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4th year psych > Dementia > Flashcards

Dementia Flashcards

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1
Q

Is dementia a diagnosis or a clinical syndrome

A

syndrome

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2
Q

Most common type of dementia

A

55% Alzheimers

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3
Q

2nd most common type of dementia

A

25% vascular (can be mixed w alzheimers)

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4
Q

3rd most common type of dementia

A

Lewy body 10%

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5
Q

Prevalence of lewy body dementia?

A

5%

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6
Q

Prevalence of dementia at 90y

A

25%

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7
Q

Diagnostic criteria of dementia (3)

A

Multiple cognitive defecits

Resulting impairment in ADLs

Clear consciousness

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8
Q

Do pts with dementia normally have insight?

A

No often

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9
Q

Can pts with dementia get psychotic symptoms? If so which ones?

A

Yes

persecutory delusions (made worse by forgetfulness)

visual and auditory hallucinations

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10
Q

What are BPSDs?

A

Behavioural and psychological symptoms of dementia

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11
Q

What should you include in an assessment of susp. dementia (1st presentation)?

A
  1. ask about concerns, cognitive, behav and psych symptoms
  2. Risk factors, co-morbidities and drugs
  3. Discuss possibility of dementia
  4. Assess cognition
  5. Assess daily functioning
  6. Exacerbating factors for BPSD
  7. Examination
  8. Investigations
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12
Q

Which co-morbidities are especially relevant in an assessment of susp. dementia (1st presentation)?

A

Stroke

Epilepsy

Depression

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13
Q

Which risk factors are there in an assessment of susp. dementia (1st presentation)?

A

FHx

Learning disabilities

Stroke

Parkinsons

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14
Q

Which drugs are relevant in an assessment of susp. dementia (1st presentation)?

A

Benzos

Anticholinergics

Analgesics

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15
Q

Examples of cognitive symptoms to ask about in an assessment of susp. dementia (1st presentation)?

A

memory

concentration

Language

Orientation

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16
Q

Examples of behavioural sx to ask in an assessment of susp. dementia (1st presentation)?

A

aggression

wandering

restless

inappropriate behaviour

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17
Q

Examples of psych sx to ask in an assessment of susp. dementia (1st presentation)?

A

hallucinations

delusions

mood

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18
Q

What should you include when you discuss the possibility of dementia in an assessment of susp. dementia (1st presentation)?

A

advise more detailed assessment

Ask if they’d like to know the diagnosis

Who they would want to involve

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19
Q

How do you assess cognition in an assessment of susp. dementia (1st presentation)?

A

MMSE (accounting for e.g. education level, language, sensory deficits, previous functioning)

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20
Q

What do you assess in daily functioning in an assessment of susp. dementia (1st presentation)?

A

Personal care, managing finances, taking drug treatments

Safety and home and outside

Social functioning and support

Driving

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21
Q

What are exacerbating factors for BPSD in an assessment of susp. dementia (1st presentation)?

A

Co-morbs and acute illness (pain, infection, constipation, dehydration, anaemia, delirium)

Underlying psych

Sensory- visual and hearing

Drug SEs

Able to communicate verbally

Carer- emotional upset? Able to communicate w pt?

Environment- change, routine, over or under stimulated?

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22
Q

what examinations do you do in an assessment of susp. dementia (1st presentation)?

A

Neuro for FND

Gait and balance

Cardio- HTN, arrhyth…

Wt loss

Visual and auditory

Other acute illness

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23
Q

Investigations in an assessment of susp. dementia (1st presentation)?

A

Bloods: FBC, ESR, Ca, U&Es, LFTs, HbA1c, TFTs, B12 and folate

If indicated- MSU, CXR, ECG, syphilis screen, HIV

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24
Q

What are the 5 As of alzheimers?

