Dementia & Delirium Flashcards
(54 cards)
What is dementia?
Several diseases A Syndrome Cognitive impairment Decline in both memory and thinking Affects ability to perform personal ADLs Present for at least 6 months Nearly always progressive
Name 5 different types of dementia
Alzheimer's disease Vascular Dementia Frontotemporal Dementia Lewy body Dementia Alcoholic Dementia
What is the course/onset for the following types of dementia:
Alzheimer’s
Vascular
Frontotemporal
Alzheimer’s - Gradual, insidious onset. Slow progression
Vascular - Gradual or abrupt onset, erratic course
FTD - Gradual onset, may progress quickly
When might Frontotemporal dementia progress more quickly than usual?
In younger patients
Describe the course/onset for the following types of dementia:
Lewy body Dementia
Alcoholic Dementia
LBD - Fluctuating, episodic course, may initially look like delirium
Alcoholic - Gradual, but cognitive status fluctuates with drinking and withdrawal episodes
How do the 5 different types of dementias usually present (early on)?
Alzheimer’s - Usually memory impairment
Vascular - Variable, may have prominent dysexecutive features
FTD - Loss of executive ability and impaired social behaviours
LBD - Perceptual disturbance (hallucinosis) and Parkinsonism
Alcoholic - Memory problems, dysexecutive (frontal) features
What neurological features is often associated with Lewy body Dementia?
Parkinsonism
What are the mood and behavioural changes observed in the following dementias?
Alzheimers
Vascular
FTD
Alzheimer’s - Minimal initially, pre-existing anxiety may worsen
Vascular - Depression common after stroke, emotional lability
FTD - Apathy, loss of volition, disinhibition may be early features
What are the mood and behavioural changes observed in the following dementias?
LBD
Alcoholic
LBD - May be paranoia, suspiciousness (psychotic Sx)
Alcoholic - Depression commonly associated with alcohol misuse problems
What are the structural brain abnormalities seen in the 5 dementias?
Alzheimer’s - Volume loss in medial temporal lobe, posterior cingulate, precuneus
Vascular - Evidence of infarcts, bleeds, white matter ischaemia
FTD - Frontotemporal atrophy
LBD - No specific abnormalities
Alcoholic dementia - Age disproportionate cortical and WM atrophy
What might you see in the early stages of dementia?
Forgetfulness and other memory Sx
Subtle changes in mood and behaviour
Minimal intrusion into ADLs
What might you see in the mid-stages of dementia?
Memory problems more apparent
Cognitive difficulties may emerge e.g. language and executive function
Marked behaviour changes
Complex ADLs are difficult e.g. finances, planning
Some people are aware, some are not
What might you see in the late stages of dementia?
Severe and pervasive memory problems
Major cognitive disability e.g. failure to recognise people
Severe behaviour changes e.g. inhibition, irritability, severe apathy
Severe disability e.g. incontinence
What are the important questions to ask in a history involving a patient with suspected dementia?
What is the course of Sx over time
Evidence of disability on daily life (ADLs)
Anything specific that has made then come now?
Any changes to general health?
What kind of examinations can you do for a patient with suspected dementia?
Cognitive screening assessments
Neurological exam
CVS Exam
What kind of cognitive assessment can you do in suspected dementia?
GPCOG
AMT
MMSE
MOCA
What investigations can you do for suspected dementia?
Bloods - Dementia screen
Imaging - CT, preferably MRI
Functional brain imaging
Justify the investigations used in dementia?
Bloods -
Imaging - Check for demyelination and dilatation of ventricles
To subtype the dementia
Functional brain imaging - check perfusion with glucose metabolism
Name some additional special tests you might do for dementia and why
EEG - To investigate unusual, atypical presentations
Lumbar puncture
What does conservative treatment in dementia usually involve?
Informing and explain to patient and family
Psychological support - help remain engaged in life
Practical advice +/- assistive tehnologies
What are the types of medications that we can give in Alzheimers dementia?
Cholinesterase inhibitors
NMDA Receptor Antagonists
Name some cholinesterase inhibitors used in the treatment of dementia
Donepezil
Rivastigmine
Galantamine
Name the NMDA receptor antagonist used in Alzheimer’s dementia
Memantine
What is the drug used in the treatment of Lewy body Dementia?
Rivastigmine
