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Y3 - Psych > Dementia > Flashcards

Dementia Flashcards

(49 cards)

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1
Q

What is dementia?

A

An acquired, progressive impairment of cognition without clouding of consciousness that has been present for at least 6 months
The impairment needs to be present in at least 2 cognitive domains

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2
Q

What are the cognitive domains?

A 
Language
Movement
Behaviour
Memory
Visuospatial
Executive function
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3
Q

What are the features of cognitive decline?

A 
Memory loss
Reduced attention and concentration
Slow and muddled thinking
Loss of insight into actions
Disorientation in space and time
Muddled speech and difficulty understanding what is being said
Repetitive purposeless movements
Restlessness and wondering
Odd and disorganised behaviour
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4
Q

What are primary degenerative conditions that cause dementia?

A

Alzheimer’s disease
Lewy body
Picks disease

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5
Q

What are secondary causes of dementia?

A

Vascular dementia
Depression
Infective (HIV, syphilis, encephalitis, CJD (mad cow))
Neurological (huntington’s parkinson’s, motor neurone disease, intracranial tumour)
Alcohol abuse
Head injury

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6
Q

What is the most common cause of dementia?

A

Alzheimer’s disease

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7
Q

What are the genetic changes in Alzheimer’s disease?

A

Polymorphisms in the ApoE gene

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8
Q

What are the macroscopic changes in Alzheimer’s disease?

A

Cortical atrophy with thinning of sulci and gyri, with the occipital lobe being spared
Compensatory ventricular enlargement

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9
Q

What are the histological changes in Alzheimer’s disease?

A

Extra cellular and peri-vascular deposition of B-amyloid plaques

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10
Q

What are the neurotransmitter changes in Alzheimer’s disease?

A

Reduced acetylcholine in the nucleus basalis of Meynert

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11
Q

What age does Alzheimer’s disease typically present?

A

Over 60s

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12
Q

What are the symptoms of Alzheimer’s disease?

A

Progressive memory loss
Disorientation - especially somewhere new
Speech - trouble getting words out and understanding speech
Behaviour - wondering, restless, agitation, frustration, aggressive outbursts

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13
Q

What is vascular dementia?

A

Cognitive decline as a consequence of multiple small vessels infarcts within the brain

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14
Q

What is the pattern of onset of vascular dementia?

A

Sudden onset with stepwise progression of symptoms

symptoms develop, plateau, suddenly get worse then plateau again

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15
Q

What symptoms are seen in vascular dementia?

A

Functional deficits - gait disturbance, urinary incontinence
Mood and personality disturbance, mood disorders
Memory loss
Preservation of insight

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16
Q

How is vascular dementia diagnosed?

A

Clinical assessment

SPECT scan shows reduced attenuation throughout the brain

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17
Q

What is lewy body dementia?

A

Cognitive decline caused by levy body deposition in the substantia nigra

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18
Q

What are the characteristic clinical features in lewy body dementia?

A

Fluctuating cognitions with lucid periods and recurrent visual hallucinations

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19
Q

What are the symptoms of lewy body dementia?

A 
Difficulty with executive function (multi-tasking and complex tasks)
Parkinsonism
Psychosis
REM sleep disorders
Memory loss in late disease
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20
Q

What worsens the symptoms of lewy body dementia?

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A

Typical antipsychotics

21
Q

What is the difference between the clinical features of Parkinson’s and lewy body dementia?

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A

Time of onset of cognitive decline:
Parkinson’s - cognitive decline at least a year after the onset of parkinsonism
Lewy body - cognitive decline before or at the same time as onset of parkinsonism

22
Q

How is lewy body dementia diagnosed?

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A

SPECT scan shows low dopamine uptake in the basal ganglia

23
Q

What is frontotemporal dementia?

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A

Dementia causing behavioural and speech problems that affects the frontal and temporal lobes

24
Q

What is the age of onset of frontotemporal dementia?

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A

Younger - <70

25
What is a specific examples of frontotemporal dementia?
Pick's disease
26
What is the pathophysiology of Pick's disease?
Picks cells - swollen neurones | Pick bodies - intracytoplasmic filamentous inclusions
27
What is the presentation of frontotemporal dementia?
Change in behaviour and personality - decline in interpersonal skills Apraxia - progressive decline in understanding of words and ability to produce speech Insight is lost relatively quickly but memory is preserved
28
What is the presentation of dementia in Huntington's disease?
Emotional disturbance Cognitive decline Motor disturbance - clumsiness, chorieform movements
29
What is normal pressure hydrocephalus?
A potentially reversible cause of dementia seen in those aged 50-70
30
What are causes of normal pressure hydrocephalus?
Subarachnoid haemorrhage Trauma Idiopathic
31
What is the presentation of normal pressure hydrocephalus?
Ataxia Urinary incontinence Reduced cognitive function
32
How is normal pressure hydrocephalus diagnosed?
CT - hydrocephalus seen | Lumbar puncture would show normal opening pressures
33
What is the management of normal pressure hydrocephalus?
VP shunt
34
What are the cognitive assessment tools - and when should they be used?
Mini mental state exam - to guide whether a pt needs more assessment MOCA and ACE III - both for more in depth assessment
35
What is the non-pharmacological management of dementia?
Support groups Address concerns of the individual Reassurance Measures to maximise QoL - care services, OT assessment, community alarm
36
What are the options for pharmacological management of dementia?
Cholinesterase inhibitors NMDA antagonist Non-specifics: antidepressants, anticonvulsants, benzodiazepines - for associated depression or behavioural disturbance
37
What are examples of cholinesterase inhibitors?
Rivastigmine Donepezil Galantamine
38
How do cholinesterase inhibitors work?
Inhibit acetyl cholinesterase - this increases the amount of ACh in the synapse Not a treatment but can slow cognitive decline and improve behaviour
39
In which conditions are cholinesterase inhibitors most effective?
Alzheimers disease | Also used in lewy body dementia
40
What are the side effects of cholinesterase inhibitors?
``` GI upset Hyper-salivation Vivid dreams Sleeplessness Urinary incontinence ```
41
What is an example of NMDA antagonists?
Memantine
42
What conditions can NMDA antagonists be used in?
Severe Alzheimer's | Second line to cholinesterase inhibitors
43
What are side effects of NMDA antagonists?
Drowsiness Dizziness Constipation Balance disorders
44
What is delirium?
Impaired consciousness with intrusive abnormalities of perception and affect of acute onset and fluctuating course
45
What are the clinical features of delirium?
``` Impairment of consciousness Disturbance of cognition Psychomotor disturbance Disturbance of sleep-wake cycle Emotional disturbance ```
46
What are some drugs that can cause delirium?
``` Anticholinergics Anticonvulsants Anti-parkinsonism drugs Steroids Opiates Sedatives ```
47
What are risk factors for delirium?
``` Increasing age Dementia or other cognitive deficit Previous episode of delirium Peri-operative Existing sensory deficits Immobility Social isolation New environment Stress ```
48
What is the management of delirium?
Identify and treat cause Corroborative history Manage environment, provide support Pharmacological - haloperidol, lorazepam (start low and go slow)
49
What is the prognosis of delirium?
Mean duration 1-4 weeks | Minority can become chronic

Y3 - Psych (12 decks)

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