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54 CNS > Dementia > Flashcards

Dementia Flashcards

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1
Q

DSM-5 criteria (A)

A

Significant cognitive decline in 1 or more cognitive domain:
- Learning and memory
- Language
- Executive function
- Complex attention
- Perceptual-motor
- Social cognition

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2
Q

DSM-5 criteria (B)

A

The cognitive deficits interfere with independence in everyday activities.

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3
Q

DSM-5 criteria (C)

A

The cognitive deficits do not occur exclusively in the context of a delirium.

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4
Q

DSM-5 criteria (D)

A

The cognitive deficits are not better explained by another mental disorder.

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5
Q

Areas of manifestation of dementia

A

Cognitive
Psychological
Behavioural
Sleep
Physical

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6
Q

MMSE score for mild AD

A

20-24 (out of 30)

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7
Q

MMSE score for moderate AD

A

10-19 (out of 30)

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8
Q

MMSE score for severe AD

A

<10 (out of 30)

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9
Q

MMSE score for severe AD

A
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10
Q

Types of dementia

A
  1. AD
  2. Vascular dementia
  3. Lewy body dementia
  4. Frontotemporal dementia
  5. Mixed type
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11
Q

Modifiable risk factors

A
  1. Age (5-10% >65y/o, 50% >85y/o)
  2. Female
  3. Ethnicity: black, Hispanic
  4. Genetics: APOE*4
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12
Q

Non-modifiable risk factors

A
  1. HTN
  2. DM
  3. Binge drinking
  4. Smoking
  5. Limited physical activity
  6. Obesity
  7. Hearing loss
  8. Depression
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13
Q

Clinical evaluations

A
  • Medical history (both patient and family/friend/caregiver)
  • Functional deficits
  • Cognitive deficits
  • Absence of alternative conditions
  • Labs (not routine)
  • Imaging (adjunct)
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14
Q

Laboratory testing (rule out)

A

Thyroid & Vitamin B12

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15
Q

Structural brain imaging (AD)

A

Generalised or focal cortical atrophy, often asymmetrical

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16
Q

Structural brain imaging (vascular)

A

Brain infarcts or white matter lesion

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17
Q

Structural brain imaging (frontotemporal)

A

Frontal lobe or anterior temporal lbe atrophy

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18
Q

Structural brain imaging (others)

A

Brain mass (tumour), hydrocephalus

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19
Q

MoCA scoring (mild)

A

18-25

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20
Q

MoCA scoring (moderate)

A

10-17

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21
Q

MoCA scoring (severe)

A

<10

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22
Q

Pathophysiology of AD

A
  1. Senile plagues
  2. Neurofibillary tangles (NFTs)
  3. Cholinergic deficits
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23
Q

Major constituent of senile plaques

A

Aggregates of b-amyloid peptide

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24
Q

How is Ab peptides derived?

A

Cleavage of amyloid precursor proteins (APP) via action of b- and γ-secretases

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25
What is the alternative pathway of Ab peptides?
a- and γ- secretases
26
Major constituent of NFTs
Hyper-phophorylated tau protein aggregates forming paired helical filaments (PHF)
27
What are tau?
Tubulin associated protein for microtubule stabilisation & intracellular transport
28
Goals of AD management
1. Slow progression 2. Disease modifying (not available) 3. Delay institutionalisation - Support & education for caregivers - Manage behavioural problems
29
What are the commonly used anti-cholinesterase inhibitors?
1. Donepezil 2. Galantamine 3. Rivastigamine
30
MOA of AIs
Inhibits acetylcholinesterase enzyme from breaking down EACh, increasing duration and level of EACh at the synaptic cleft for cholinergic neurotransmission
31
How long should AIs be titrated to reach target dose and minimise AEs?
4-8 weeks
32
Side effects of AIs
Cholinergic hyper activation: N?V, diarrhoea
33
Less common side effects of AIs
Muscle cramp Bradycardia Loss of appetite Increased gastric juice secretion
34
Initial dose of Donepezil
5mg OD in the evening (oral) 5mg/day weekly (patch)
35
Usual range of Donepezil
5-10mg (mild-moderate) 10-23mg (moderate-severe)
36
Dosage adjustment - Donepezil
No adjustment required
37
Initial dose of Rivastigmine
1.5mg BD (oral) 4.6mg/day (patch)
38
Usual range of Rivastigmine
3-6mg OD (oral) 9.5-13.3 mg/day (patch)
39
Rivastigmine metabolism
Renal
40
Dosage adjustment - Rivastigmine
Renal, hepatic, low body weight - consider lower dose
41
Initial dose of Galantamine
4mg OD (oral) 8mg OM (ER)
42
Usual range of Galantamine
8-12mg BD (oral) 16-24mg OD (ER)
43
Dosage adjustment - Galantamine
Moderate renal/hepatic impairment: max daily = 16mg Not recommended for severe renal/hepatic impairment
44
Efficacy monitoring of AIs
Day to day life improvement
45
Non-pharmacological 1
Cognitively stimulating activities (reading, games)
46
Non-pharmacological 2
Physical exercise (aerobic and anaerobic)
47
Non-pharmacological 3
Social interactions with others (family events)
48
Non-pharmacological 4
Healthy diet such as Mediterranean diet
49
Non-pharmacological 5
Adequate sleep (uninterrupted sleep and with sufficient number of hours)
50
Non-pharmacological 6
Proper personal hygiene (regular bathing)
51
Non-pharmacological 7
Safety, including inside the home and outside
52
Non-pharmacological 8
Medical and advanced care directives (designation of lasting power of attorney)
53
Non-pharmacological 9
Long term health care planning
54
Non-pharmacological 10
Financial planning
55
Non-pharmacological 11
Effective communication
56
Non-pharmacological 12
Psychological health (participating in personally meaningful activities such as playing music)
57
BPSD 1
Agitation & aggression
58
BPSD 2
Depression
59
BPSD 3
Anxiety
60
BPSD 4
Apathy
61
BPSD 5
Psychotic symptoms
62
BPSD 6
Wandering
63
BPSD 7
Nocturnal disruption

54 CNS (13 decks)

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