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CP3 @ UoN - Medicine & Surgery > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia?

A

A syndrome of acquired global impairment of higher cerebral function

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2
Q

How common is dementia?

A

5% of >65yrs

20% of >80yrs

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3
Q

What are the diagnostic criteria for dementia?

A 
Evidence of impairment of memory + >1 of:
   -language impairment
   -apraxia
   -agnosia
   -impairment of executive functioning
Impairment of functioning
No other medical/psychiatric explanation
Present for >6mo
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4
Q

What is mild cognitive impairment?

A

Evidence of early memory decline on formal memory tests w/o clinical evidence of other features of dementia

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5
Q

What are the three main phases of dementia?

A

Early phase
Middle phase
Late phase

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6
Q

What are the features of the early phase of dementia?

A 
Short term memory loss
Difficulty embracing change
Repetition of qs
Minor behavioural changes
Lasts 3-4yrs
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7
Q

What are the features of the middle phase of dementia?

A 
Difficulty w/ daily tasks
Need frequent prompting
Failure to recognise people
Hallucinations
Increasing support required for daily life
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8
Q

What are the features of the late phase of dementia?

A

Incontinence
Aggression
Wt loss
Occurs in last 1-2yrs of life

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9
Q

What frontal lobe sx can be present in dementia?

A

Personality change (dulling of personality, social withdrawal, disinhibition)
Difficulties w/ reasoning/abstract thought
Difficulty initiating actions

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10
Q

What temporal lobe sx can be present in dementia?

A

Difficulty w/ short term memory
Difficulty holding attention on tasks
Poor speech production

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11
Q

What parietal lobe sx can be present in dementia?

A

Problems recognising faces/objects (Agnosia)
Difficulty carrying out sequence of actions
Clumsiness

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12
Q

What are the causes of dementia?

A 
Degenerative
Vascular
Trauma
Malignancy
Hydrostatic
Toxic
Endocrine
Metabolic
Infective
Psychiatric
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13
Q

What are the degenerative causes of dementia?

A 
Alzheimer's disease
Frontotemporal dementia
Lewy Body dementia
Parkinson's disease
Huntington's disease
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14
Q

What are the vascular causes of dementia?

A

Multi-infarct dementia
Cerebral infarcts
Binswanger’s disease
Systemic vasculitis

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15
Q

What are the traumatic causes of dementia?

A

Major head injuries

Repetitive minor trauma

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16
Q

What are the malignant causes of dementia?

A

1o/2o neoplasm

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17
Q

What are the hydrostatic causes of dementia?

A

Hydrocephalus
Normal-pressure hydrocephalus
Intracranial haematomas

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18
Q

What are the toxic causes of dementia?

A

Alcohol-related
Heavy metal poisoning (Wilson’s)
Drug related

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19
Q

What are the endocrine causes of dementia?

A

Hypothyroidism

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20
Q

What are the metabolic causes of dementia?

A

B1/B12/Folate deficiencies

Uraemia/liver failure

21
Q

What are the infective causes of dementia?

A

3o syphilis
HIV
Creutzfeld-Jakob disease
Cryptococcus

22
Q

What are the psychiatric causes of dementia?

A

Depressive pseudodementia

23
Q

What are the common causes of dementia?

A 
Alzheimer's (62%)
Vascular (17%)
Mixed AD/vascular (10%)
Lewy Body (4%)
Frontotemporal (2%)
Parkinson's (2%)
24
Q

What investigations are appropriate in suspected dementia?

A

MMSE/MOCA (insensitive to frontal-executive dysfunction/visuo-spatial deficits)
Bloods (FBC, U&Es, LFTs, ESR, Ca, TFTs, glucose, lipids)
CT/MRI head
ECG

25
Q

How can MMSE scores be used to assess severity of disease?

A 
>27 - normal
21-26 - mild dementia
14-20 - moderate dementia
10-13 - moderate/sev dementia
<10 - sev dementia
26
Q

What is the cause of Alzheimer’s Disease (AD)?

