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ESA 5 - Nervous System > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia?

A

Progressive decline in higher cortical function leading to global impairment of memory, intellect, and personality, which affects the ability to cope with activities of daily living

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2
Q

What are the causes of pernament dementia?

A
  • Alzheimer’s diesase
  • Fronto-temporal dementia
  • Dementia with Lewy-Bodies
  • Vascular dementia
  • Creutzfeldt-Jacob disease - rare
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3
Q

What are the reversible causes of dementia?

A
  • Depression
  • Trauma
  • Vitamin deficiency
  • Alcohol
  • Thyroid disorders
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4
Q

How does dementia present?

A
  • Memory deficit
  • Behavioural
  • Physical
  • Language disorder
  • Visuospatial disorder
  • Apraxia
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5
Q

What memory deficits are present in dementia?

A

Struggle to learn new information and have short term memory loss initially, which progresses to long term memories

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6
Q

What are the behavioural symptoms of dementia?

A
  • Altered personality
  • Disinhibition
  • Labile emotions
  • Wandering
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7
Q

What are the physical presentations of dementia?

A
  • Incontinence
  • Reduced oral intake
  • Difficulty swallowing
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8
Q

What language disorders might dementia present with?

A
  • Anomic aphasia
  • Difficulty understanding language
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9
Q

What visuospatial symptoms might dementia present with?

A

Unable to identify visual and spatial relationships between objects

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10
Q

What is apraxia?

A

Difficulty with motor planning, resulting in inability to perform leaned purposeful movements

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11
Q

What investigations should be done when a patient presents with suspected dementia?

A
  • Full history and mini-mental state examination
  • Full neurological examination
  • Blood tests
  • CT/MRI of the head
  • Memory clinic follow up
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12
Q

What might be required when obtaining a full history from a patient with dementia?

A

Collateral history from family, as patient might be trying to hide it or not remeber

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13
Q

Why is a full neurological examination required in dementia?

A

As focal neurological signs might show different diagnoses

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14
Q

What is the use of CT/MRI scans in dementia?

A

Sometimes not that helpful, but show other causes, e.g. tumour or RICP

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15
Q

Why do blood tests need to be done in suspected dementia?

A

To check for reversible causes

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16
Q

What needs to be looked for in the blood tests of suspected dementia?

A
  • TFTs to check for thyroid disorders
  • Vitamin B12
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17
Q

Why is memory clinic follow up important in dementia?

A

Need someone to care for the patient after, e.g. home visits, social care

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18
Q

How is it decided if a patient has delirium or dementia?

A

CAM (confusion assessment method) score

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19
Q

What symptoms would indicate delirium rather than dementia?

A
  • Acute change or fluctuating mental status
  • Altered consciousness- hypo/hyperactive
  • Inattention
  • Disorganised thinking
20
Q

What signs might be seen on the CT scan of someone with dementia?

A
  • Dilation of ventricles
  • Generalised atrophy
21
Q

What signs might be seen on the MRI of someone with dementia?

A

Hippocampal atrophy

22
Q

Describe the rate of progression of vascular dementia?

A

Normal and steady, then some sort of insult leading to abrupt decrease. It then stays level until there is another insult, when there is another abrupt decrease

23
Q

Describe the state of decline of Alzheimers dementia

A

Steady rate with no improvement

24
Q

Describe the rate of decline in Lewy-Body dementia?

A

More sporadic decline, with an overall decline but periods of improvement

25
Q

What happens to the brain macroscopically in Alzheimers?

A

There is a loss of cortical and subcortical white matter, causing gyral atrophy with narrow gyri and wide sulci, along with marked ventricular dilation reflecting the loss of white matter

26
Q

What is the microscopic pathology in Alzheimers?

A
  • Formation of amyloid-beta plaques
  • Formation of neurofibrillary tangles
27
Q

What leads to the production of amyloid-beta peptide?

A

The proteolytic breakdown of amyloid precursor protei n

28
Q

How long does the mild stage of Alzheimers last?

A

2-4 years

29
Q

What is the mild stage of Alzheimers marked by?

A

Minor memory loss, as well as difficulty learning and remembering new information

30
Q

What remains intact in mild Alzheimers disease?

A

Long-term memory and some reasoning

31
Q

Why might it be difficult to diagnosis mild Alzheimers disease?

A

Patients may be aware of their decline, and hide it well

32
Q

How long does the moderate stage of Alzheimers last?

A

2-10 years

33
Q

What does the patient experience in the moderate stage of Alzheimers?

A
  • Withdrawal
  • Confusion
  • Increasing difficulty in self care
  • Daily tasks
  • Poor judgement
  • Difficulty communicating
34
Q

What behavioural changes occur in moderate Alzheimers?

A
  • Anger
  • Anxiety
  • Frustration
  • Restlessness
35
Q

How long does the severe stage of Alzheimers last?

A

1 to 3 years

36
Q

What happens to the patient in the severe stage of Alzheimers?

A
  • Completely incapacitated
  • Will not eat unless fed
  • May not speak
  • Do not recgonise people
  • Loss of bodily functoin control, e.g. swallowing, bladder, and bowel
  • Violent episodes and aggression common

*

37
Q

Where do Lewy-Bodies form in Lewy-Body dementia?

A

In the cortex and substantia nigra

38
Q

What are the key clinical features of Lewy-Body dementia?

A
  • Substantial fluctations in the degree of cognitive impairment over time
  • Parkinson’s symptoms
  • Visual hallucinations
  • Frequent falls
39
Q

What is the pathology of vascular dementia?

A

Arteriosclerosis of the blood vessels supplying the brain leads to diffuse small vessel disease and infarcts, resulting in a decreased/cut off blood supply to specific parts of the brain

40
Q

How is vascular dementia managed?

A

Assess cardiovascular risk, and treat hypertension/high cholesterol if present

41
Q

What are frontotemporal dementias?

A

A diverse group of conditions, with similar presentation but different pathologies

42
Q

What are the potential pathologies behind fronto-temporal dementias?

A
  • Frontotemporal lobar degeneration with tau pathology
  • Pick’s disease
  • Familial tauopathies
43
Q

What are the key clinical features of frontotemporal dementias?

A
  • Alteration of social behaviour and personality, including agitation and depression
  • Impaired judgement and insight
  • Speech output falls, eventually to a state of mutism
44
Q

What are the categories of management of dementia?

A
  • Therapies
  • Memory aids
  • Social care
  • Drugs
45
Q

What memory aids can be used in dementia?

A
  • Orientation boards
  • Remembrance therapy
  • Life stories
46
Q

What social care considerations need to be made in a patient with dementia?

A
  • Risk assessment
  • Care needs
  • Mental capacity act
47
Q

What drugs are used in the treatment of dementia?

A
  • Cholinesterase inhibitors
  • Memantine

ESA 5 - Nervous System (18 decks)

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