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Psykiske lidelser > Dementia > Flashcards

Dementia Flashcards

1
Q

What are the Types of Dementia and their respective prevalences?

A

Alzheimers disease 60-70%
Vascular dementia(s) 18-32%
Frontotemporal dementia 10-20%
Lewys Body dementia 5%

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2
Q

What are the types of vascular dementia?

A

Multi-infarct dementia
Subcortical vascular dementia

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3
Q

Which symptoms are required for diagnosis of dementia?

A

Reduced cognitive functioning in at least two domains:

Social cognition
Attention
Memory
Psychomotor speed
Language
Executive functioning
Social judgment

Visuospatial functioning

ICD-11

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4
Q

How long does the impairment in ADL have to be to qualify for dementia?

A

6 months

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5
Q

What does ADL stand for?

A

Activities of Daily Living

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6
Q

How are learning and IQ related in the context of dementia?

A

IQ is affected much later than learning in the development of dementia.

Because learning and IQ are related, can a high IQ but low learning be an early sign of dementia.

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7
Q

Which tests are used for screening dementia?

A

MMSE (Mini Mental State Examination)

ACE (Addenbrooke’s Cognitive Examination)

VFT (Verbal Fluency Test)

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8
Q

What does the MMSE test for?

A

it is 30 items, that test for:

  1. cognition
  2. orientation in space-time
  3. memory
  4. attention
  5. following instructions
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9
Q

What is the scoring of the MMSE?

A

mild: 20-26 points
moderate: 10-19 points
serious: <10 points

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10
Q

Functioning+Points of MMSE scoring: Mild

A

20-26 Points

Person can live at home, with some help.
Driving should be evaluated

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11
Q

Functioning+Points of MMSE scoring: Moderate

A

10-19 Points

Person needs help for living at home

Misunderstandings can happen pga communication/reasoning problems

3A: Aphasia, Agnosia, Apraxia

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12
Q

Functioning+Points of MMSE scoring: Serious

A

<10 Points

Person needs help 24/7
Decision making, conversation strongly impaired

Cognitive issues lead to agresive behaviour, unrest, anxiousness, screaming,…

Many issues cannot be communicated anymore (bedsores, infections,…)

Very late: Motor issues

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13
Q

On which dimensions does the ACE test for?

A

Addenbrooke’s Cognitive Examination test for:

Attention
Memory (episodic, semantic, learning, free/cued recall)
Wordflow
Language
Visual Spacial Orientation (Clock/3D Cube)

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14
Q

For which types of dementia does the VFT test for?

A

Frontotemporal dementia:
- Semantic Issues -

Alzheimers disease:
- Phonemic Issues -

Some reasearch says that it is not enough to disdinguish between them

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15
Q

How does the VFT work?

A

The person has 60 seconds for naming items according to a rule.

Right, wrong, repeating words, subcategories and closeness of words are evaluated.

Less than 14/17 items is a problem

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16
Q

In context of the VFT what are indicators for which dementias?

A

Problems with phonemic similar words -> Frontotemporal dementia

Problems with semantic similar words -> Alzheimers disease

But research shows, that this is not super reliable

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17
Q

How can dementia be postponed?

A

Using cognitive activities

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17
Q

How can ADL of Dementia be improved?

A

Clear structure of the day

Precise and clear communication

Error-Free-Learning (learning from errors cannot happen, because they are not recognized)

Habitualization+Priming

Stabilizing circadian rhythm

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18
Q

Which other issues can increase dementia symptoms?

A

Urinary infection
Dehydration
Metabolism issues
vitamin deficiencies

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18
Q

What are medicines used for treating dementia?

A

Acetylcholinesterase inhibitors (ACE-H)

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18
Q

Which medication should be avoided with dementia?

A

Antidepressiva+Antispychotics, because they can decrease cognitive and motor functioning and increase the chance of accidents

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18
Q

What are the prevalences of dementia with age?

A

< 69 - 0,9%
70-74 2,3%
75-79 6,1%
80-84 17,6%
85-89 31,7%
90+ 40,7%

19
Q

What is the comorbidity of dementia with depression?

A

40%

20
Q

How can multi-infarct dementia be treated?

A

Multi-infarct dementia could be caused by high blood pressure, which could be treated

21
Q

What is a sign of subcortical dementia?

A

Slowed processing and attention, usually before memory issues.

