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Y4 Acute Care > Dementia > Flashcards

Dementia Flashcards

1
Q

What is Dementia?

A

Neurodegenerative syndrome w progressive decline in several cognitive domains

(Memory / Concentration / Language / Learning etc)

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2
Q

How is a diagnosis of dementia made? (4 things)

A
  1. History
  2. Cognitive testing
  3. Examination
  4. Medication review
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3
Q

What are the Key Features of the History needed for diagnosing Dementia? (5 things)

A
  1. Patient History
  2. Collateral History
  3. Timeline of decline
  4. Cognitive domains affected
  5. Non-cognitive symptoms
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4
Q

What Non-Cognitive symptoms suggest LATE disease dementia? (3 things)

A
  1. Agitation
  2. Aggression
  3. Apathy (lack of interest / enthusiasm)
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5
Q

What Cognitive Testing should you do for sus Dementia pt? (3 things)

A
  1. AMTS (Dementia screen test)
  2. Function and language tests
  3. Mental State Examination (to identify anxiety / depression / hallucinations)
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6
Q

What does Examination help identify in sus Dementia? (3 things)

A
  1. Physical causes
  2. Risk factors (e.g for Vascular dementia)
  3. Parkinsonism
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7
Q

What is the use of Medication Review in sus Dementia?

A

To exclude drug-induced cognitive impairment

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8
Q

What investigations should you do for sus Dementia? (4 things)

A
  1. Look for Reversible / Organic causes
  2. PET / SPECT
  3. EEG
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9
Q

What investigation can you do for other causes of Dementia? (8 things)

A
  1. FBC - anaemia
  2. ESR & CRP - infection / vasculitis
  3. T4 and TSH - hypothyroidism
  4. U&Es - renal failure / electrolyte disturbances (high / low Ca)
  5. B12 / B9 (folate) - vitamin deficiencies
  6. LFT – alcohol related / encephalopathy
  7. Coagulation screen + Albumin - assess liver function
  8. Glucose
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10
Q

What will an MRI show you in sus Dementia? (3 things)

A
  1. Underlying vascular damage
  2. Structural pathology
  3. Identifies other reveresible pathologies:
  • Subdural haematomas
  • Normal-pressure Hydrocephalus
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11
Q

What scan should you do when Dementia diagnosis is unclear / to confirm subtype?

A

PET / SPECT

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12
Q

When should you do a EEG for sus Dementia? (4 things)

A

When sus:

  1. Delirium
  2. Frontotemporal Dementia
  3. CJD (degenerative brain disorder that leads to dementia)
  4. Seizure disorder
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13
Q

What are the Subtypes of Dementia? (4 things)

A
  1. Alzheimer’s disease (AD)
  2. Vascular dementia
  3. Lewy body dementia
  4. Fronto-temporal dementia
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14
Q

What are the causes of Dementia? (8 things)

A

Diabetes

Ethanol

Medication

Environment (CO poisoning)

Nutritional

Trauma

Infection

Alzheimer’s (most common cause)

DEMENTIA

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15
Q

What are the CF of Dementia? (7 things)

A
  1. Memory loss / can’t retain new info
  2. Language impairment
  3. Concentration loss
  4. Poor judgment
  5. Apraxia (inabilty to perform an action)
  6. Behavioural disturbance
  7. Personality change
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16
Q

What is the pathophysiological steps of Alzheimer’s? (2 + 5 things)

A
  1. Amyloid Precusor Protein (APP) degrades into –> Beta-Amyloid Peptide
  2. Beta-Amyloid Peptide accum results in:
    1. Progressive neuronal damage (cortex + hippocampus)
    2. Neurofibrillary tangles
    3. Beh Amyloid plaques
    4. Loss of ACh
    5. Vascular Fx
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17
Q

What are the parts of the brain most vulnerable to neuronal loss in Alzheimer’s? (4 things)

A
  1. Hippocampus
  2. Amygdala
  3. Temporal neocortex
  4. Subcortical nuclei
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18
Q

What are the Risk Factors for Alzheimer’s? (5 things)

A
  1. Age (60+, risk doubles every 5 yrs)
  2. FHx
  3. Down’s syndrome (inevitable) (40 yrs old +)
  4. Apolipoprotein-E e4 alleles
  • ApoE usually breaks down B-amyloid, but the ApoE-e4 allele version is less effective
    1. Vascular (HTN / Diabetes / AF)
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19
Q

What are the MACROSCOPIC pathological changes in Alzheimer’s?

