Week 4- Dementia - Overview and Epidemiology Flashcards
what is dementia?
“an acquired generalised impairment of
intellect, memory and personality, but with no impairment of
consciousness can affect daily activity”.
or
This is the name given to a group of chronic, progressive, degenerative
organic brain disorders all with a common characteristic: Continuous
deterioration in cognitive function leading to a gradual decrease in
intellectual capacity.
what are the clinical features of dementia?
Features: Impaired memory and poor cognitive function Impaired thinking Disturbed behaviour Lack of insight Lack of spontaneity Poverty of speech Low mood
what are the clinical features of dementia? Impaired memory and poor cognitive function:
forgetfulness poor attention disorientation in time and place agnosia (recognition of objects, people, self) dysphasia (names of things) dyspraxia (understanding commands)
what are the clinical features of dementia? Impaired thinking:
Impaired thinking: Slow Impoverished Incoherent Rigid
what are the clinical features of dementia? disturbed behaviour:
Disturbed behaviour: Disorganised Inappropriate Distracted Restless Antisocial
what is the prevalence of dementia?
It is estimated that more than 850,000 people currently diagnosed with
Dementia in the UK
By 2021, this figure is likely to reach over 1 million people and by 2051 over 2
million
The prevalence increase with age, affecting approximately
• 1 in 1,400 of those aged 40-64
• 1 in 100 of those aged 65 – 69
• 1 in 25 of those aged 70 – 79
• 1 in 6 of those aged 80 years and over
what are some main facts about dementia?
• Two thirds of people living with dementia do so in the community
• Two thirds of care home residents have a diagnosis of dementia
• One quarter of acute hospital beds are occupied by someone with a diagnosis
of dementia
• The Dementia UK report 2014 states that dementia care cost the taxpayer
£26.3 billion per annum
what are the risk factors of dementia?
Older Age Poor Cognitive Performance Low BMI or overweight Slow Physical Performance Not eating your Veg! Lack of alcohol consumption Diabetes Depression and Bipolar apoE4 MRI showing white matter disease Ventricular enlargement Carotid artery thickening History Of bypass surgery
what parts of the population is affected by dementia?
Learning Disabilities- Have a higher risk of suffering from Dementia due to
premature aging. Also increased genetic risk
Parkinson’s
BME- Greater risk of early onset
what is the mortality for dementia?
Survival rate from diagnosis is approx. 5-8 years
In 2017, Deaths where Dementia was mentioned on the death certificate
accounted for 903 deaths per 100,000 population
how many types of dementia are there? how many common ones?
There are over 400 types of dementia. In accordance to DSM-V, the 4 most common are
what are the 4 main types of dementia?
Alzheimer’s disease/ Dementia ~ 50-60% of cases
Vascular disease/Dementia ~ 20-25% of cases
Lewy body disease/Dementia ~15-20% of cases
Frontotemporal lobar degeneration/Frontotemporal Dementia ~ 7% of cases
what are other classifications for dementia?
Traumatic brain injury,
Substance/medication induced, HIV infection, Prion disease,
Parkinson’s disease, Huntington’s disease, due to another medical
condition, mixed aetiologies, unspecified
what are the main clinical features of Alzheimer?
-memory impairment which will have a gradual onset and continuous decline
-may have other dementia
- Aphasia, problems with lanuage and speech
- Apraxia, problems to do familiar movement on command
- Agnosia, loss of ability to recognise faces, voices and places
- Disturbance of executive functioning, struggle to plan and concentrate, problem solving, time management
-Other features may include:
Depression, Psychosis, Behavioural and
Personality Changes
what is the progression and staging of Alzheimer disease, within year 1-3 (early stage) what may the patient experience symptom wise?
-language difficulties
-depression
-losing direction when out and about
-Recent Memory Impairment
and Forgetting Names
-Increased Number of
Accidents whilst Driving
-Impaired Activity
of Daily Living
what is the progression and staging of Alzheimer disease, within year 2-7 (mid stage) what may the patient experience symptom wise?
-aphasia, problems with speaking, typing
-amnesia, memory loss, problems forming new memories
-Inability to bathe,eat,toilet or
dress without assistance
-Inability to calculate
solutions and problem
solve
-Behavioural and
Psychiatric Changes
what is the progression and staging of Alzheimer disease, within year 2-7 (late stage) what may the patient experience symptom wise?
-seizures
-Short and Long Term
Memory Loss
-Double incontinence help when toileting
-Mutism or nonsensical
speech
-Complete
dependence on
others
-Rigid Posture
what is the aetiology of Alzheimer?
