Dementia Flashcards
(71 cards)
1
Q
What is dementia?
A
syndrome that affects all part of the brain
leads to impairment and deterioration of cognition
so you get a decline of day to day function in clear consciousness
2
Q
What is the ICD 10?
A
lists factors needed to be present to diagnose dementia
3
Q
What things are seen when people have dementia?
A
loss of memory hard to learn new information environment awareness is preserved cognitive abilities decline= planning, organising less emotional control
4
Q
How long should the symptoms of dementia be present for it to be diagnosed as dementia?
A
6 months
5
Q
How is Alzheimer’s dementia defined?
A
- Impaired memory + 1 of:
aphasia (impairment of language)
apraxia (motor disorder where a person has difficulty planning to perform a task)
agnosia (inability to process sensory information)
executive dysfunction (lack of organization)
6
Q
What are the different types of dementia?
A
Alzheimer’s dementia (50-60%)
Vascular dementia (15-20%)
Dementia with Lewy bodies (10-15%)
Frontotemporal dementia (4-6%)
7
Q
What is the overall prevalence of dementia in over 65’s?
A
7%-10%
8
Q
What do you need to do to diagnose dementia?
A
- history
- PMH
- FH
- COLLATERAL HISTORY - physical exam
- cognitive tests
- other investigations
9
Q
What test is used to look at cognitive function?
A
ace III
10
Q
What does the ace III cognitive test look at?
A
impairments on attention
impaired memory
mild impairment on naming things
language and spatial recognition is intact
11
Q
What will a CT/ MRI scan show in a dementia patient?
A
hippocampal atrophy
12
Q
What non-cognitive features arise with dementia?
A
depression anxiety hallucination wandering angry agitated apathy= lack of interest
13
Q
Other than memory deficits what other problems do patients with ALZHEIMER’S face?
A
7 A'S anosognia agnosia aphasia apraxia altered perception amnesia apathy
14
Q
What is anosognia?
A
unaware something is wrong with the person
15
Q
What is agnosia?
A
cant recognise things through their senses
16
Q
What is aphasia?
A
loss of language ability
17
Q
What is apraxia?
A
cant do motor functions
18
Q
What is altered perception?
A
misinterpretation of information from sensory organs
19
Q
What are the risk factors for alzheimer’s?
A
increasing age diabetes hypertension atrial fibrillation family history genes associated with dementia (Apo E4) hypothyroidism head trauma
20
Q
What is the mini mental state examination score of an alzheimer’s patient?
A
between 10-26
score reduces by about 3 points per year
21
Q
What is the pathophysiology of alzheimer’s?
A
neuronal cell death- mainly cholinergic
amyloid plaques
neurofibrillary tangles
22
Q
What are amyloid plaques made of?
A
beta amyloid
cleaved from amyloid precursor proteins
23
Q
On what chromosome are amyloid precursor proteins found?
A
21
24
Q
What do neurofibrillary tangles do?
A
damage axons of neurones
disrupt neurones cytoskeleton leading to neuronal dysfunction and death.
25
Which people are most likely to develop dementia?
people with mild cognitive impairment and hippocampal atrophy
26
What is vascular dementia?
happens after stroke
| caused by reduced blood supply to the brain due to diseased blood vessels- leading to neuronal cell death
27
How many types of vascular dementia are there and what are they?
2: small vessel and large vessel
28
What is large vessel disease?
Strategic single infarct e.g. thalamus
Multiple cortical GREY MATTER infarcts (MID)
20-30% post-stroke develop dementia (not immediately after the stroke)
29
What is small vessel disease?
vascular dementia form
multiple lacunar infarcts in WHITE MATTER
can also happen bc of occluded single deep artery in the brain
30
What is the history like of a patient with vascular dementia?
stepwise deterioration (deteriorates, stable, deteriorates, stable)
31
What could the ace III test show for a vascular dementia patient?
episodic memory loss less severe than alzheimer's
| executive function affected
32
How can vascular dementia be diagnosed- using what test?
diagnosed/screened for using the hachinski ischaemia
33
What is the difference between lewy body dementia and parkinson's dementia?
parkinsons dementia= IF THEY HAVE HAD PARKINSONIAN MOTOR SYMPTOMS 12 MONTHS PRIOR TO GETTING DEMENTIA
lewy body dementia= if patient has COGNITIVE AND MOTOR SYMPTOMS DEVELOPED IN 12 MONTHSOR if cognitive symptoms occur before motor symptoms
34
What is lewy body dementia?
if patient has COGNITIVE AND MOTOR SYMPTOMS DEVELOPED IN 12 MONTHS OR if cognitive symptoms occur before motor symptoms
35
What is parkinsons dementia?
IF THEY HAVE HAD PARKINSONIAN MOTOR SYMPTOMS 12 MONTHS PRIOR TO GETTING DEMENTIA
DIRECT CONSEQUENCE OF PARKINSONS
36
What is the pathophysiology of lewy body dementia?
- buildup of neuronal inclusions (small build up of substances)
- abnormally phosphorylated neurofilaments, ubiquitin and alpha synuclein
- they found in paralimbic areas, neocortical areas and the brain stem
- reduction in Ach
- degeneration of axons and dendrites (lewy neurites)
- buildup of amyloid plaques
37
What happens in the neocortical region of the brain?
neocortex involved in sight and hearing
38
What happens in the paralimbic region of the brain?
paralimbic area is involved in emotion processing, goalsetting, motivation and self-control
39
What is clinically seen in lewy body dementia?
