14 - Dementia Syndromes Flashcards Preview

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Flashcards in 14 - Dementia Syndromes Deck (13)
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1
Q

What is the definition of dementia syndromes?

A

Decline of memory and (or) other cognitive abilities from a previous level of function, which must be sufficiently severe to cause impairment in occupational or social functioning

Change from previous level of functioning
Multiple cognitive/behaviour domains affected

2
Q

What are the cognitive domains that are affected by dementia syndromes?

A
Memory
Language
Visuo-perceptual skills
Praxis
Attention
Executive Functions
3
Q

Describe the distribution of dementia syndromes

A

70% Alzheimers
17% Vascular Dementia, due to multiple strokes normally
13% other dementias

4
Q

What are the changes from DSM-IV to the DSM-V for Alzheimer’s disease?

A

Re-terms dementia into major neurocognitive disorder

The same as DSM-IV, but doesn’t require memory impairment, as long as evidence of genetic mutation known to cause Alzheimer’s

Acknowledges existence of “atypical” variants

5
Q

What’s required when diagnosing dementia?

A

Clinical history of decline in cognitive function and impairment of daily livings

Objective evidence of cognitive and/or behavioural impairment on neuropsychological testing

Deficits and presentation can’t be explained by another condition

Preferable: evidence of progressive decline across repeated neuropsychological testing

Associated biomarkers

6
Q

What is the typical presentation of Alzheimer’s disease?

A

After age 60

Memory impairment often the first presenting complaint (both failure to encode and store)

As disease advances, language, visuo-spatial and executive functions compromised

General demeanour and personality preserved until late in disease

Neurofibrillary tangles and amyloid plauqes. Atrophy in mesial temporal lobe (including hipp.), partietal lobes and dorsolateral prefrontal cortex

7
Q

Describe atypical variants of Alzheimer’s disease

A

Earlier onset
Memory is usually not compromised in early stages

Visual Variant AD or Posterior Cortical Atrophy

  • visuo-spatial impairments (judging spatial locations)
  • visual agnosia (impaired object recognition)
  • apraxia (assembling, dressing)
  • significant changes in parietaland occipital lobes

Frontal Variant AD

  • executive dysfunction (poor planning and organisation, impaired mental flexibility)
  • personality change
  • significant changes in frontal lobe
8
Q

Describe Fronto-Temporal Dementia

A
  • Called Pick’s disease for a long time
  • Disease concentrated in frontal and temporal lobes
  • Different pathology: Pick bodies

Earlier onset, 40-50s
Various variants; behavioral, semantic, progressive non-fluent aphasia

9
Q

Describe the Behavioural Variant of Fronto-Temporal dementia

A

Frontal lobe atrophy

Personality and behaviour change (disinhibition, apathy, emotional blunting, over-eating)

Executive dysfunction on neuropsychological testing

  • Mental inflexibility
  • Concrete thinking
  • Planning problems

Memory and visuo-perceptual skills relatively spared

10
Q

Describe the Semantic Variant of Fronto-Temporal dementia

A

Anterior-Lateral temporal lobe atrophy (more commonly left)

Progressive loss of semantic knowledge

Visuo-perceptual skills, memory, personality preserved

11
Q

Describe the Progressive Non-Fluent Aphasia Variant of Fronto-Temporal dementia

A

Frontal and temporal lobe atrophy

Non-fluent speech

Agrammatic

Visuo-perceptual skills, memory, personality preserved

12
Q

Describe Vascular (Multi-Infarct) Dementia

A

Second most common dementia

Caused by hypertension, leading to multiple strokes in the brain. Symptom onset usually related to cerebro-vascular events.

Progression more step-wise, with periods of plateau.

Distribution of lesions varies widely, and so does the neuropsychological picture

A more “subcortical” neuropsychological picture.

  • Slow speed of processing
  • Attention problems
  • Memory problems secondary to; attention and difficulties initiating memory search
  • Motor and other neurological problems can be present
13
Q

Describe dementia in Parkinson’s disease

A

Apathy, difficult in “getting going”
Slowed mental processing
Attention impairments, especially shifting impairments
Visuo-spatial impairments
Visual hallucinations
Memory; problems with recall
cognitive impairments occur after motor disorder