Demographic Factors Increasing Age Family History Down Syndrome Genetic Factors Down Syndrome ApoE4 Environmental and Medical Risk Factors Low IQ Previous Head Injury Cerebrovascular disease Depression Diabetes Mellitus Obesity
what is vasular dementia?
2nd most common
Sudden onset followed by a step wise progressive decline
Onset is usually around late 60’s-70’s
Caused by an infarct, generally there is a history of hypertension, stroke and TIA
Approx 10% of people develop Dementia after a first stroke and more than a 1/3 after
recurrent strokes
prevention is the best treatment (good management of blood pressure, diabetes, heart
disease, cholesterol, smoking)
what are the clinical features of vascular dementia?
Emergent of Emotional and Personality changes ( inc Depression), followed by
memory impairment
Apraxia
Agnosia
Dysarthria, muscles used for speech become weak
Dizziness
what are some other focal neurological signs ( which are not present in AD)?
Gait disturbance – in Late VaD there is a shuffling gait which differentiates
from Parkinson’s by it’s broad base and preserved arm swing
Weakness of extremities
Extensor plantar response
Pseudobulbar palsy
Exaggeration of deep tension reflexes
what are some risk factors for vascular dementia?
Family history Male sex Hypertension History of stroke or transient ischaemic attacks (TIAs) Diabetes mellitus (DM) Smoking Atrial fibrillation (AF) Recent studies have shown similar risk factors as for AD
what is Lewy Body dementia? features
Progressive cognitive decline, especially in attention and visuospatial ability
A variant of Klezmers disease, more common in men
Persistent and well-formed visual hallucinations, sometimes auditory
Early gait disturbances
Parkinson’s type features
Other psychotic feature
what are other supportive features of Lewy Body dementia?
Repeated falls Syncope Transient loss of consciousness Systemised delusions Non-visual hallucinations REM sleep behaviour disorder Depression Extremely sensitive to the side-effects of antipsychotics
what is the aetiology of lewy body dementia?
Closely related to Parkinson’s disease and both characterised as
synucleinopathies
Family History
No known environmental risk factors
what is frontotemporal dementia?
Most common form of presenile Dementia
Onset between 45-70 years of age
Frontal lobe pathology responsible for behavioural and personality changes
Temporal lobe pathology responsible for language disorder
what is the onset and progression of frontotemporal dementia?
Insidious onset, slow progression
Early loss of insight
Early signs of disinhibition
Distractibility and impulsivity
what are some language and effective features of frontotemporal dementia?
Language Features Progressive decrease in speech output Echolalia Perseveration Affective Features Depression Apathy Emotional blunting
what is the aeitiology of Frontotemporal Dementia?
Primarily Unknown
Mutations in progranulin (GRN)
TAU- linked to Chromosome 17
TDP-43 and C90RF72 genes
how is the clinical diagnosis and the importance of early diagnosis of dementia?
Reversible/treatable conditions such as pseudo-dementia are detected and
excluded
Patient and family have time to plan for the future
Personal affairs may be put in order while the individual still has insight.
Able to discuss discussions their future care while they still have insight and
agree Advanced Directives for example.
Early access by the person with dementia and their family, to support groups,
e.g. Alzheimer’s disease Society
Treatment that may slow progression of the disease can be more effectively
targeted to the right stage of the disease.
Complete history, including medical, physical and mental state examinations
Review any medicines being taken as those with anticholinergic and sedative
side effects can impact adversely on cognition
Diagnostic criteria from either DSM or ICD have been met
Psychometric tests have been performed
neuroimaging has been performed if possible e.g MRI and CAT scans
what are some investigations for establishing the cause of dementia and potential diagnosis?
Primary Care FBC U and E’s LFT’s CRP Calcium and Phosphate Thyroid Function Vitamin B12 and Folate Urine dipstick Blood Glucose Temperature
In Secondary Care MRI and CT scan Urinalysis HIV status Neuropsychological assessment EEG
what are some clinical screening tools that can be used to diasnose dementia?
Mini-Mental State Examination- MMSE
Abbreviated Mental Test Score-AMTS
Alzheimer’s Disease Assessment Scale- cognitive subscale- ADAS-cog
Addenbrooke’s Cognitive Examination 3 –ACE3 or mini ACE
what is the Mini-Mental State Examination- MMSE?
-most common tool used
MMSE to assess cognitive function and decline
MMSE tests memory, attention, calculation, orientation, language, ability to
follow command and praxis
Primarily used to aid diagnosis of Alzheimer’s and recommended by NICE to
assess the severity of AD and response to Pharmacological treatment
Takes less that 10-15 minutes to perform
8 Questions
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