A

amnesia

agnosia

aphasia

apraxia

associated BPSD

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25
Key feature of Alzheimers?
Gradual onset with memory loss
26
Macroscopic changes seen in Alzheimers?
Cortical atrophy Enlarged ventricles
27
Microscopic changes seen in Alzheimers?
Neurofibrillary tangles Amyloid plaques (beta) Decreased Acetylcholine
28
Describe the amyloid cascade hypothesis for Alzheimers
APP gene --> amyloid precursor protein --> Aβ protein plaques are cleaved off APP by secretase enzyme (which is coded for by presenelin 1 and 2 genes), these aggregate --> toxicity, inflammation, oxidative stress, tau dysfunction and neurofibrin tangle formation--> leads to neuronal death and dysfunction
29
What are three genes whose mutations are implicated in familial (early onset) Alzheimers?
APP gene Presenelin 1 Presenelin 2
30
What are the three varients of the APO gene?
E2, E3, E4
31
Which APO gene increases risk of Alzheimers?
APO E4
32
Are there neurotransmitter changes seen in Alzheimers? Which ones? What does this lead to?
Yes- defecit of ACh, serotonin, noradrenaline and somatostatin- this leads to the loss of the cell bodies of neurones that secrete them.
33
What are two pharmacological management options in Alzheimers
Acetylcholinesterase inhibitors- compensate for the loss of acetylcholine- this can arrest and temporarily reverse cognitive decline and may improve behaviour Memantine in moderate to severe- glutamate antagonist- prevents excitatory neurotoxicity
34
What is the progression of vascular dementia like?
Stepwise pattern of FND
35
Difference between vascular and Alzheimers dementia?
Vascular more 'patchy' cognitive impairment and stepwise.
36
Many people have mixed ______ and vascular dementia
Alzheimers
37
Vascular dementia has at least one area of __________ _________
Cortical infarction
38
Following a stroke, the risk of dementia is increased by ???
9 times
39
Vascular risk factors apply to both _____ and ______ dementia
Vascular and alzheimers
40
What are the vascular risk factors?
Smoking, DM, HTN, high cholesterol
41
What can you do as well as controlling vascular risk factors to try reduce the risk of further stroke related deterioration in VD?
low dose aspirin
42
How does Lewy Body dementia present? (4)
Fluctuating cognition and alertness Vivid visual hallucinations Spontaneous parkinsonism Sleep disorder
43
Can you give antipsychotics to LBD?
No- severe reaction
44
What is a pharmacological treatment option for LBD?
AChEi
45
What is the microscopic changes found in LBD?
lewy bodies and neurites in basal ganglia and cerebral cortex Often also Alzheimer's-like changes
46
Parkinson's disease dementia is similar to what type? When can it be diagnosed?
Lewy body If the parkinson's preceded the dementia by >1y
47
what % people with parkinson's develop dementia?
25% (and if they survive 20y, 80%)
48
Frontotemporal dementia has a younger or older mean age of onset?
Younger
49
Features of FTD?
Early personality changes Relative intellectual sparing- memory problems tend to come later
50
Which lobes are affected in FTD?
frontal anterior temporal
51
What is the pathology of FTD?
It varies... tend to have ubiquitin or tau positive inclusions
52
Diagnostic criteria for alcohol related dementia
Aren't any. Difficult to distinguish from other types, especially Alz. May occur in combination.
53
Features of alcohol related dementia
Global deterioration in intellectual function Some have frontal lobe damage- disinhibition, worse planning and executive function Korsakoff's features- memory changes. Generally somewhere on a spectrum between global dementia and Korsakoff's psychosis. Can have psychosis, depression, anxiety, apathy, personality changes May also get peripheral neuropathy and cerebellar ataxia.
54
Can alcohol related dementia be treated?
Yes if early enough- stop alcohol and replace vitamins (esp thiamine)
55
Onset and severity of alcohol related dementia directly linked to _____
amount of alcohol consumed
56
Onset of alcohol related dementia can be as early as ___ but is normally ___--____
30 50-70
57
Why does damage occur in alcohol related dementia?
Alcohol is a neurotoxin Or because of malnutrition- thiamine defic.
58
What are other forms of dementia?
Repeated head trauma Subdural haematoma SAH/head inj/meningitis --> normal pressure hydrocephalus Huntington's Chorea MND Infection (HIV, syphilis, prion) Metabolic (rare) (hyperparathyroid and hypothyroid)
59
MND dementia is always what type?
Fronto-temporal
60
Which dementias can have pharmacological treatment? Which treatments?
AChEi in Alzheimers and Lewy body Memantine in Alzheimers Aspirin in vascular
61
What is it important to rule out in dementia?
Reversible causes (these could be superimposed)
62
Psycho management of dementia?
Cognitive stimulation e.g. group activities Teach carers techniques for behavioural management
63
Social management of dementia
Home care Day centres Intermittent respite Residential/nursing care
64
What do people with dementia often die of ?
Bronchopneumonia
65
How is the life expectancy of someone with dementia altered?
Reduced even accounting for physical health
66
Is vascular dementia prognosis worse or better than alzheimers?
worse- progression less consistent and vulnerable to cardiac and stroke related death
67
What are 4 reasons for cognitive impairment without dementia?
mild cognitive impairment Subjective cognitive impairment Severe depression in old age Slowly progressive acute confusional state
68
What is mild cognitive impairment?
Deterioration in cognition insufficient to meet dementia criteria. About 15%--> dementia within a year. 50% within 3 years
69
What is subjective cognitive impairment?
Report cognitive impairment e.g. remembering names, but perform within normal ranges on psychometric tests for age and education
70
How do MCI and SCI link?
MCI often preceded by 15y of SCI
71
What proportion of the population report being forgetful?
1/3
72
Severe depression in old age can present as____? Features?
pseudodementia- prominent forgetfulness and poor self care
73
what are slowly progressive acute confusional states?
May present with a dementia-like picture e.g. subdural haematoma, myxoedema, vitamin deficiencies.
74
Does a diagnosis of dementia stop you from driving?
Must inform the DVLA. Doesn't in itself stop you, but must do so when unsafe. Can do an assessment with DVLA if you want. The Alzheimer's society website has v good advice. Most people stop within about 3y

4th year psych (15 decks)

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