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402 - Exam - CNS > Dementia > Flashcards

Dementia Flashcards

(61 cards)

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1
Q

?

A

• problems with reasoning
• problems with communicating
• personality change
• loss of nerves

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2
Q

What age is early dementia

A

<65

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3
Q

The types of dementia?

A

Alzheimer’s - most common
Vascular
Lewybody
Frontaltemporal

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4
Q

What is declarative memory

A

When thinking about something consciously - a friends birthday

Two types
• eposodic - most affected
• semantic

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5
Q

Non-declarative memory?

A

Operates unconsciously - riding a bike without consciously thinking about the movements

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6
Q

Which part of the brain is affected in Alzheimer’s and what are the features

A

Hippocampus - memory

• brain atrophy
• amyloid plaques
• tau tangles

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7
Q

Pathiology of Amyloid plaques

A

APP gene is found in chromosome 21

It is metabolized to form beta amyloid, which clumps together to form amyloid plaques

These plaques damage brain cells that make Acrtylecholine, decreasing their levels and causing cognitive decline

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8
Q

Pathiophysiology of Tuaism

A

Tau is a key protein needed in the structure of neurons

Neurofibrially tangles occur due to the addition of too many phosphate groups

These tangles distrust neurons that produce Acetylcholine

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9
Q

Are amyloid plaques intrasellcuar or extra cellular

A

Extra cellular

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10
Q

Are tau tangles intra or extra cellular

A

Intra

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11
Q

Vascular dementia pathiophysiology

A

Reduced blood flow to the brain due to damaged blood vessels

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12
Q

Features of vascular dementia

A

White matter damage

Vascular changes

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13
Q

What can trigger vascular dementia

A

TIA, stroke, HTN, surgery

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14
Q

Pathiology of dementia with meet bodies

A

Clumps of alpha synuclien form affecting communication between cells

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15
Q

Features of Lewy bodydementia

A

REM sleeping disorders
Visual hallucinations!!
Parkinsomnia (rigidity, hallucinations, testing tremur)

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16
Q

Frontaltemporal dementia Pathiology

A

Tau tangles cause cell death

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17
Q

Features of Frontaltemporal?

A

Impulsive behaviour

Language difficulty

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18
Q

How is the circadian rhythm affected in Alzheimer’s

A

The circadian rhythm is the body’s internal clock - regulated sleep and wake cycle

It is controlled by the hypothalamus and melatonin

In Alzheimer’s melatonin production is disrupted cause INSOMNIA (aka sundowning)

Sundowning causes increased confusion, agitation and anxiety in the evening

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19
Q

Risk factors

A

Older age
Learning difficulties- Down syndrome
Mutation in APP gene
Parkinson’s
CVD, cerebral vascular disease

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20
Q

Differential diagnosis

A

Hypothyroidism
Vitamin deficiency
Mild cognitive impairment
Depression

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21
Q

What cognitive tests can be used

A

10 CS

6 CIT

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22
Q

What bloods can be taken to rule out cognitive decline

A

• thyroid
• vit b12
• calcium
• FBC
• LFT
• HbAlc
• CRP
• ESR

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23
Q

Who will federal be made to

A

Memory clinic

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24
Q

What are the non pharamacolgical management in mild - mod

A

Cognitive rehabilitation

Combative stimulation therapy

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25
What is management of mild to mid AD
AChE inhibitors Donzapil Rivastigmine Galantamine
26
What if these are CI
Mementine
27
Mod to severe AD
+ memantine
28
Severe AD
Memantine
29
Lewy body - management mild to moderate
1st line- donzapil or rivastigmine If ci - galantine
30
Severe management of least body
Same as mild to mod But if AChE inhibitors give Memantine
31
Management of vascular
AChI or mementine ONLY IF AD, Lewy body or Parkinson’s is suspected
32
MOA of AChE inhibitors
Reversibly inhibits acetylcholinesterase to increase acetylcholine levels improving cognition
33
Caution
Asthma COPD Bradycardia Peptic ulcers Renal impairment Heart block (arythmia) or sick sinus syndrome - AVOID
34
Which drugs should this be used in caution with // interactions
Bradycardia agents - beta blockers (atenolol), CCB - increased risk of bradycardia Anticholinergics Enzyme inhibitors- grapefruit juice, antifungals, HIV meds Enzyme inducers - ridampicin
35
ADRs
N, V Ulceration Anorexia - appetite decrease Agitation Hallucinations Insomnia Sezuires Urinary incontinence Bradycardia, AV block
36
Which AChI inhibitor requires monitoring for body weight
Rivastigmine
37
Which drug also modulates nicotic receptors and is derived from snow drops?
Galantine
38
Memantine moa
NMDA antagonist to block excessive glutamate Voltage dependent Non competitive
39
ADRs
Drowsiness Dizziness Constipation HTN
40
Interaction
Warfarin - increasing anticoagulation Other NMDAs - ketamine, amantadine Amantadine (increases CNS toxicity)
41
Which agents should be avoided in bradycardia
AcHi inhibitors
42
Which patients with which conditions should are caustioned in memantine
Eplieptic
43
What are non-cognitive symptoms called in dementia and what are they
Behavioral and psychological symptoms of dementia BPSD Aggression, agitation, hallucinations, anxiety, sleep disturbances
44
What are the only 2 uk licensed antipsychotic drugs in dementia
Haloperidol and risperidone
45
What should you do before giving these
Rule out infection
46
When should you give antipsychotics
If patient is in danger to themselves or others
47
Why should antipsychotics be avoided in the elderly
Causes stoke or death Risperidone increases risk of falls
48
In which condition should they be caustioned in
Parkinson’s, Lewy body dementia
49
Management of anxiety or depression in dementia
only CBT and relaxation Antidepressants only for pre existing mental health issues
50
How long should antipsychotics be used for
6 weeks then review
51
MMSE scoring in dementia ranges from 0-30 Score of <10
Severe dementia
52
Score of 10 -19
Moderate
53
20-24
Mild
54
25-29
Mild cognitive impairment
55
Chronic alcohol consumption can reduce the levels of which vitamin
Vitamin b1 thiamine
56
What symptoms occur
Lack of sight Blunt behavior
57
Management?
High dose thiamine replacement
58
Which drug comes as a transdermal patch
Rivastigmine
59
Antipsychotic drugs can worsen the motor features of which conditions
Parkinson’s or dementia with Lewy bodies
60
hemiparesis (partial paralysis) is a feature of what type of dementia
Vascular
61
Loss of episodic memory is a feature of which dementia
AD

402 - Exam - CNS (10 decks)

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