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Sem 4 - Nervous System > Dementia > Flashcards

Dementia Flashcards

(45 cards)

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1
Q

What is dementia?

A

Refers to a progressive decline in higher cortical function

Leads to a global impairment of memory, intellect and personality

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2
Q

What are the causes of dementia?

A

Alzheimer’s disease

Dementia with Lewy-bodies

Vascular dementia

Fronto-temporal dementia

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3
Q

Which causes of dementia are the most and least common?

A

Most common - Alzheimer’s disease

Least common - fronto-temporal dementia

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4
Q

What are the signs and symptoms of dementia?

A

Memory deficit

Behavioural changes

Physical difficulties

Language disorder

Visuospatial disorder

Apraxia

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5
Q

What is the most common symptom of dementia?

A

Memory deficit

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6
Q

What are the features of memory deficit in dementia?

A

Short-term memory loss

Then progresses to long-term memory loss

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7
Q

What are the features of behavioural changes with dementia?

A

Altered personality

Disinhibition of abnormal behaviour

Fluctuating emotions

Wandering

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8
Q

What are the features of physical difficulties with dementia?

A

Incontinence

Difficulty swallowing

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9
Q

What are the features of language disorder with dementia?

A

Anomic aphasia

Difficulty understanding language

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10
Q

What is anomic aphasia?

A

Can speak fluently and describe what they mean but cannot name it

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11
Q

What is apraxia?

A

Difficulty with motor planning, inability to perform learned purposeful movements

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12
Q

Why is there such a wide range of signs and symptoms with dementia?

A

Due to any of the lobes of the brain being affected

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13
Q

How is dementia diagnosed?

A

Full history, mini mental state examination, collateral history from family

Full neurological examination

Blood tests

CT/MRI head

Memory clinic follow up

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14
Q

How does the mini-mental state examination work?

A

Four types of cognitive function tested
Give points based on their response
Add up points to get total
Result is baseline of cognitive function

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15
Q

What are the uses of the mini-mental state examination in dementia?

A

Part of diagnosis of dementia

To classify into mild, moderate or severe dementia

Monitor rate of cognitive decline, and hence progression of dementia

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16
Q

Why is a full neurological examination done in patients with dementia?

A

To rule out other causes

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17
Q

What blood tests are done for patients with dementia? Why?

A

Thyroid function tests

Vitamin B12

To rule out thyroid disorder, vitamin deficiency, as these can present with an acute reversible cognitive decline

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18
Q

What is used to distinguish between delirium and dementia?

A

Confusion assessment method CAM

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19
Q

How does the Confusion assessment method work?

Study These Flashcards
A

Acute change or fluctuating mental status

Altered consciousness

Inattention

Disorganised thinking

Give a point for each feature
Add up points
Total of 2 or more means delirium

20
Q

What is meant by altered consciousness in the Confusion assessment method?

Study These Flashcards
A

E.g. hypoactive meaning withdrawn

E.g. hyperactive meaning agitated

21
Q

How can inattention be tested for?

Study These Flashcards
A

Asking the patient questions, can’t keep to the point

Asking the patient to count backwards, they can’t do this

22
Q

What are the causes of delirium in the elderly?

Study These Flashcards
A

Infection

Pain

23
Q

How is delirium treated?

Study These Flashcards
A

Treat underlying cause, gives return to baseline cognitive function

24
Q

Why are CT/MRI head scans done for a patient with dementia?

Study These Flashcards
A

To rule out vascular pathology, tumours

As these can present with an acute cognitive decline

25
What is seen on a CT scan of a patient with dementia?
Atrophy of cortical matter Dilation of ventricles
26
What can be seen on an MRI scan of a patient with dementia?
Thinner gyri Wider sulci
27
What is the rate of cognitive decline with Alzheimer’s disease?
Steady decline over a few years
28
What is the rate of cognitive decline with vascular dementia?
A vascular event occurs e.g. stroke, causing a sudden drop in cognitive function Then patient continues with this level of cognitive function until the next vascular event
29
What is the rate of cognitive decline with Lewy-body dementia?
Cognitive function increases and decreases for short periods of time But there is an overall cognitive decline
30
What is the macroscopic pathology of Alzheimer’s disease?
Loss of cortical grey matter and subcortical white matter Narrow gyri, wide sulci Ventricular dilation
31
What is the microscopic pathology of Alzheimer’s disease?
Amyloid beta plaques Neurofibrillary tangles
32
How do amyloid beta plaques form?
Breakdown of amyloid precursor protein into amyloid beta peptide Occurs excessively in patients with Alzheimer’s disease
33
What are the stages of Alzheimer’s disease?
Mild Moderate Severe
34
What are the features of mild dementia?
Minor memory loss, short-term memory loss
35
What are the features of moderate dementia?
Confusion Poor judgement Difficulty communicating Behavioural changes e.g. anger, anxiety
36
What are the features of severe Alzheimer’s disease?
Patients are completely incapacitated Violent episodes of aggression
37
What is the pathology of vascular dementia?
Atherosclerosis of blood vessels supplying the brain | Reduced blood supply to parts of the brain, ischaemia and infarction
38
How is vascular dementia managed?
Reduce risk factors of cardiovascular disease e.g. hypertension, hyperlipidaemia To prevent further vascular events and cognitive decline
39
What is pathology of dementia caused by Lewy-bodies?
Lewy bodies in the cortex and substantia nigra
40
What other symptoms can dementia with Lewy-bodies cause? Why?
Parkinson’s symptoms | Due to substantia nigra being affected too
41
What is the pathology in fronto-temporal dementia?
Tau proteins form Pick bodies in frontal lobe
42
What are the particular signs and symptoms in fronto-temporal dementia? Why?
Behavioural changes e.g. altered personality, disinhibition of abnormal behaviour Language expression decreases to aphasia Due to frontal lobe dysfunction
43
How is dementia managed?
Social care e.g. risk assessment, care needs, mental capacity act Drugs Memory aids e.g. orientation boards, life stories Therapies e.g. pets, babies
44
What drugs are used to manage dementia?
Cholinesterase inhibitors
45
How effective are cholinesterase inhibitors at managing dementia?
Only prevent progression of Alzheimer’s disease in a few patients for a few months

Sem 4 - Nervous System (25 decks)

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