REM sleep disorder- vivid dreams
hallucinations
parkinsonism
falls
40
What is frontotemporal dementia known as?
Pick's disease
41
Who can frontotemporal dementia affect?
people younger that 65 (pre-sentile dementia)
42
What is seen in frontotemporal dementia?
tau protein bodies
| atrophy of frontal and anterior temporal lobe
43
What are clinical features of frontotemporal dementia?
```
language problem
- semantic aphasia
- progressive non fluent aphasia
behviour problem
- apathy
- personality change
```
44
What is semantic aphasia?
lose meaning of words
45
What is progressive non fluent aphasia?
lose ability to speak
46
How is alcohol linked to dementia?
alcohol affects frontal lobe- personality change
alcohol= drunk= can fall- vascular problems
can get:
wernicke's encephalopathy
korsakov's
47
What is wernicke's encephalopathy ?
syndrome: impaired consciousness, ataxia, opthalmoplegia (paralysis of muscles around the eye)
Wernicke's encephalopathy is an acute syndrome caused by dietary thiamine deficiency, often the result of alcoholism. It is characterised by a triad of symptoms; impaired consciousness, ataxia and opthalmoplegia.
48
Why do you get wernicke's encephalopathy ?
dietry thiamine deficiency- often result of alcoholism
49
What is korsakov's?
amnesia- cant put down new memories but fine with old ones
| confabulate
50
Who is involved in care of dementia patient?
nurse, psychiatrist, OT, social worker, psychologist
51
What pharmacological management do you need for dementia patients?
Acetylcholinesterase inhibitors
| Memantine
52
What are examples of Acetylcholinesterase inhibitors?
donepezil (most commonly used)
rivastigmine (comes as a patch, also licensed for lewy body dementia)
galantamine
53
What do Acetylcholinesterase inhibitors do?
- increase Ach levels
- improve behavioural problems
- improve visual hallucination (lewy body dementia)
54
What are Acetylcholinesterase inhibitors used for?
mild/moderate dementia and lewy body dementia
55
When is memantine used?
severe Alzheimer’s dementia
OR
used for people who cannot tolerate cholinesterase inhibitors e.g. bradycardic people
56
Who shouldn't be given Acetylcholinesterase inhibitors?
People who are generally bradycardic should not be given cholinesterase inhibitors as it will further slow down the heart and cause falls
57
What is challenging behaviour?
behaviour of such an intensity, duration and frequency that the physical safety of the person or other is placed in serious jeopardy, or behaviour which is likely to seriously limit or deny access to ordinary community facilities
58
How do you address challenging behaviour?
ABC charts= record the challenging behaviour:
A= antecedent = WHAT HAPPENED BEFORE THE BEHAVIOUR?
B= behaviour= WHAT WAS THE CHALLENGING BEHAVIOUR?
C= consequence= WHAT HAPPENED AFTER THE BEHAVIOUR?
- after ABC- make a care plan
59
What is acopia?
means a person cant cope with activities of living
60
What are neuropsychological symptoms of dementia?
Neuropsychological symptoms -> amnesia, aphasia, apraxia, agnosia (4As), we can measure these by using screening tools such as the MMSE (mini mental state examination), Addenbrooke's Cognitive Examination or the MOCA (Montreal Cognitive Assessment)
61
What are neuropsychiatric symptoms of dementia?
Referred to as BPSD, behavioural and psychiatric disorders in dementia, examples include depression, paranoia, hallucinations, anxiety, aggression, wandering, personality change. These symptoms appear as the dementia progresses
62
What are the 2 categories of daily life acitivites?
Instrumental (looking after finances, going shopping, cooking, driving)
Basic (dressing, washing, going to toilet)
63
What are three levels of alzheimer's?
Mild -> Presents with short term memory loss, recent events muddled, some disorientation in time, mild aphasia but attention preserved, some problems with activities of daily living (ADL, esp. instrumental).
MMSE score of 30-20
Moderate -> Increased memory deficit, disorientation in both time and place, basic ADL starts to be affected. Basic ADL start to be affected
MMSE score of 20-10
Severe -> Deterioration of personality, severe language problems and disorientation
MMSE score of <10
64
What do amyloid plaques do?
toxic to nerve cells
65
What does APP get cleaved by?
it gets cleaved by gamma and beta secretase to form soluble beta amyloid.
66
Why is beta amyloid bad?
beta amyloid starts forming oligomers and depositing in the brain leading to glial activation and inflammation.
67
What do you see in dementia with lewy bodies?
neuronal inclusions (protein aggregates)
abnormally phosphorylated neurofilaments
ubiquination of α synuclein.
marked decline in Ach.
Lewy neurites (small cytoplasmic projections of neurones that are degenerated)
some amyloid plaques.
68
What are the non-motor symptoms of parkinson's?
* Dementia
* Depression
* Psychosis
* REM sleep disorder
69
What is BPSD?
Behavioural and psychological symptoms of dementia:
- Apathy
- Anxiety
- Depression
- Agitation
- Wandering
- Disinhibition
70
What are the risk factors for alzheimer's?
```
Increasing age
Vascular risk factors (diabetes, hypertension, AF, smoking)
Family history
Apo E4 allele status
Hypothyroidism RR 2.3
Head Trauma RR 1.8
```
71
What is the drug management for LBD?
Cholinesterase Inhibitors
Rivastigmine – patch or BD tablets
NMDA receptor antagonist
Memantine
Avoid antipsychotics
