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PSYCHIATRY > Clinical Aspects of Dementia > Flashcards

Clinical Aspects of Dementia Flashcards

1
Q

What is Dementia? (4)

A
  • progressive GLOBAL cognitive decline
  • irreversible
  • decline in FUNCTIONING
  • it is a SYNDROME (not disease)
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2
Q

What is key for management of Alzheimer’s? (4)

A
  • should start ASAP
  • plan for FUTURE care
  • PEER support
  • plan for FUTURE decision-making (power of attorney)
  • ensure pt UNDERSTANDS the illness and how to manage
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3
Q

How is cognitive testing done?

A
  • ACE-III (Addenbrooker Cognitive Assessment)
  • MoCA (shorter, several versions)
  • FAB
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4
Q

What specific questionnaire is given to a relative/friend for them to fill in, to get a COLLATERAL hx?

A

Short Informant Questionnaire on Cognitive Decline in the Elderly
(Short IQCODE)

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5
Q

What is assessment is conducted to see how well a dementia pt fxns at home ?

A

Occupational Therapy Assessment

—-observation of activites

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6
Q

What are reversible causes of COGNITIVE impairment?

A 
Vascular
Infection, inflammation (NEURO)
Neoplasia
Drugs, 
Iatrogenic
Congenital
Allergy, alcoho
Trauma
Endocrine (THYROID)
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7
Q

What is seen in Mild Cognitive Impairment?

A
  • noticeable cognitive impairment
  • Little deterioration of FUNCTION
  • ACE-III: 75-90
  • MoCA: 24-26
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8
Q

What is Subjective Cognitive Impairment?

A
  • pt FEELS they are cognitively IMPAIRED, but day-to-day fxn and cognitive tests are normal (hard to convince them otherwise)
  • a/w ANXIETY (increased> memory lapses), DEPRESSION or stress
  • —-they usually have a relative/ friend with DEMENTIA
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9
Q

What is seen with Alzheimer’s Disease?

A
  • short term memory loss (one of the first symptoms)
  • dysphasia
  • dyspraxia (hard to coordinate body movements)
  • agnosia
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10
Q

What is seen on MRI or CT of the brain?

A
  • normal
  • may have Medial temporal lobe ATROPHY
  • post. cortical atrophy
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11
Q

What symptoms are seen with Vascular dementia?

A
  • dysphasia
  • dyscalculia
  • frontal lobe symptoms
  • affective symptoms
  • —FOCAL neurological signs
  • STEP WISE decline
  • vascular risk factors
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12
Q

What is seen on IVX of Vascular dementia?

A
  • moderate-severe SMALL vessel disease (multiple LACUNAR infarcts)
  • SPECT—-patchy reduction in tracer UPTAKE THROUGHOUT the brain
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13
Q

Name the 3 syndromes of Fronto-Temporal Dementia.

A
  1. Behavioural Variant
  2. Primary Progressive Aphasia
  3. Semantic Dementia
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14
Q

What is seen in the Behavioural variant Dementia?

A
  • behavioural changes
  • executive DYSFXN
  • Impulsivity
  • loss of SOCIAL skills
  • disinhibition
  • apathy, obessions
  • change in diet
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15
Q

What is seen in Semantic Dementia? (3)

A
  • impaired meaning of WORDS
  • empty speech, but fluent
  • can’t retrieve NAMES
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16
Q

What is seen in Primary Progressive Dementia?

A
  • effortful NON-fluent speech
  • speech sound errors
  • lack of grammar
  • lack of words
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17
Q

What is seen on ivx of Frontotemporal Dementia?

A
  • CT/MRI: frontotemporal ATROPHY

- SPECT: frontotemporal REDUCTION in tracer uptake

18
Q

What is symptoms are seen in LEWY body dementia?

A
  • INATTENTION
  • poor executive function
  • poor VISUOSPATIAL skills
19
Q

What is diff. in the presentation of LB dementia?

A
  • VISUAL hallucinations
  • fluctuating cognition
  • REM sleep disorder
  • Parkinsonism
  • positive DAT scan
20
Q

When does dementia in Parkinsons set in?

A
  • 80% get dementia after 15-20 years of PD
  • must have parkinsons for at least 1 year to dementia onset
  • PD dementia and LB dementia —–diff. pathology
21
Q

When is a CT scan performed?

A
  • to R.O tumor/bleed/large stroke
  • to quantify vascular changes
  • to see structural changes of Alzheimers
22
Q

When is an MRI performed?

A
  • when pt is YOUNG

- fast progression of symptoms

23
Q

When is SPECT performed ?

A
  • used to check for FRONTOTEMPORAL dementia

- to clarify Alzheimers dx

24
Q

When is DAT performed?

A
  • to differentiate DLB from DPD
25
Q

How to differentiate dementia from pseudodementia of depressed mood?

A
  • depressed mood PRECEDED first !
  • memory testing shows, performance IMPROVES` when interest aroused
  • pts with dementia are COOPERATIVE; willing to make mistakes
26
Q

What lab ivx should be considered for dementia?

A
  • FBC
  • Liver fxn
  • Thyroid fxn
  • Vit. B12
  • Folate
  • Thiamine
  • calcium
  • glucose
  • —–only with HIGH clinical suspicion: HIV and syphilis test
27
Q

What are the DDX for dementia?

A
  1. Delirium (acute and Impaired consciousness, persecutory delusions)
  2. Dementia (paranoid delusions)
  3. Depression (diurnal variation, Auditory hallucinations)
  4. Psychosis (
28
Q

What is first line rx for DEMENTIA according to NICE guidelines?

A
  1. aromatherapy
  2. Music/dance therapy
  3. Animal-assisted therapy
  4. Massage (reduces agitation)

——drugs sets in after

29
Q

When is Acetylcholinesterase Inhibitors given and why?

A
  • given to Alzheimer’s pts and DLB/DPD

- said to IMPROVE cognitive fxn and behaviour for upto a year

30
Q

MOA of Acetylcholine esterase?

A
  • increases the conc. of and duration of AXn of ACh in the CNS `
31
Q

What are the S.Es of CHOLINESTERASE inhibitors?

A
  • N.D
  • heachache
  • Muscle cramps
  • Bradycardias
  • worsening of COPD and asthma
32
Q

What should be checked prior to prescribing cholinesterase inhibitors?

A
  • PULSE
33
Q

What is the use of Memantine?

A
  • for Alzheimer’s Disease

- said to improve cognition, MOOD and BEHAVIOUR in moderate to severe AD.

34
Q

What are side effects of Memantine?

A
  • High BP
  • sedation
  • dizziness
  • headache
  • constipation
35
Q

What is the MOA of Memantine?

A
  • NMDA glutamine receptor antagonist
36
Q

When is an anti-psychotic given?

A

when pt is severely distressed and agitated (possible harm to self and others)

  • Haloperidol
  • Olanzapine
  • —oral first!
37
Q

When is a benzodiazepine given?

A
  • if antipsychotic fails to calm the agitated pt

- Lorazepam (IV)

38
Q

What occurs in the LATER stages of dementia?

A
  • physical comorbidity INCREASEs

- REDUCED ability to carry out ACTIVITIES independently; hence need for support services

39
Q

What is given for Agitation in a pt with Fronto-temporal Dementia?

A
  • trazodone
40
Q

RX for visual hallucinations?

A
  • cholinesterase inhibitors

- antipsychotic

41
Q

RX of ANXIETY?

A
  • anti-depressants
  • benzodiazpines
  • pregabalin

PSYCHIATRY (32 decks)

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