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Flashcards in Dementia Deck (82)
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1

Definition (4)

Acquired
General
Progressive impairment of cognitive function
Impaired activity of daily living

2

Cognitive functions impaired

Memory
Recall
Orientation
Language
Abstraction

3

Prevalence at 60yo and doubling time

1% at 60, doubles every 5 years

4

Prevalence at 85yo

30-50%

5

Categories of dementia (Vitamin D Vest)

Primary degenerative
Vascular
Infectious
Trauma
Rheumatological
Neoplastic
Vitamin, Intracranial tumor, Trauma, Anoxia, Metabolic, Infection, NPH, Degenerative, Huntingtons, Vascular, Endocrine, SOL, Toxic

6

Reversible causes of dementia

Alcohol (withdrawal, intoxication)
Medications (benzodiazepines, anticholinergics)
Heavy metal toxicity
Hepatic/renal failure
Wilsons
Vit B12
Hypo/hyperglycemia
Cortisol
Thyroid
Normal pressure encephalus
Depression
Intracranial tumor
Subdural hematoma

7

Common differentials

MCI
Delirium
Depression
Alzheimers
Vascular dementia
Lewy body dementia

8

Uncommon differentials

Amnesia
Aphasia
FTD
Parkinsons
Huntingtons
Brain tumors
Cushings
Hypothyroid
+PTH
SLE
Syphillis
Wilsons
TB
Lyme disease
CJD

9

Primary neurodegenerative causes (4) with key clinical features

Alzheimers- Anterograde amnesia, aphasia, apraxia, agnosia, disturbance in executive function
Dementia with lewy body- visual halluncinations, parkinsonism, fluctuating cognition
Frontotemporal dementia- behavioural / language presentation
Huntingtons disease- chorea

10

Vascular causes of dementia with key clinical features

Multi-infarct dementia->acute onset, stepwise, focal neurological signs, dysexecutive
Vasculitis->systemic S&S of vasculitis

11

Infectious causes (6) with key clinical features

HIV
Syphillis->ataxia, myoclonu, tabes dorsalis
Chronic encephalitis
Chronic meningitis->F,H,N, meningismus, localising neurological defects
Abscess->+ICP, localising neuro signs
CJD->rapidly progressive, myoclonus

12

Traumatic causes

DAI, subdural, epidural hematoma->history, +ICP, papilloedema, localising neuro signs

13

Neoplastic causes

Mass effect, edema, hemorrhage, seizure->+ICP, localising signs, systemic symptoms of cancer

14

Emergency consideration for suspected dementia

Delirium

15

Initial test to order when delirium not ruled out

FBC, UEC, fasting blood glucose, urinalysis MCS, UDS

16

Importance of herpes simplex

Most common cause of sporadic encephalitis

17

How does HSV encephalitis present

Acute febrile illness
Altered mental status
Headache, seizure, focal neurology

18

What to give in all cases of suspected HSV encephalitis

Aciclovir

19

History

Psychiatric evaluation
Premorbid function
Geriatric giants
Changes in cognition, function, personality, language, skills, behaviour
Abrupt, step wise, gradual->vascular
Acute->infection, metabolic, lesion, medication, stroke, hydrocephalus
Rapid decline->delirium
Gait abnormalities, urinary incontinence
Change in ability to manage ADLs, and instrumental activities
Family history
Drug and alcohol
Past medical history
Stroke risk factors->hx, TIA, hypertension, cholesterol, diabetes, CAD, AF
Parkinson's disease inquiry
Transient neurological->gait, incontinence

20

What are the activities of daily living (6)

Eating
Bathing
Dressing
Toileting
Transferring
Continence

21

What are the instrumental activities of daily living (8)

Housework
Cooking
Cleaning
Shopping
Finances
Telephone
Transport

22

Cognitive assessment tool and score when indicates an abnormal result

MMSE

23

Components of MMSE

Orientation
Registration
Attention and calculation
Recall
Language

24

Components of language assessment (6)

Name two objects
Repeat "no ifs, ands, or buts"
Follow a three stage command
Read and obey the following
Write a sentence
Copy the design

25

Physical examination- what to test and what it may mean

General: vitals, BP, hearing and vision
CN->vascular may have visual field defects. Ataxia, nystagmus and lateral gaze palsy may suggest alcohol
Motor->vascular and hemiparesis
Sensory->peripheral neuropathy may indicate vitamin, toxic metabolic
Co-ordination and gait->vitamin B12, NPH, vascular
Reflexes-> may have primitive, asymetric in vascular, myoclonus in CJD
CV->hypertension, dysrhythmias, PVD, vascular disease, CHF

26

What are the geriatric giants in history

Confusion, incontinence, falls, polypharmacy
Memory and safety
Behavioural

27

Behaviour issues in dementia

Mood
Anxiety
Psychosis
Suicide
Personality
Aggression

28

Safety issues in dementia

Wandering
Leaving electrical items on
Losing objects
Leaving doors unlocked

29

Laboratory investigations

UEC, glucose
FBC w. differential
TSH
Vit B12
Folate
ESR
CRP
Urinalysis
Urine MCS
CXR

30

Other tests to consider based on history

HIV
Urine toxicology
Collage vascular
Urinalysis for heavy metals
Syphyllis serology
CSF
FDG-PET