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Geris, ICU, Tox > Dementia > Flashcards

Dementia Flashcards

1
Q

Normal Pressure Hydrocephalus

Sx
Imaging
Lx
Tx

A

Triad - urinary incontinence/urgency, dementia/confusion, gait disturbances - ataxic or practice

Ix - Hydrocephalus with min cortical atrophy
LP - high pressure, normal counts

Rx - Shunt (30-50% will improve)

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2
Q

Headache exacerbated by coughing/valsalva

A

Intracranial hypotension

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3
Q

HIV related dementia

-cardinal features

A

Psychomotor retardation, apathy, impaired memory

CD4 <200

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4
Q

Wernicke’s encephalopathy

Korsakoff

A

W - confusion, ataxia, ophtalmoplegia

K - similar to above, chronic. Confabulation and Poor recall is main feature

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5
Q

Alzheimers

Age group
Risk Factors
Genetics

A

> 60 yoa, prevalence doubled every 5 years after 65
RF - age, fly hx
Genetics - Apolipoprotein (APP) e4, Presenilin -1, Presenelin 2.
Others - Trisomy, DM, Head trauma

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6
Q

Alzheimers

Pathophysiology

A
  1. Neurofibrillary tangles
    - tau becomes hyperphosphorylated
  2. Amyloid beta plaques
    - due to improper cleaving of amyloid protein
  3. Decreased neurotransmitters esp Ace and nicotinic cholinergic
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7
Q

Alzheimers classic features

A

Memory impairments first
Then language and visuospatial
May have symmetric akinetic-rigid dystonic syndrome.

50% of patients with “Mild Cognitive Impairment” will progress to AD over 4 years

Late features
Capgras syndrome - belief caregiver is an imposter
Disrupted sleep-wake patterns

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8
Q

Imaging AD

A

Postetior predominant cortical atrophy

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9
Q

Early prominent gait disturbances

Mild memory loss

A

Vascular or NPH

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10
Q

Resting tremor, stooped posture, bradykinesia

A

PD

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11
Q

Fluctuating alertness, visual hallucinations

A

LBD

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12
Q

Loss of proprioception and vibration

A

B12 def

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13
Q

Rapid progression, prominent psych and myoclonic features

A

CJD

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14
Q

Prominent behavioural changes, focal ant-predominant atrophy on imaging

A

FTD

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15
Q

AD Management

A

Cholinesterase inhibitors - donepezil, galantamine, rivastigmine
NMDA receptor antagonists - memantine

Others
Vit E
Vit B, omega 3 fatty acid

No evidence/benefit
Ginko biloba - no evidence, not harmful
Statins
NSAIDs

Harmful - Oestrogen replacement

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16
Q

Cholinesterase inhibitors
MOA
AE

A

Donepezil, Galantamine, Rivastigmine
Decreases cholinesterase activity, increases available Ach

Can use for 6m and cont IF clinically meaningful response

Donepezil - heart block
Rivastigmine - GI
Galantamine - GI

17
Q

Memantine
MOA
AE

A

Memantine
○ Glutamate, the main excitatory neurotransmitter in the CNS, binds to NDMA receptor
○ Excessive stimulation leads to excitotoxicity and damage
○ No evidence of benefit in milder disease

AE- dizziness, confusion, hallucinations

18
Q

LBD

Age group
Risk Factors
Genetics

A

Mean age 75 years
Distinctive - hallucinations, cog fluctuation, parkinsonism, sleep d/o
M:F = 4:1

Genetics - alpha-synuclein gene
Others - Presenilin 1 and 2 + APP e4 (similar to AD)

19
Q

LBD Pathophysiology

A

profound deficiency of Ach - correlates with degree of hallucination but not severity of dementia

Dopamine loss in caudate nuclear and substantial nigra

Abnormal alpha-synuclein deposits –> neuronal death –> profound dopamine dysfunction

