DEMENTIA Flashcards
(28 cards)
What are the major domains of cognition?
Declarative episodic memory
Executive cognitive functioning
Visuospatial function
Language
What is dementia?
Deterioration in cognition that impairs ADLs
What are the differences between dementia and delirium?
Delirium is acute onset, has in attention, can also get hallucinations mood disturbances involuntary movements and irrational flight of ideas.
What are the key pathological changes in AD?
Cerebral atrophy
Neuronal loss
Amyloid plaques and neurofibrollary tangles.
What are RFs for alzheimers?
Age
FHx
Low cognitive reserve (reduced brain function)
Low physical activity, smoking, alcohol
Protective factors against AD?
Higher level of education
Mentally active
Socially active
Reg exercise and diet
What are the types of dementia?
Alzheimers Lewy body Vascular Frontotemporal - Parkinson's
How do you differentiate Lewy body with Parkinson’s?
Parkinson’s disease dementia will have long standing PD
DLB has visual hallucinations, falls, fluctuating alertness.
What is the clinical presentation of AD?
Early - atrophy of medial temp lobes -> benign forgetfulness, diff with ADLs but 20% present with language (first word diff), executive (organisational diff), visuospatial (navigational difficulty)
Middle - unable to work, easily confused, language impairment from atrophy of LATERAL POSTERIOR TEMPORAL CORTEX
Late - atrophy of FRONTAL LOBE -> loss of judgement and reasoning
End stage - rigid, mute, incontinent and bedridden.
What changes would you expect on MMSE of AD?
Yearly decline in 3-3.5 points.
Will be affected by level of education and language.
What test should you use for fronto-temporal?
Frontal assessment battery not MMSE
What are the key clinical features of alzheimers dementia?
Chronic progressiveness Atleast two areas of cognition - agnosia - amnesia - ataxia - aphasia - executive dysfunction
Ix?
LAB
CBE EUC LFT CRP BGL urinalysis
TFT B12/FOLATE
HIV/SYPHILLIS if expected
RAD
CT/MRI head
What are the complications of AD?
Aspiration (most common) SEPSIS PE HEART DISEASE MALNUTRITION
Management of dementia?
Non pharm
Nutrition - if poor associate with morbidity and mortality -> nutritional supplements, risk of aspiration
Exercise
Psychosocial - counselling support (respite), driving ability, consider Advance Directives
Pharm (limited use)
Anticholinesterases (MMSE 10-24), mild MMSE improvement of 1-2 points, contraindicated
Memantine for mod to severe
Only PBS if given prior to anti-chol I.e 1st line.
Why use Anticholinesterases?
Prevents break down of acetylcholine.
Hence increases level and duration
What is ADVANCED DIRECTIVE??
‘Advance directive’ is a general term describing
• Enduring power of attorney for financial matters
• Enduring power of guardianship for lifestyle (e.g. nursing home) and health care
• Medical power of attorney for medical treatment
• Advance health care directive: written statement stating sort of medical treatment the individual may or may not want after he/she is no longer able to make these decisions
What are features of LBD?
Visual hallucinations
Parkinsonism
Fluctuating course
Features of frontotemporal?
Executive so dysinhibition and disorganisation
Personality changes
What drug shouldn’t be given in LBD?
Typical Antipsychotic.
Risk of NEURO malignant syndrome (reduced dopamine levels). Therefore give quitepine.
What are reversible dementia causes?
Infectious/inflammatory
- HIV, SYPHILLIS, pneumonia, UTI
IATROGENIC, intoxication
- alcohol
- Anticholinergics, benzodiazepines
Endocrine/metabolic
- hypothyroidism
- glucose
- organ failure
- electrolyte
- b12/folate
Neurological
- SOL
- TBI
Limits of MMSE?
Does not distinguish DDD Language/cultural Education level Doesn't test all cognitive - executive Sensory and motor deficits - tremor, arthritis, visual impairment
What tests after MMSE?
RUDAS
CLOCK DRAWING
FAB
GDS
What is Memantine?
NMDA RECEPTOR ANTAGONIST.
For moderate to severe AD.
Benefit greatest with cholinesterase inhibitor but is not PBS when coupled.