A

Widespread cerebral atrophy (esp cortex + hippocampus)

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20
Q

What are the MIROSCOPIC pathological changes in Alzheimer’s? (2 things)

A
  1. Amyloid plaques
  2. Neurofibrillary tangles (bc abn aggregation of Tau prot)
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21
Q

What investigations should you do for sus Alzheimer’s?

A
  1. CT / MRI
  2. MMSE
  3. Neuropsychological testing (to confirm cogn imp)
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22
Q

What’s the use of a CT / MRI in sus Alzheimer’s? (2 things)

A
  1. To check for Cerebral atrophy (esp Cortex + Atrophy) = AD
  2. To exclude other dementia causes
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23
Q

What medications can you give for MILD - MODERATE Alzheimer’s?

A

AcetylcholinEsterase inhibitors (Donepezil / Rivastigmine / Galantamine)

24
Q

What medications can you give for MODERATE - SEVERE Alzheimer’s?

A

NMDA receptor antagonist (Memantine)

25
Q

What is Vascular Dementia? (2 things)

A
  1. 2nd most common cause of dementia
  2. Results from cerebrovascular events / chronic ischaemia
26
Q

What are the main subtypes of Vascular Dementia? (3 things)

A
  1. Stroke related VD (multi/single infarct dementia)
  2. Subcortical VD (caused by small vessel disease)
  3. Mixed dementia (VD + AD)
27
Q

What is the speed of onset / deterioration in Vascular Dementia?

A
  • Sudden onset
  • Step-wise deterioration
28
Q

What are the risk factors for Vascular Dementia? (6 things)

A
  1. Stroke / TIA Hx
  2. AF
  3. Smoking
  4. HTN
  5. DM
  6. Hyperlipidaemia
29
Q

What are the causes of Vascular Dementia? (4 things)

A
  1. Cerebral artery atherosclerosis
  2. Carotid artery embolization
  3. Chronic HTN –> Cerebral arterioles sclerosis
  4. Vasculitis
30
Q

What do the CF of Vascular Dementia depend on?

A

Area of brain that’s damaged

31
Q

What are the CF of Vascular Dementia where the FRONTAL part of the brain is affected?

A

Executive dysfunction (frontal)

(attention, problem solving, creativity, emotional regulation)

32
Q

What are the CF of Vascular Dementia where the LEFT PARIETAL part of the brain is affected? (3 things)

A
  1. Aphasia (language / speech problem)
  2. Apraxia (inability to perform an action)
  3. Agnosia (can’t recognise objects / faces / voices)
33
Q

What are the CF of Vascular Dementia where the RIGHT PARIETAL part of the brain is affected? (3 things)

A
  1. Hemineglect (neglecting one side) (see pic) (+ will only draw half a clock like in The Good Doctor)
  2. Confusion
  3. Agitation
34
Q

What are the CF of Vascular Dementia where the TEMPORAL part of the brain is affected? (3 things)

A

Anterograde amnesia (unable to create new memories)

35
Q

What CF will you have in Vascular Dementia caused by SUBCORTICAL infarcts? (5 things)

A
  1. Personality / mood changes
  2. Mild memory deficit
  3. Gait disturbance
  4. Urinary frequency / urgency
  5. Improvements occur between cerebrovascular events
36
Q

What investigations should you do for Vascular Dementia? (2 things)

A
  1. MRI / CT scan
  2. Neuropsychological testing
37
Q

What might you see on a MRI / CT scan of Vascular Dementia? (2 things)

A
  1. Cortical / Subcortical infarcts
  2. White matter changes
38
Q

What investigations should you do after you see a infarct on a MRI / CT of Vascular Dementia? (4 things)

What will these investigations reveal?

A
  1. Carotid Doppler US - Reveal carotid plaques
  2. Echocardiogram - Reveal cardiogenic emboli
  3. ECG - Reveal arrhythmias
  4. Risk factor screening

(investigations to find the cause of the infarct)

39
Q

How does Vascular Dementia compare to Alzheimer’s in Neuropsychological Testing?

