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Clinical Neuroscience > Dementia + delirium > Flashcards

Dementia + delirium Flashcards

1
Q

Types of dementia

A
  • Alzheimer disease
  • Vascular dementia
  • Lewy body dementia
  • Frontotemproal
  • Aids related
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2
Q

Cognitive symptoms of dementia
What lobe is involved?

A
  • impaired memory - temporal
  • impaired orientation - temporal
  • impaired learning capacity - temporal
  • impaired judgement - frontal
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3
Q

Non cognitive symptoms of dementia

A
  • behavioural symptoms - agitation, aggression, sexual disinhibition
  • depression + anxiety
  • insomnia
  • daytime drowsiness
  • visual + auditory hallucinations
  • persecutor delusions
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4
Q

How is dementia diagnosed?

A

By exclusion:
- exclude delirium
- exclude organic causes of cognitive decline:
- hypothyroidism
- hypercalcaemia
- B12 deficiency
.
Look for features of progressive cognitive decline, impairment of daily living in patients with a normal conscious level

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5
Q

Macroscopic pathological features of Alzheimer disease

A
  • Global cortical atrophy
  • Sulcal widening
  • Gyri narrowing
  • Enlarged ventricles (primarily lateral + 3rd)
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6
Q

Microscopic pathological features of Alzheimer disease

A

Plaques
Tangles

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7
Q

What are Alzheimer plaques composed of?

A

Amyloid beta

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8
Q

What is amyloid precursor protein?
How is it normally broken down?
What pathology can occur?

A
  • A protein involved in repairing neurones after damage
  • Normally it is replaced + chopped up into soluble parts by a + gamma secretases
  • In Alzheimer disease, B secretase causes insoluble breakdown > formation of B amyloid plaques
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9
Q

How are plaques formed in Alzheimer disease?

A

Amyloid precursor protein is broken down by B secretase into insoluble parts > forming B amyloid plaques

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10
Q

Outline Alzheimer disease in relation to Tau tangle formation

A
  • B amyloid plaque induce pathological response in neuron > hyperphosphrylation of Tau proteins
  • change in shape of Tau proteins
  • reduced support of cytoskeleton
  • neuron death
  • aggregate into tangles
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11
Q

Function ofTau proteins

A

Play a role in stabilising microtubules within neuronal cytoskeleton

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12
Q

Types of Alzheimer disease

A

Sporadic (most common)
Familial

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13
Q

Outline sporadic Alzheimer disease

A
  • 90-95%
  • causes are poorly understood
  • increasing prevalence with age
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14
Q

Outline familial Alzheimer disease

A
  • 5-10%
  • early onset dementia
  • PSEN1/2 genes implicated > mutation of gamma secretase
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15
Q

Relationship between Down syndrome and Alzheimer disease

A

Disease can present as early as 40 years old

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16
Q

Symptoms of Alzheimer disease

A
  • initially symptoms hard to detect
  • short term memory loss initially
  • motor and language skills affected
  • long term memory loss
  • disorientation
17
Q

What is used to assess severity of dementia?

A

Mental state examination

18
Q

Treatment of Alzheimer disease

A
  • Acetyl cholinesterase inhibitors pyridostigmine
  • Memantine (glutamate receptor antagonist) for advanced cases
19
Q

Outline Lewy body dementia

A
  • dementia features early then Parkinsonian features
  • caused by misfolding of alpha synuclein
  • misfolded aggregate into Lewy bodies
  • deposition into cortex (dementia type symptoms) + substantia nigra (Parkinsonian features)
20
Q

Early symptoms of Lewy body dementia

A

Cognitive symptoms:
- distressing hallucination
- depression
- REM sleep disorders - sleep walking/talking

21
Q

Late symptoms of Lewy body dementia

A

Parkinsonian symptoms:
- bradykinesia
- resting tremor
- stiffness

22
Q

Treatment of Lewy body dementia

A

Symptom based
Levodopa

23
Q

What is frontotemporal lobe dementia?

A

Frontal + temporal lobe atrophy
Umbrella term for heterogeneous group of disease that can be characterised on the type of glial + neuronal proteinaceous inclusions or underlying genetic mutation

24
Q

How does frontotemporal lobe dementia occur?

A
  • aggregate proteins
  • Tau protein hyperphosphorylation (Pick’s disease)
  • frontal + temporal lobe atrophy
25
Q

Symptoms of frontotemporal lobe dementia

A
  • behavioural + emotional changes
  • inappropriate social behaviour
  • loss of motivation without depression
  • broca type aphasia
26
Q

How does AIDs dementia occur?

A
  • occurs when CD4+ count falls below threshold
  • entry of HIV infected macrophages into brain > inflammation + neuron damage
27
Q

Clinical features of AIDs dementia

A
  • congitive impairment
  • psychomotor retardation
  • tremor
  • ataxia
  • dysarthria
  • Incontience
28
Q

Outline vascular dementia

A

Cognitive impairment caused by cerebrovascular disease (multiple small strokes)

29
Q

Risk factors for vascular dementia

A
  • previous stroke or MI
  • hypertension
  • hypercholesteroaemia
  • diabetes
  • smoking
30
Q

What is delirium?

A

An acute, fluctuating syndrome of disturbed consciousness, attention, cognition + perception

31
Q

Causes of delirium

A

DELIRIUM
- Drugs
- Epilepsy / Electrolyte imbalance (renal)
- Liver failure / Low oxygen
- Infection e.g. UTI
- Retention
- Intracranial e.g. stroke
- Uraemia
- Metabolism e.g. hypoxia

32
Q

Difference in presentation of delirium and dementia

A

Delirium - sudden onset
Dementia - progressive

33
Q

Types of delirium + their presentation

A
  • Hyperactive: agitated, aggressive + delusions
    Or
  • Hypoactive: drowsy + withdrawn
34
Q

Treatment of delirium

A
  • treat/minimise precipitating factors
  • encourage normal day/night cycle
  • allow wandering if safe
  • involve loved ones
  • distraction techniques
  • haloperidol as last resort
35
Q

What medication is used in delirium?

A

Haloperidol

36
Q

What must be excluded when making a diagnosis of dementia?

A
  • exclude delirium
  • exclude organic causes of cognitive decline:
  • hypothyroidism
  • hypercalcaemia
  • B12 deficiency
37
Q

Difference between Parkinson’s disease + Lewy body dementia

A
  • Parkinson’s disease: movement disorder followed by dementia
  • Lewy body dementia: dementia followed by movement disorder (Parkinsonism)
38
Q

Why should you not give anti-psychotics in Lewy body dementia?

A

It can cause neuroleptic malignant syndrome

39
Q

Features of neuroleptic malignant syndrome

A

Fever
Confusion
Tachycardia
Tachypnoea
Fluctuating BP
Elevated creatine phosphokinase
Rigidity

Clinical Neuroscience (20 decks)

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