools that can be used for rapid screening of functional autonomy in suspected dementia
the Pfeffer Functional Activities Questionnaire (FAQ)
or the Disability Assessment for Dementia (DAD)
can diagnosis of MCI or dementia be made solely on impaired result on cognitive screening tests
no it shouldnt be
in which disorders might the DCQ be particularly helpful
behavioural variant FTD
primary progressive aphasia
alzheimers disease variants
as it is based on updated criteria for atypical syndromes like these –> MMSE, MoCA were not designed for screening for atypical syndromes and are often not sufficient to capture subtle cognitive and social cognition changes associated with atypical dementia
why is getting corroborative history essential when someone has subjective concerns about their cognition
has prognostic significance
what is recommended as one of the primary tools for tracking cognitive response and change over time
folstein’s MMSE
*has been used in several clinical trials of cholinesterase inhibitors
what is one major determinant of hospitalization or nursing home placement for patients with dementia
caregiver burnout
should be regularly assessed in followup of patients with dementia
what is a structured scale to measure caregiver burnout
Zarit Burden Interview
is MRI or CT preferred? why?
MRI–> higher sensitivity to some vascular lesions as well as for some subtypes of dementia and rarer conditions
what should you look for on CT when assessing dementia
hippocampal atrophy
should you do CT or non contrast CT when assessing dementia
non con
what type of imaging can be helpful in assessing/diagnosing cognitive imapirment linked to Lewy Body Disease
SPECT scan (where diagnosis is suspect but remains unclear)
consider PET scan first due to cost
what motor marker is suggestive of future dementia
slower gait speed
when slow gait speed + cognitive impairment the risk is higher
by how much does parkinsonism increase risk of developing dementia
up to 3x
what are two other factors associated with development of dementia
sleep disturbance
hearing impairment
–> should assess both of these in primary clinics as dementia risk factor
(insufficient evidence to support assessment of vision as dementia risk)
what diet is recommended to decrease risk of cognitive decline
mediterranean
what type of exercise interventions have been shown to improve cognitive outcomes in older adults
dance
mind body (ie yoga, qi gong)
aerobic and/or resistance exercise
how does OSA affect risk of dementia
treatment with CPAP in presence of OSA may improve cognition and decrease risk of dementia
for those on a cholinesteras inhibitor for alzheimers, parkinsons dementia, lewy body or vascular dementia for MORE THAN 12 months, when should you consider discontinuation of the medication
when:
1. there has been a CLINICALLY MEANINGFUL WORSENING of dementia as reflected by changes in cognition, functioning, global ax over the past 6 MONTHS in absence of other medical condition or enviro factors
- NO clinically meaningful benefit was observed at any time during treatment
- person has severe or end stage dementia
- development of intolerable side effects
- medication adherence is poor and precludes safe ongoing use of meds
**this is the same for deprescription of memantine in those taking for same indications
should you prescribe cholinesterase inhibitors for frontotemporal dementia or other neuro-degenerative conditions
these should be discontinued
*same for memantine
