Revision - Dementia Flashcards
What is vitamin B9?
Folate
What electrolyte derangement can cause metabolic induced dementia?
Sodium
Give 2 endocrine causes of dementia
1) hypothyroidism
2) hyperparathyroidism
What are the 4 key features of Alzheimer’s (mnemonic 4A’s)
1) Amnesia
2) Agnosia
3) Aphasia
4) Apraxia
Give 3 classes of drugs that are used in the mx of Alzheimer’s
1) Acetylcholinesterase inhibitors e.g. donepezil, galantamine, rivastigamine
2) NMDA inhibitor e.g. memantine
3) Antidepressants
Role of NMDA inhibitors (e.g. memantine)?
Blocks excessive glutamate
There are several subtypes of vascular dementia. What is the most common?
Cerebrovascular infarcts
In which type of dementia are they Parkinsonism features?
LBD
What are the 4 core features of LBD?
1) Fluctuating cognition
2) Visual hallucinations
3) REM sleep disorder
4) Parkinsonism
What is the core features of FTD?
Prominent changes in personality and behavior or language difficulties with relative sparing of memory.
Can AChEIs & memantine be used in mx of VaD?
Yes - also focus on CVS risk factors
Lewy bodies are also present in Parkinson’s disease. How does the location of these lewy bodies differ between LBD and Parkinson’s disease?
LBD - widespread
PD - substantia nigra
What drugs are patients with DLB highly sensitive to?
Neuroleptics (i.e. antipsychotics)
What can the use of antipsychotics in LBD lead to?
Can induce or worsen Parkinsonism (as suppress dopamine).
Can lead to NMS.
Can AChEIs be used in mx of LBD?
Yes
What scan can help distinguish LBD from other types of dementia?
Dopamine transporter scan (DaT)
What protein is often deposited in FTD?
Tau protein
What are 4 key clinical signs in FTD?
1) personality & behavioural changes e.g. apathy, disinhibition
2) cognitive decline
3) language impairments
4) motor abnormalities e.g. muscle weakness, dysarthria
What are seen on an EEG in Creutzfeldt-Jakob disease?
Periodic sharp wave complexes
What medications can be used to help control behavioural symptoms in FTD?
Selective serotonin reuptake inhibitors (SSRIs) and antipsychotics (their use must be carefully balanced against side effects).
Note - AChEIs are NOT used in FTD
What area of the brain is most affected by cerebral atrophy in Alzheimer’s?
Median temporal lobes (most responsible for memory)
4 diagnostic features for dementia?
1) no clouding of consciousness
2) disturbance of higher cortical functions
3) deterioration in functioning
4) >6m
In what type of dementia is there a loss of semantic memory?
FTD
How long are motor symptoms present for in parkinson’s disease before onset of cognitive symptoms?
At least 1 year
If cognitive symptoms and Parkinson’s features start within a year of each other (either being present first), what is the condition?
LBD
Which acetylcholinesterase inhibitor (AChEI) can help with hallucinations in LBD?
Rivastigmine
What chart can be used to assess BPSDs?
Behavioural ABC chart
Which is the ONLY antipsychotic licensed for the management of agitation?
Risperidone
Which test is the gold standard for screening and diagnosis for cognitive impairment?
ACE-iii
What 5 domains are tested in ACE-III?
1) attention
2) memory
3) fluency
4) language
5) visuospatial
What score in the ACE-III indicates likely dementia?
< 82/100
REM-sleep disorder is a distinctive feature of DLB.
What may partners of patients report?
Patients and their partners may report violently acting out their dreams as many as 40 years before the onset of the dementia symptoms.
What is seen on a CT head in Alzheimer’s?
Widespread cerebral atrophy, mainly involving the cortex & hippocampus
Which type of dementia is MND associated with?
FTD
What is the most common ophthalmological condition associated with Charles-Bonnet syndrome?
ARMD
What is Charles-Bonnet syndrome characterised by?
Persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness.
This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis)
Risk factors for Charles-Bonnet?
Advanced age
Peripheral visual impairment
Social isolation
Sensory deprivation
Early cognitive impairment
