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Psychiatry > Clinical Aspects of Dementia > Flashcards

Clinical Aspects of Dementia Flashcards

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1
Q

What is the standard test done in most psychiatry of old age departments?

A

ACE - III

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2
Q

Aside from the ACE-III, what other forms of cognitive testing may be done? When?

A

MoCA (montreal cognitive assessment)

Shorter, several versions, validated in many languages

FAB – frontal assessment battery

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3
Q

What kind of history is very important in someone with cognitive impairment?

A

Collateral history

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4
Q

What is given to the person you are taking a collateral history from?

A

Short Informant Questionnaire on Cognitive Decline in the Elderly

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5
Q

What does the OT assessment involve?

A

Cognitive performance testing

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6
Q

Describe cognitive performance testing.

A
  • Observation of activities – washing, dressing, using phone, shopping, making toast, travelling
  • Estimates cognitive level and level of supervision required for daily living
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7
Q

Sometimes, someone may not have dementia but just a….

A

Mild cognitive impairment

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8
Q

There are many reversible causes of cognitive impairment

A

TRUE

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9
Q

List some causes of reversible cognitive impairment?

A

Basically anything that causes a physical disturbance can cause a cognitive impairment

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10
Q

What is mild cognitive impairment?

A

Noticeable cognitive impairment with little deterioration of function

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11
Q

What is the common score for someone with a mild cognitive impairment using ACE-III?

A

80-90

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12
Q

What is the common score for someone with a mild cognitive impairment using MoCA?

A

24-26

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13
Q

What is the annual conversion rate of mild cognitive impairment to dementia?

A

10-15%

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14
Q

How should patients with mild cognitive impairment be managed?

A

With yearly cognitive testing.

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15
Q

What are the 4 key symptoms of Alzheimer’s dementia?

A
  • Memory loss, particularly short term.
  • Dysphasia.
  • Dyspraxia.
  • Agnosia. (inability to interpret sensations/recognise things)
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16
Q

What may be seen on CT/MRI of a patient with Alzheimers?

A

May be normal, or there may be medial temporal lobe atrophy or temporoparietal atrophy

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17
Q

What are the 2 variants of Alzheimers?

A
  • Frontal.

* Posterior cortical atrophy.

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18
Q

What symptoms are more common in vascular dementia than Alzheimers?

A

Dysphasia, dyscalculia, frontal lobe and affective sx

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19
Q

Give an example of an affective symptom that is more common in vascular dementia then Alzheimers?

A

Depression

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20
Q

What type of signs might vascular dementia be associated with?

A

Focal neurological signs

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21
Q

What kind of risk factors do those with vascular dementia have?

A

Vascular risk factors

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22
Q

What type of decline is vascular dementia associated with?

A

Step-wise

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23
Q

Describe step-wise decline?

A

Symptoms stay the same for a while then suddenly get really bad

  • Like a set of stairs going down
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24
Q

What is seen on CT/MRI of someone with vascular dementia?

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A

Moderate-severe small vessel disease or multiple lacunar infarcts

25
Moderate-severe small vessel disease or multiple lacunar infarcts is seen in what condition on CT/MRI?
Vascular dementia
26
What is seen on SPECT scan of someone with vascular dementia?
Patchy reduction in tracer uptake throughout the brain
27
Name the 3 main variants of frontotemporal dementia.
* Behavioural * Primary progressive aphasia * Semantic dementia
28
What is seen on CT/MRI of someone with frontotemporal dementia?
Frontotemporal atrophy
29
What does SPECT scan of someone with frontotemporal dementia show?
Frontotemporal reduction in tracer uptake
30
Describe the behavioural variant of frontotemporal dementia.
Behavioural changes, executive dysfunction, disinhibition, impulsivity, loss of social skills, apathy, obsessions, change in diet
31
Describe primary progressive aphasia.
Effortful non-fluent speech, speech/sound articulatory errors, lack of grammar, lack of words
32
Describe semantic dementia.
Impaired understanding of meaning of words, fluent but empty speech, difficulty retrieving names
33
Outline the criteria for dementia with Lewy Bodies.
* Dementia – with common early involvement of reduced attention, executive function and visuospatial skills + * Two of: * visual hallucinations * fluctuating cognition (delirium-like) * REM sleep behaviour disorder * Parkinsonism (not more than one year prior to onset of dementia) * positive DAT scan
34
After 15-20 years of having Parkinson's, what % of patients have dementia?
80%
35
What must happen with Dementia to be classified as 'Dementia with Parkinson's?
Must have parkinsonism for at least one year prior to the onset of Dementia
36
What investigation will be positive in dementia with parkinson's?
DAT scan
37
Describe the DAT scan of someone with parkinsonism
1. Comma shaped basal ganglia | 2. Full stop shaped basal ganglia
38
Name 3 cholinesterase inhibitors.
* Donepezil. * Rivastigmine. * Galantamine.
39
When does a patient get a cholinesterase inhibitor?
Once they are diagnosed with dementia
40
What cholinesterase inhibitor is used in DLB and DPD?
Rivastigmine
41
What effects do cholinesterase inhibitors have in dementia?
Slow cognitive decline, and treat BPSD (behavioural and psychological symptoms in dementia)
42
What types of Dementia do these have more effect in? Compared to what?
DLB/DPD than Alzheimer’s
43
What side effects are associated with cholinesterase inhibitors?
GI (esp. nausea and diarrhoea), headache, muscle cramps, bradycardias, worsen COPD/asthma
44
What should you always do before prescribing a cholinesterase inhibitor?
Check pulse
45
When should you never give a cholinesterase inhibitor?
In active peptic ulcer or severe asthma/COPD
46
What is memantine licensed in the treatment for?
Alzheimer's
47
What is the effect of memantine?
Slow cognitive decline, and may treat BPSD
48
What do the recent BAP guidelines suggest?
Memantine should be started soon after diagnosis of Alzheimers dementia.
49
Although this tends to be WELL TOLERATED, what side effects may memantine be associated with?
``` Hypertension – check BP before starting. Sedation. Dizziness. Headache. Constipation. ```
50
What should always be done before starting memantine?
Check BP
51
What is given if patient has visual hallucinations in dementia?
Cholinesterase inhibitors, antipsychotics
52
What is given if a patient with dementia suffers from insomnia?
Melatonin, Z drugs, benzodiazepines, sedating antidepressants
53
What should NOT be used in Lewy Body Dementia?
Antipsychotics
54
What should always be discussed at diagnosis?
Driving
55
Does a dementia diagnosis need to be reported to the DVLA?
YES!!!!!!
56
Outline what happens once a person’s new diagnosis of Dementia is reported to the DVLA.
1. Patient fills in CG1 form. 2. DVLA requests a report from the doctor. 3. Doctor then decides if the pt can drive while investigations are ongoing
57
What investigations are done in determining whether a person with Dementia is safe to drive?
* Rookwood Driving Battery. | * On road test.
58
List reversible causes of cognitive impairment.
* Delirium * Depression * Other psychiatric disorders

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