dementia Flashcards
investigation for dementia (in GP)
10-point cognitive screener, 6- item cognitive impairment test
blood tests: FBC, U&Es, LFTs, calcium, glucose, ESR/CRP, TFTs, vit B12 and folate
refer for CT head
pharmacological management of alzheimer’s disease
3 acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine)
memantine (NMDA receptor antagonist) is second line (can be used as an add on in moderate or severe)
contraindications and adverse effects of donepezil
contraindicated in patients with bradycardia
adverse effects: insomnia
characteristic pathological feature of lewy body dementia
alpha-synuclein cytoplasmic inclusions (lewy bodies) in substantia nigra, paralimbic and neocortical areas
features of lewy body dementia
progressive cognitive impairment (occurs before parkinsonism)
- may be fluctuating
parkinsonism
visual hallucinations
investigations for lewy body dementia
clinical diagnosis
SPECT
management of lewy body dementia
both acetypcholinesterase inhibitors (donepezil, rivastigmine) and memantine used
three types of frontotemporal lobar degeneration
frontotemporal dementia
progressive non fluent aphasia
semantic dementia
presentation of frontotemporal dementias
onset before 65
insidious onset
relatively preserved memory and visuospatial skills
personality change and social conduct problems
focal gyral atrophy with knife-blade appearance
frontotemporal dementia / pick’s disease
vascular dementia subtypes
stroke related VD
subcortical VD- caused by small vessel disease
mixed dementia- VD and Alzheimer’s
presentation of vascular dementia
several months or years of sudden or stepwise deterioration of cognitive function
diagnosis of vascular dementia
comprehensive history
formal screen of cognitive impairment
MRI scan- shows many infarcts and extensive white matter changes