A

Protein plaques/tangles in cortical areas causing cell death

27
Q

How does AD present?

A

Progressive loss of ability to learn/retain/process new information
In later stages behavioural changes develop

28
Q

What are the subtypes of Vascular Dementia (VD)?

A

Post-stroke dementia
-develops in 25% of stroke sufferers w/i 1yr
Cortical vascular dementia
-multiple small infarcts in cerebral cortex
Subcortical vascular dementia
-affects subcortical areas only, associated w/ HTN
-if widespread known as Binswanger’s

29
Q

How does VD present?

A

Similar to AD but

  • stepwise progression of disease
  • personal/family hx OR sx/signs of vascular disease
  • early gait disturbance w/ unsteadiness/falls
30
Q

What is required for the diagnosis of VD?

A

Radiological evidence of cerebrovascular disease

31
Q

What is the cause of Lewy Body Dementia (LBD)?

A

Formation of ‘Lewy Bodies’ in basal ganglia/cortex

32
Q

How does LBD present?

A

Progressive cognitive decline AND

  • visual hallucinations
  • fluctuating cognition
  • features of parkinsonism
33
Q

What are the supportive features of an LBD diagnosis?

A

Falls/syncope
Sensitivity to neuroleptics
REM sleep behaviour disturbance

34
Q

How does Parkinson’s disease dementia present?

A

Around 30% of pts w/ PD
Classic PD w/ initial unilateral sx for a few years followed by decline in cognitive function
-if early bilateral signs think LBD

35
Q

How does FTD present?

A 
In early stages cognition remains intact
Behavioural changes (blunting, loss of inhibition, decline in personal hygiene, hyperorality)
Language difficulties (echolalia, complete aphasia)
Early loss of insight, primitive reflexes present
36
Q

What is the cause of Creutzfedlt-Jakob (CJ) disease?

A 
Prion disease (mad cow disease)
Inheritable forms
37
Q

How does CJ disease present?

A

In middle age w/ dementia
Visual disturbance
UMN signs in limbs
EEG diagnostic

38
Q

What is the cause of Huntington’s disease?

A

Autosomal dominant inheritance of Huntington’s gene

Anticipation

39
Q

How does Huntington’s present?

A

Progressive dementia

Chorea

40
Q

What is Delirium?

A

Change in cognition developing over a short period of time, typified by disturbance of attention/arousal

41
Q

What are the features of Delirium?

A

Change in cognition, acute confusional state
Tendency for sx to fluctuate w/ sleep-wake cycle
Evidence that delirium is a direct consequence of
-medical condition
-drug withdrawal
-intoxication

42
Q

What are the three main types of delirium?

A

Hypoactive (40%)
Hyperactive (25%)
Mixed (35%)

43
Q

What are the features of hypoactive delirium?

A

Apathy
Withdrawal
Lethargy
Reduced motor activity

44
Q

What are the features of hyperactive delirium?

A

Increased motor activity
Agitation
Hallucinations
Challenging behaviour

45
Q

What are the features of mixed delirium?

A

Mixed picture w/ fluctuation throughout day

46
Q

What is the management of delirium?

A

Identify/treat underlying cause
Non-pharmacological - promote orientation, maintain hydration/nutrition, 1:1 nursing
Pharmacological - control pain, avoid sedation
Prevent complications
Pt/relative explanations

47
Q

What are the common complications of delirium?

A

Pressure ulcers
Falls
Incontinence
Nosocomial infections

48
Q

What is the prognosis of delirium?

A

1/3 get completely better
1/3 get a little better
1/3 stay the same/get worse

49
Q

What is the management of dementia?

A 
MDT care, assess social needs, OT/physio
Reduce vascular risk
Cognitive stimulation therapy
Mild-mod AD/LBD
   -AChE inhibitors (donezepil, galantamine, rivastigmine)
Severe AD/LBD
   -NMDA antagonists (memantin)
Manage BPSDs

CP3 @ UoN - Medicine & Surgery (135 decks)

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