Dementia Flashcards
What is dementia?
Dementia is a syndrome characterised by an appreciable deterioration in cognition resulting in behavioural problems and impairment in the activities of daily living.
Decline in cognition is extensive, often affecting multiple domains of intellectual functioning.
What is the aetiology of dementia?
The majority of cases of dementia have degenerative and vascular causes. Other causes include infections, inflammatory diseases, neoplasm, toxic insults, metabolic disorders, and trauma.
What are the risk factors for dementia?
Age
Family history
Smoking and alcohol use
Atherosclerosis
Cholesterol
Diabetes
Mild cognitive impairment
Summarise the epidemiology of dementia.
The prevalence of dementia is approximately 1% at the age of 60 years, and doubles every 5 years, to reach 30% to 50% by the age of 85 years.
What are the signs and symptoms of dementia?
The most commonly affected areas include memory, visual-spatial, language, attention and problem solving. Most types of dementia are slow and progressive.
- Agitation
- Depression
- Anxiety
- Abnormal motor behavior
- Elated mood
- Irritability
- Apathy
- Disinhibition and impulsivity
- Delusions (often believing people are stealing from them) or hallucinations
- Changes in sleep or appetite.
What investigations would you do for dementia?
Cognitive testing
Brain MRI or CT- shows degeneration
Bloods- to rule out other causes
What are the main types of dementia?
Alzheimer’s Dementia (50-80%)
Vascular Dementia (20-30%)
Lewy Body Dementia (10-25%)
Frontotemporal Dementia (10-15%)
How does Alzheimer’s Dementia present?
- Gradual progressive onset
- Memory loss, especially for names and recent events
- Language deficits
- Rapid forgetting
- Impaired visuospatial skills
- Normal gait and neuro exam early
- Later affective disturbances; behavioral symptoms such as aggression
How does Alzheimer’s Dementia present on imaging?
- Generalised atrophy (esp. medial temporal)
- Beta amyloid plaques
- Neurofibrillary tangles
How does vascular dementia present?
- Abrupt or gradual onset
- Focal neurological signs
- Signs of vascular disease
How does vascular dementia present on imaging?
- Strokes
- Lacunar infarcts
- White matter lesions
- Vulnerable to cerebrovascular events
How does Lewy Body dementia present?
- Insidious onset, progressive with fluctuations
- Fluctuating cognition
- Visual hallucinations
- Neuroleptic sensitivity
- Shuffling gait
- Increased tone
- Tremors
- Falls
How does Lewy Body dementia present on imaging?
- Generalised atrophy
- Lewy bodies in cortex and midbrain
How does frontotemporal dementia present?
- Insidious onset, typically in 50s-60s, rapid progression
- Disinhibition
- Socially inappropriate behaviour
- Poor judgement
- Apathy, decreased motivation
- Poor executive function
How does frontotemporal dementia present on imaging?
- Frontal and temporal atrophy
- Pick cells and pick bodies in cortex