Memory can be retrieved with a cue. -> It is not gone like in other dementias

Problems with the myelination of the axons (derfor SUBcortical)

22
Q

What are signs of multi-infarct dementia?

A

The person often has issues with tasks/skills that are related to the areas affected. They loose more and more specific skills.

Memory issues usually happen later and are often weaker

23
Q

What are risk factors for vascular dementia?

A

Smoking, High blood pressure, Arteriosclerosis, irregular heart beat

(nearly) NO genetic predispositions

24
Q

Prognosis of Vascular dementias

A

usually worse than Alzheimers

25
Q

How can vascular dementias be diagnosed?

A

Through looking for changes in the brain tissue with an MRI

26
Q

What is the prognosis of Vascular dementia?

A

It is worse than Alzheimers.
Around 5 years.
The person is most likely to die of a strike/heart attack

27
Q

When does frontotemporal dementia often start?

A

It starts early, between 45-65
(2/3 of cases)

28
Q

Which brain areas are usually most affected by frontotemporal dementia and what does that lead to?

A

It affects mostly the frontal and temporal areas of the brain

That leads to problems with inhibition and language

29
Q

How is Huntington’s disease connected to dementia?

A

It can lead to symptoms such as dementia

30
Q

What causes Huntington’s disease?

A

Too many CAG repeats in Chromosome 4 lead to a protein becoming toxic.

31
Q

How many CAG repeats are needed for Huntingtons’s disease?

A

> 40 disease will develop

27-40 increased risk

32
Q

At which age does Dementia with Lewy bodies develop?

A

Usually between 60-80 years

33
Q

What are characteristics for Dementia with Lewy bodies?

A

REM sleep behaviour disorder
Visual hallucinations (People/Animals)
-> Do NOT use antipsychotics
Paranoia
Motor problems
It usually starts earlier (50 vs 65)
It progresses faster than other dementias
Short life expectancy (4 years after diagnosis)

Fast fluctuating cognitive functioning

34
Q

How should Dementia with Lewy bodies NOT be treated?

A

With Antipsychotics, that makes the symptoms worse

35
Q

How is Dementia with Lewy bodies and Parkinsons related?

A

Both have problems with the Basal ganglia and people with Parkinsons almost always have high counts of Lewy bodies

36
Q

How many people with Alzheimers have Dementia with Lewy bodies?

A

50%

37
Q

With Alzheimers, which parts of Memory are affected?

A

At first storing in Episodic Memory (Anterograde Amnesia)

Semantic memory in such that connections between facts are lost, not the facts themselves

Procedural memory is not affected

38
Q

How can people with Alzheimers be influenced?

A

By Priming, they activate things that they see directly in their environment

39
Q

What are protective/risk factors for Dementia/Alzheimers?

A

High education
Active work life
Meaningful activities
Hobbies
High IQ
Physical activity in middle age
Emotionally taxing events (moving, loss, trauma)

-> They can give cognitive resources to draw from

-> They delay onset, but can make it worsen faster

40
Q

What are the prevalences of Alzheimers over the ages? What about gender differences?

A

65 years 2%
Doubles every 5 years.
People 80-85 years 16%
85-90 years 33%
> 100 years 66%

Women have a higher chance than men

41
Q

What is the cause of Alzheimers?

A

Senile plaque collects in the dendrites

Tau proteins build up in the nerve cells

-> This kills nervecells -> Atrophy

42
Q

Which area is first affected with Alzheimers?

A

The Hippocampus

43
Q

What determins deadlyness with Alzheimers?

A

Earlier lifestyle choices (smoking, training, learning)
Condition
Depression
Urinary infections

44
Q

How to test for Alzheimers?

A

Testing Cerebral spinal fluid for Tau proteins (that can be done before symptoms start)

Testing for memory problems (recall + recognition)

It can only be diagnosed 100% after death via autopsy

45
Q

Is Dementia mainly genetic?

A

Yes, especially early dementia. In later phases lifestyle has also an effect

46
Q

What are common comorbidities of Dementia?

A

That one often has multiple types of Dementia at the same time

Depression 50%

47
Q

What is usually the cause of death for patients with Alzheimers?

A

Pneumonia (lung infection)

48
Q

What is the Dementia mantra?

A

Use it or loose it!

49
Q

How long is the average lifetime of a person after they are diagnosed with Alzheimers?

A

~ 6 years

Psykiske lidelser (14 decks)

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