Dementia Flashcards
What is dementia?
Acquired decline in memory and other cognitive functions in an alert person sufficiently severe to cause functional impairment and present for more than 6 months
- ie forgetting to take tablets
- Unable to use phone
- Difficulty washing/dressing
Causes of dementia?
Alzheimers Vascular dementia Mixed Alzeimers/Vascular Dementia with Lewy Bodies ‘Reversible’ causes
Causes of dementia - Alzheimers?
> Slow, insidious onset
Loss of recent memory first
Progressive functional decline
RISK FACTORS
> Age!
> Vascular risk factors
> Genetics
Causes of dementia - Vascular dementia?
> Classically step-wise deterioration
Executive dysfunction may predominate rather than memory impairment
Associated with gait problems often
> Often have known vascular risk factors:
- type II DM, AF, IHD, PVD
Causes of dementia - Lewy body?
> May have parkinsonism
Often very fluctuant
Hallucinations common
Falls common
> Probably under-diagnosed
Causes of dementia - fronto-temporal dementia?
> Onset often at earlier age
> Early symptoms different from other types of dementia
- Behavioural change
- Language difficulties
- Memory early on often not affected
> Usually lack insight into difficulties
How can we diagnose dementia?
The mini-mental state exam
Problems with diagnosing dementia and the tests used?
> Can be culturally/ generationally/ intellectually specific
Can be falsely reassuring
Use as screening and monitoring tools, not as only means of diagnosis
- REMEMBER HISTORY IS KEY
> What matters to the patient is often whether they can function independently at home, not how much they score on MMSE
Management of DEMENTIA – non-pharmacological therapy?
> Support for person and carers > Cognitive stimulation > Exercise > Environmental design > Avoiding changes in environment/social support etc > Advanced care planning
Reversible causes of dementia?
Hypothyroidism Intracerebral bleeds/tumours B12 deficiency Hypercalcaemia Normal pressure hydrocephalus
ALWAYS REMEMBER DEPRESSION
