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Lucy Knox - Year 2.5 > 236 - Dementia > Flashcards

236 - Dementia Flashcards

1
Q

What are differentials of an elderly person with ? dementia?

A

Physical illness (hypothyroid? infection?)
Delerium
Mild cognitive impairment (decline greater than expected but doesn’t interfere with daily life)
Depression
Sensory impariments

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2
Q

What are the ICD 10 criteria for dementia?

A 
Acquired impairment > 6 months in memory
\+ impaired in at least 1 of:
   - executive function
   - language
   - Praxis
   - Gnosis
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3
Q

What are the 4 domains of impariment seen in dementia?

A

Cognitive
Activities of daily living
Neuropsychiatric / behavioural
Caregiver burden

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4
Q

What are some cognitive tests used in dementia?

A 
6 item CIT: Kingshill
Clockface test
Mini mental state exam
ACE-III: addenbrookes
MoCA: montreal cognitive exam
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5
Q

What key tests should be done when thinking of dementia?

A

Bloods (inc. TFT, B12/folate)
CXR
EEG
CT brain - for exclusion or other causes, and can see ischaemia or atrophy.

? MRI brain - better white matter detail, but hard to tollerate when confused

SPECT/DAT/PET - specialised tests to look at regional blood flow ect.

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6
Q

What are 5 main types of dementia?

A 
Alzheimers (50%)
Vascular
Parkinson's
Lew-body
Fronto-temporal
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7
Q

Describe Alzheimer’s dementia

A

Insidious onset + gradual decline.

B amyloid plaques and neurofibrillary tangles (caused by Tau protein)

Deficit in Cholinergic (AcH) system - Glutamate overactivation of NMDA - get cerebral atrophy and ventricular dilatation.

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8
Q

What are the risk factors for dementia?

A

Age >70
F:M is 2:1
Head injury, environment…
Genetics - 40% of

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9
Q

Describe Vascular dementia?

A

Sudden onset with step wise deterioration.
Mood and behavioural changes occuer
Insight is preserved
Can fluctuate

Neuropathology: atherosclerosis -> single or multiple thrombolic infarcts

On imaging: Large volume infarcts, lacunae (small volume deep grey matter ischaemia. Leukonosis (looks white despite being grey matter)

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10
Q

What are the risk factors for vascular dementia?

A 
Smoking
Diabetes
High cholesterol
High Bp
Male
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11
Q

Describe parkinson’s dementia?

A

Pt has prominent parkinsonian features that are present >6 months before the dementia began,

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12
Q

What is Lewy-body dementia?

A 
Mild parkinsonian motor featires
Cognitive and motor onset together
Fluctuating cognition
Vicid hallucinations
act out dreams
Repeated falls

Lewy bodies often see in substansia nigra

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13
Q

Describe front-temporal dementia

A

Pt express apathy, reduced motivation, self-neglect, disinhibited, reduced social awareness.

Have personality changes
Loss of language
Variable memory loss
Ofter

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14
Q

What is delerium?

A

An acute, sudden onset fluctuating, confusional state.

Abnormal attention and arousal, perceptual abnormalities, impaired conscious level.

Increase risk of death

Usually associated with illness - so treat cause
Review medication
Avoid provocation or over stimulation

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15
Q

What is BPSD in dementia?

A

Behavioural + psychiatric symptoms of depression

60% of pt have these, espeically in later stages.

eg. agitation, agression, restlessness, depression, anxiety, delusions, disinhibitions.

Management - Antipsychoitics? Only if really needed, study showed they actually increase mortality.
Try alternative therapies - reminiscence, aromatherapy

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16
Q

What medication is available for Alzheimer’s?

A

Mild/mod: Acetylcholinesterase inhibitors - Donepexil, Rivastigmine, Galantamine.
- not a cure but maintains level for longer, reduces ACh break down, so more in cleft, and also reduces formation of B-amyloid plaques.

Mod-severe: NMDA receptor antagonist - Memantine
Blocks effects of pathologically elevated/toxic levels of glutamate that cause dysfunction

17
Q

What side effects do you get with Rivastigmine (or other Acethylcholinesterase inhibitors)?

When is their use cautioned?

A

N+V, Diarrhoea, Weight loss, dizziness

Caution: arrhythmia’s, epilepsy, asthma

18
Q

What side effects can you get with memantine?

A

Constipation, hibe BP, Dyspnoea, headache, hallucinations

19
Q

What medication can be used in someone with Vascular dementia?

A

Nothing specific - reduce vascular risk factors

Aspirin, statins…

? night sedation - Zopidone

20
Q

Where is LTM stored/processed?

A

Medial temporal areas

21
Q

What is declarative memory?

A

Explicit
Semantic - concepts
episodic - autobiographical

22
Q

Where is declarative memory processed?

A

In medial temporal love, hypothalmus and thalmus

23
Q

What is non-declarative memory?

+ where is each part processed?

A

Implicit
Procedural memory, skills, habits - Striatum
Motor learning - cerebellum
Emotional conditioning - Amygdala

24
Q

Describe the information flow as sensory information is processed and memorised..

A

Sensory info -> cortical association areas -> parahippocampal + thinal cortices -> hippocampus -> mamillary bodies (in hypothalmus) -> Thalmus

25
Q

What part of the information flow does korsakoff’s syndrome affect?

A

B1 (thiamine) deficiency
Stops mamillary bodies -> thalamus section

Causes: retrograde + anterograde amnesia

26
Q

What parts of the information flow does damage to medial temporal lobes affect? What does it cause?

A

Affects parahippocampal and hippocampal areas
Causes Severe anterograde amnesia

eg. HM or clive wearning

27
Q

What do different parts of the cortex in the brain do roughly?

A

Frontal - select and plan appropriate responses + personality

Parietal - Attending to stimuli

Occipital - visual cortex

Temporal - Identifying the nature of the stimuli

28
Q

Damage to where causes someone to understand language but not be able to construct their own - speaking with halted, badly syntaxed speech?

A

Broca’s area - frontal lobe

29
Q

Damage to where causes someone not to be able to understand language, they speak fluent but non-sensical speech with good grammar?

A

Wernickes area - temporal lobe

30
Q

When you damage the temporal lobe what can happen to your sensory recognition?

A

Agnosia - can’t recognise sensory stimuli
Visual agnosia - Can see but not name items
Prosopagnosia - Can’t recognise faces

31
Q

How do neurones die? Why?

A

Apoptosis
Necrosis
Autophagy

Often due to misfolded toxic protein eg. B amyloid or Tau

32
Q

What in too high levels is excitotoxic and can cause neuronal death?

A

Glutamate

what memantine tries to reduce

33
Q

What is senescence?

A

The impact of time on the body

34
Q

Can you prevent ageing?

A

Rat studies - chronic undernutrition - lives longer

Reproductive cost - sexual activity reduced lifespan of male fruit flies

35
Q

What is ageism?

A

Unjustifiable difference in treatment based solely on age.

Lucy Knox - Year 2.5 (15 decks)

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