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Ageing SOH > Dementias > Flashcards

Dementias Flashcards

1
Q

Definition

A

Acquired and persistent generalised disturbance of higher cortical functions in an otherwise fully alert person

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2
Q

Dementia is reversible. True or false?

A

False

- irreversible

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3
Q

Neuropathology

A

Progressive loss of neurones

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4
Q

What is the biggest risk factor?

A

Age

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5
Q

Clinical features

A 
Forgetfulness
Memory loss
Confusion
Poor reasoning and logic
Personality changes 
Poor judgement
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6
Q

What tests are used to diagnose dementia

A 
MMSE 
Addenbrookes cognitive assessment 
MoCA 
Frontal assessment battery 
Detailed neuropsychological testing
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7
Q

Addenbrookes cognitive assessment - what are the 5 domains

A

Memory
Fluency
Language
Visuospatial functioning

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8
Q

MOCA - when is it used

A

Rapid screening

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9
Q

When would detailed neuropsychological testing be used

A

If the patient has a particularly low or high IQ to decide whether their current mental state is related to underlying disease

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10
Q

What is the standard imaging investigation?

A

CT scan

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11
Q

When would an MRI scan be used to investigate?

A

If the patient is younger
If there is fast progression
If there are other atypical features

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12
Q

Which type of dementia is SPECT most useful for?

A

Fronto-temporal dementia

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13
Q

What scan is used if query levy body dementia?

A 
DAT scan 
(dopamine active transport scan)
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14
Q

CSF findings

A

Elevated CSF tau and phospho-tau hypo-metabolism

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15
Q

Management - non-pharmacologial

A

Advance planning should be arranged whilst patients have the capacity to make their own decisions

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16
Q

Management - medications for dementia can cure it. True or false?

A

False

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17
Q

Management - first line pharmacological agent

A

Cholinesterase inhibitor

  • donepezil
  • rivastigmine

This slows cognitive decline

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18
Q

Cholinesterase inhibitor - MOA

A

Inhibits acetyl cholinesterASE so that it doesn’t get rid of ACh. This means that more ACh is available in the synapse and thus cholinergic transmission is boosted

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19
Q

Cholinesterase inhibitor - side effects

A

Nausea
Diarrhoea
Headache
Bradycardia

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20
Q

Do not use cholinesterase inhibitor if patient is ______

A

Bradycardic

- check pulse before administering medication

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21
Q

Cholinesterase inhibitor - name 3 contraindications

A

Active peptic ulcer
Severe asthma
Severe COPD

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22
Q

Advanced dementia with behavioural disturbance is managed with

A

Memantine

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23
Q

Dementia and driving

A

Must be reported to DVLA

Doctor makes decision if patient can still drive whilst investigations are ongoing

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24
Q

Name 4 types of dementia

A

Alzheimers disease
Vascular dementia
Fronto temporal dementia
Dementia with lewy bodies

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25
Q

What is the most common cause of dementia in elderly?

A

Alzheimers disease

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26
Q

Alzheimers disease - usually presents after the age of?

A

60

27
Q

Alzheimers disease - more common in males/females

A

Females

28
Q

There is increased/decreased incidence of Alzheimers disease in a patient with trisomy 21. Why?

A

Increased incidence due to amyloid precursor protein

29
Q

Alzheimers disease - neuropathology

A 
Cortical atrophy 
Dilation of ventricles 
Formation of amyloid plaques 
Neurofibrillary tangles 
Widening of sulci 
Narrowing of gyri
30
Q

Alzheimers disease - neurofibrillary tangles

A

Found especially in the hippocampus

Tau protein is hyper-phosphorylated and causes the tangles

31
Q

Alzheimers disease - amyloid angiopathy. What does it stain with?

A

Congo red

32
Q

Alzheimers disease - clinical features

A 
Short term memory dysfunction
- learning new things is difficult
Can still remember things that happened a long time ago 
Dysphasia 
Dyspraxia 
Agnosia
33
Q

Is it possible to diagnose a patient without scanning them?

