The clinical aspects of dementia and its effects on patients Flashcards
what are the features of dementia
intellectual function and memory loss
deterioration in ADL
social behaviour change
a syndrome, not a specific disease
there is no single diagnostic test or biomarker
no treatment to alter the course of disease
what are the neuropsychological features of dementia
amnesia
aphasia
agnosia
apraxia
what are the neuropsychiatric features of dementia
behavioural and psychological symptoms
what is the function of the frontal lobes
sequencing and fluency
emotional expression, problem solving, memory, language, judgment, and sexual behavior. personality and communication.
what is the function of the temporal lobes
language, memory, speech and auditory
how do you test function in the temporal lobes
address test, object recall, serial 7s
how do you test function in the frontal lobes
Luria hand sequencing task
Verbal fluency 1 minute words F,A, S, animals
what is the function of the parietal lobes
spatial awareness, language, integration of sensory information
how do you test function in the parietal lobes
clock face
name objects
draw a cube
agnosia (inability to recognise things)
what are the features of the addenbrookes cognitive exam
20 mins score out of 100 reliable multidomain available on iPad
how long does it take for the patient to notice symptoms after the beginning of pathological changes to the brain
15-30 years
what is T1 to T4
1- earliest possible diagnosis if we develop biomarker tests
2- earliest possible diagnosis using current technology
3- timely diagnosis
4- late stage diagnosis
what is mild cognitive impairment
subjective memory impairment not meeting dementia diagnostic criteria and no impact on activities of daily living
may develop into dementia but recovery is also possible
how can early diagnosis of alzheimers be useful
detection and treatment slow rate of disease progression at a preclinical stage and will have a greater disease modifying effect than targeting patients with MCI
could be with biomarkers of neuroimaging
what is perfusion SPECT
single photon emission computed tomography
images variations in regional cerebral blood flow which displays characteristic abnormalities in early AD
what is FDG-PET
fluoro deoxyglucose positron emission tomography
uptake of FDG proportional to cerebral glucose metabolism
what is amyloid imaging
beta amyloid is a normal product of cell metabolism
overproduction and insufficient clearance of beta amyloid is responsible for accumulation of plaques of beta amyloid
what is Pittsburgh compound B positron emission tomography
binds to beta amyloid allowing imaging of beta amyloid burden
good for early detection
can detect response to treatments
what CSF markers are being investigated for diagnosis and management of Alzheimer’s
amyloid beta
total tau
phosphorylated tau
not currently useful
what drugs are currently available for mild and moderate Alzheimer’s
donepezil
galatamine
rivastigmine
what drug is used to manage moderate and severe alzeimers
memantine
what symptoms are included in BPSD
hallucinations delusions misidentifications depression anxiety apathy elation disinhibition irritability aggression agitation sleep disturbances stereotypies hyperorality eating disturbance hypersexuality
likely to be one of the most problematic aspects for patients and carers
What are the features of DLB
cognitive decline fluctuations in attention and alertness visual hallucinations motor features of parkinsons transient LOC
what is young onset dementia
30-64 years old
what are the features of frontotemporal dementia
behavioural disorder loss of personal and social awareness disinhibition stereotyped behaviour mood disorder speech disorder before 65 positive family history reduced empathy impulsivity poor self care preserved memory
what are the features of vascular dementia
- problems with planning or organising, making decisions or solving problems
- difficulties following a series of steps
- slower speed of thought
- problems concentrating, short periods of sudden confusion.
- memory
- language - eg speech may become less fluent
- visuospatial skills - problems perceiving objects in three dimensions.
what are the features of a dementia assessment
patient interview
cognitive examination
interview with relative or carer
clinical investigations- blood, biochemical, radiological
specialist assesments (psychometric assessment, occupational therapy, speech and language, neurological, geriatrics)
diagnostic confirmation