Abnormal protein inclusions
alpha-synuclein protein aka Lewy bodies

20
Q

LBD Features

A

Central feature - progressive cog decline/dementia

Core features - fluctuating cognition, recurrent visual hallucinations, spontaneous features of parkinsonism (but must present AFTER the onset of dementia)

Supporting - REM sleep d/o, low dopamine, neuroleptic sensitivity (usually with typical antipsychotics), autonomic dysfunction, syncope etc

*memory impairment comes later unlike in AD

21
Q

LBD Mx

A

Cholinesterase inhibitors - greater benefit in LBD than AD
NMDA receptor antagonists
Atypical antipsychotics - quetiapine
Levodopa/carbidopa - for parkinsonian sx

22
Q

FTD

features, age on onset, genetics

A

Social and emotional disturbance - apathy, disinhibition, compulsivity, overeating

often occurs <65 yoa, highly heritable

Genetics - C9ORF72, GRN, MAPT

23
Q

FTD pathophysio

A

MAPT gene – Tau
Progranulin gene - ubiquitin inclusion
FTLD-TDP43

24
Q

FTD diagnosis, management

A

3 of 6

  • disinhibition
  • apathy/inertia
  • loss of sympathy/empathy
  • compuslvie behavious
  • hyperoralitity
  • dysexecutive neuropsychological profile
Mx - avoid typical antipsychotics
-SSRI
-Behaviour modifications
-Cholinesterase inhibitors/memantine - don't work 
Prognosis is poor, more rapid than AD
25
Q

Corticobasal syndrome

presentation

pathopys

Mx

A

slow progressive dementia + movement disorder
p/w asymmetric rigidity, myoclonus, dystonia and apraxia, sometimes have alien limb –> eventually bilateral

Tau deposition, can occur with overlap

No treatment ?SSRI

26
Q

Parkinson’s Plus Syndrome

Pathophys
Clinical syndrome

A

Similar to Parkinsons but..

  • poor response to levodopa
  • early autonomic system involvement
  • early onset post instability with frequenters falls
  • more visual hallucinations in demnetia
  • supranuclear gaze palsy
27
Q

Cause of death in elderly population in Aus
1.
2.

A
  1. IHD

2. Dementia

28
Q

Mild cog impairment aka mild neurocognitive d/o

A

mild cog impairment, decline from previous

not severe enough to interfere with independence of ADLs

29
Q

Vascular dementia

A

unilateral spastic weakness or increase tendon reflexes
evidence of “focal” brain damange
unevenly distributed cog issues ie memory, reasoning, thinking etc

30
Q

LATE - Limbic-Predominant Age-Related TDP-43 Encephalopathy

A

New dementia type - characterized by the presence of hyperphosphorylated TDP-43

31
Q

Memory clinic benefits

A

One Australian RCT found improved psychosocial status for carers at six months after visiting a memory clinic compared to those visiting a GP (Logiudice 1999). An RCT and economic evaluation in the Netherlands found no evidence of a significant difference in cost between memory clinics and general practitioner care

32
Q

SSRI in dementia

A

citalopram - strongest evidence

good as first line for agitation

33
Q

Agitation and aggression in dementia - pharmaco

A

risperidone

olanzapine

34
Q

Prevention of cognitive decline - FINGER Trial 2015

A

Improvement in cognition with diet, exercise, vascular risk monitoring and cognitive training

35
Q

MSA

A

Multisystems atrophy
Lewy bodies, have Parkinsons ike features
Autonomic dysfunction ++ and cerebellar symptoms

MRI - hot cross bun sign

36
Q

PSP

A

Progressive Supranuclear plasy

Vertical gaze palsy, postural instability
Frontal lobe sx, Parkinsons like symptoms - bradykinesia, dementia, dysarthria

MRI - hummingbird sign

37
Q

Parkinsons Dementia

A

78% of patients with Parkinsons
Problems with cognition, mood behaviour and thought
usually executive function
Depression, apathy, anxiety - common

Geris, ICU, Tox (6 decks)

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