A

Yes

34
Q

Alzheimers disease - management

A

Cholinesterase inhibitor

Memantine

35
Q

Alzheimers disease - when would you give memantine over cholinesterase inhibitor?

A

If patient has bradycardia

36
Q

Vascular dementia - cause

A

Brought around by cerebrovascular ischaemia

37
Q

Vascular dementia - clinical features

A

Dysphasia
Dyscalculia
Frontal lobe symptoms
Focal neurological signs

38
Q

Vascular dementia - investigations

A

CT/MRI scan

  • moderate small vessel disease
  • multiple white areas around the brain
39
Q

Fronto temporal dementia - what is it otherwise known aa?

A

Pick’s disease

40
Q

FTD - definition

A

Progressive changes in character and social deterioration leading to impairment of intellect, memory and language

41
Q

FTD - common in elderly. True or false?

A

False

- common in middle age (50-60)

42
Q

FTD - which lobes are affected (and in which order)?

A

Frontal lobe - first

Temporal lobe

43
Q

Alzheimers disease - which lobe is NOT affected

A

Occipital lobe

44
Q

FTD - Neuropathology

A

Cortical atrophy

Pick’s cells (swollen neurones)

45
Q

FTD - clinical features

A

Personality and behavioural change
Speech and communication problems
Reduced attention span

46
Q

FTD - what are the 3 different syndromes

A

Behavioural variant
Primary progressive aphasia
Semantic dementia

47
Q

FTD - behavioural variant

A 
Behaviour changes 
Disinhibition
Impulsivity 
Loss of social skills 
Obsessions
48
Q

FTD - primary progressive aphasia

A

Does great on OT assessment
However, can’t communicate well
Lack of words
Non-fluent speech

49
Q

FTD - semantic dementia

A

Impaired understanding of meaning of words

Fluent but empty speech

50
Q

FTD - what investigation is best for diagnosing this condition?

A

SPECT

- fronto-temportal reduction in tracer uptake

51
Q

Lewy body dementia - what condition is it associated with?

A

Parkinson’s disease

52
Q

Lewy body dementia - definition

A

Parkinsonism + cognitive impairment

53
Q

Lewy body dementia - clinical features

A

Two of the following must be present:

  • visual hallucinations
  • fluctuating cognition
  • parkinsonism features
  • REM sleep behaviour disorder
54
Q

Lewy body dementia - parkinsonism clinical features must be present when?

A

At onset or within 1 year of symptoms

55
Q

Lewy body dementia - investigations

A

DAT scan

SPECT - look for occipital changes

56
Q

Lewy body dementia - neuropathology

A

Abnormal clumps of lewy bodies

Degeneration of the substantial nigra

57
Q

Dementia in parkinson disease is common. True or false?

A

True

58
Q

Dementia in parkinson disease usually develops _____ years after diagnosis of parkinson disease?

A

15-20

59
Q

Pseudo dementia - definition

A

Lack of neurodegenerative dementia

60
Q

Pseudo dementia - clinical features

A

Fluctuating loss of memory
Consistently depressed mood
Not progressive

61
Q

Which type of dementia typically has a quick decline?

  • Alzheimers disease
  • Vascular dementia
  • Fronto temporal dementia
  • Dementia with lewy bodies
A

Fronto temporal dementia

62
Q

Which type of dementia has fluctuating severity on a daily basis?

  • Alzheimers disease
  • Vascular dementia
  • Fronto temporal dementia
  • Dementia with lewy bodies
A

Lewy body dementia

63
Q

Which type of dementia has a stepwise decline?

  • Alzheimers disease
  • Vascular dementia
  • Fronto temporal dementia
  • Dementia with lewy bodies
A

Vascular dementia

- accumulation of multiple infarcts

64
Q

In which type of dementia do memory problems present before other signs and symptoms?

A

Alzheimers

Ageing SOH (6 decks)

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