Dementia Flashcards
(42 cards)
What is dementia?
An acquired impairment of higher mental functioning (intellect, memory personality) occurring in an alert patient. Usu progressive, very few cases are reversible.
Main features of dementia?
- Development of multiple cognitive deficits
- Condition sufficiently severe to cause impairment in function
- Chronic, progressive
- Cannot be diagnosed during delirium or depression
What are examples of the cognitive deficits of dementia?
Short term memory + one or more of:
- Aphasia (language disturbance)
- Apraxia
- Agnosia (object recognition)
- Executive function
Population diagnosed with dementia?
~8%
How does the prevalence and incidence of dementia change with ageing?
Prevalence and incidence double every 5 years after 60y. 20% over the age of 80 have dementia.
What conditions can resemble dementia?
- Normal changes with ageing
- MCI
- Delirium
- Depression
- Mild-mod intellectual disability
How does memory change in the elderly?
Normal decline in speed of processing, some decrease in recent memory.
Ax: stress, Rx, mood, pain, bereavement
What is MCI?
Memory and other cognitive complaints noted subjectively and objectively without apparent impact on general function.
What is the progression for individuals presenting with amnestic MCI?
Of pts p/w with prominent memory loss , over 50% will develop dementia in 5y
What are the common causes of dementia?
-Alzheimer’s (50-70%)
-Vascular (10-20%)
-Frontal lobe
-Lewy Body
=90% dementias
What are less common causes of dementia?
- Alcohol related
- Huntington’s
- Hydrocephalus
- Hypothyroidism
- B12 deficiency
- Neurosyphilis
What are the major proven RFx for AD?
- Age
- Down syndrome
- Genetic predisposition (APOE)
- Ethinicity
Which gene is associated with AD?
APO E4
What are the other RFx for AD?
- HTN
- DM
- Hyperlipidemia
- Smoking
- Obesity
- Significant head injury
- Nutritional (on top of vascular RF modification effect): ?fish, ?mediterranena diet ?fruti and vegie
What are AD protective factors?
- Education
- Physical activity
- Social engagement
- Cognitive activity
Time course of AD?
Insidiously progressive
- gradual onset
- steady worsening
Main features affected AD?
- New learning (amnestic features)
- Praxis
- Language
Neuro exam AD?
Normal until late stages
Structural imaging AD?
Often normal;
-may have some degree of atrophy esp hippocampus and adjacent
What pharm can be used in AD?
Cholinesterase inhibitors e.g. donepezil, galantamine, rivastigmine
Success of AD pharm Rx?
Benefits modest, 30-60% show clinical benefit.
Aim to delay progress and improve function.
Major features of vascular dementia?
- focal neuro signs
- attention, exec fun affected
- insight preserved
- radiol shows infarction
- Sudden onset, stepwise progression
- Overactive bladder and disturbance of gait common early signs
What affects VD presentation?
Location of lesions i.e. subcortical changes produce executive function changes often a/w gait disturbance and incontinence
How does fronto temporal dementia present?
- Early: behavioural changes
- Executive dysfunction
- Language disturbance (poor verbal fluency)