A
  • Similar: Language / Memory deficits
  • Vascular has MORE impared executive functioning
40
Q

What is the aim of treatment in Vascular Dementia? (2 things)

A
  1. Mainly symptomatic
  2. Addressing CVS problems and slowing progression
  • Anti-HTN drugs / anti-diabetic drugs / statins / antiplatelet drugs
41
Q

When should AcetylcholinEsterase Inhibitors and Memantine ONLY be considered for Vascular Dementia?

A

When they have comorbid Alzheimer’s

If they dont have AD, DON’T give dem da drugs

42
Q

What is Lewy Body Dementia?

A

Is a cause of Dementia characterised by Lewy bodies in Substantia Nigra + Paralimbic + Neocortical areas (–> cause damage to nerve cells)

43
Q

What are the CF of Lew Body Dementia? (3 things)

A
  1. Progressive + Fluctuating Cognitive Impairment
  2. Visual hallucinations
  3. Parkinsonism (late)
44
Q

How is are the CF of Lewy Body Dementia different to other types of Dementia? (2 things)

A
  1. Has early impairments in Attention + Executive Function not just memory loss like in AD
  2. Cognition may be fluctuating (unlike other types of Dementia)
45
Q

What investigations should you do for sus Lewy Body Dementia? (4 things)

A
  1. SPECT scan (90% sensitivity) (increasingly used)
  2. Neuropsychological Testing
  3. MMSE
  4. (Post-autopsy brain biopsy after death to see Lewy Bodies in cortical neurons)
46
Q

What medications can you give for Lewy Body Dementia? (2 things)

A
  1. AcetylcholinEsterase Inhibitors + Memantine (like for AD) –> for Cognitive symptoms
  2. Dopamine analogue –> for Motor symptoms
47
Q

What medications SHOULD YOU NOT GIVE for Lewy Body Dementia?

Why? (2 things)

A

Antipsychotics

  1. Pt are extremely sensitive to their Side Fx
  2. They can develop irreversible Parkinsonism
48
Q

What are the Complications of Lewy Body Dementia? (5 things)

A
  1. Persistent symptoms, esp Visual Hallucinations
  2. Depression
  3. Complete debilitation –> dependence on others
  4. Infection –> death
  5. Parkinsonism (from antipsychotics)
49
Q

What is FrontoTemporal Dementia? (2 things)

A

Dementia characterised by

  1. Frontal and Temporal lobe Atrophy
  2. Loss of 70+% of Spindle neurons
50
Q

What age does FrontoTemporal Dementia usually occur at?

A

Before 65

Memory loss usually occurs LATER

(2nd most common cause of Dementia before 65 yrs)

51
Q

What are the CF of FrontoTemporal Dementia? (5 things)

A
  1. Behavioural changes (early) (e.g loss of empathy)
  2. Speech difficulties (early)
  3. Cognitive Impairment (late)
  4. Executive Functioning Impairment (concentration + planning) (late)
  5. Memory problems (late)
52
Q

What investigations should you do for FrontoTemporal Dementia? (4 things)

A
  1. MRI
  2. PET / SPECT
  3. Neuropsychological Test
  4. MMSE
53
Q

What may a MRI show you in FrontoTemporal Dementia? (2 things)

A
  1. Frontal / Temporal lobe atrophy
  2. Ventricle enlargement
54
Q

What may PET / SPECT scans show you in FrontoTemporal Dementia? (2 things)

A
  1. Hypometabolism
  2. Hypoperfusion

(in affected lobe)

55
Q

What is the basis of management for FrontoTemporal Dementia?

A

NO disease modifying treatment currently recommended

So just supportive care + symptom management

56
Q

What are the management options for Symptom control of FrontoTemopral Dementia? (5 things)

A
  1. Non-pharma: Group therapy / support groups
  2. Benzodiazepines (for agitation / distress)
  3. SSRI (for depression / anxiety)
  4. Antipsychotics (low doses and only as last resort)
  5. Oxytocin (for empathy problems) (fairly new studies)

Y4 Acute Care (31 decks)

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