Dementias Flashcards by Sheryl O'Hare

Definition

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

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Dementia is reversible. True or false?

False

- irreversible

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Neuropathology

Progressive loss of neurones

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What is the biggest risk factor?

Age

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Clinical features

Forgetfulness
Memory loss
Confusion
Poor reasoning and logic
Personality changes 
Poor judgement

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What tests are used to diagnose dementia

MMSE 
Addenbrookes cognitive assessment 
MoCA 
Frontal assessment battery 
Detailed neuropsychological testing

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Addenbrookes cognitive assessment - what are the 5 domains

Memory
Fluency
Language
Visuospatial functioning

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MOCA - when is it used

Rapid screening

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When would detailed neuropsychological testing be used

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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What is the standard imaging investigation?

CT scan

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When would an MRI scan be used to investigate?

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

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Which type of dementia is SPECT most useful for?

Fronto-temporal dementia

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What scan is used if query levy body dementia?

DAT scan 
(dopamine active transport scan)

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CSF findings

Elevated CSF tau and phospho-tau hypo-metabolism

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Management - non-pharmacologial

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

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

False

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Management - first line pharmacological agent

Cholinesterase inhibitor

donepezil
rivastigmine

This slows cognitive decline

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Cholinesterase inhibitor - MOA

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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Cholinesterase inhibitor - side effects

Nausea
Diarrhoea
Headache
Bradycardia

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Do not use cholinesterase inhibitor if patient is ______

Bradycardic

- check pulse before administering medication

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Cholinesterase inhibitor - name 3 contraindications

Active peptic ulcer
Severe asthma
Severe COPD

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Advanced dementia with behavioural disturbance is managed with

Memantine

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Dementia and driving

Must be reported to DVLA

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

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Name 4 types of dementia

Alzheimers disease
Vascular dementia
Fronto temporal dementia
Dementia with lewy bodies

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What is the most common cause of dementia in elderly?

Alzheimers disease

Alzheimers disease - usually presents after the age of?

Alzheimers disease - more common in males/females

Females

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

Increased incidence due to amyloid precursor protein

Alzheimers disease - neuropathology

``` Cortical atrophy Dilation of ventricles Formation of amyloid plaques Neurofibrillary tangles Widening of sulci Narrowing of gyri ```

Alzheimers disease - neurofibrillary tangles

Found especially in the hippocampus | Tau protein is hyper-phosphorylated and causes the tangles

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

Congo red

Alzheimers disease - clinical features

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

Is it possible to diagnose a patient without scanning them?

Yes

Alzheimers disease - management

Cholinesterase inhibitor | Memantine

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

If patient has bradycardia

Vascular dementia - cause

Brought around by cerebrovascular ischaemia

Vascular dementia - clinical features

Dysphasia Dyscalculia Frontal lobe symptoms Focal neurological signs

Vascular dementia - investigations

CT/MRI scan - moderate small vessel disease - multiple white areas around the brain

Fronto temporal dementia - what is it otherwise known aa?

Pick's disease

FTD - definition

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

FTD - common in elderly. True or false?

False | - common in middle age (50-60)

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

Frontal lobe - first | Temporal lobe

Alzheimers disease - which lobe is NOT affected

Occipital lobe

FTD - Neuropathology

Cortical atrophy | Pick's cells (swollen neurones)

FTD - clinical features

Personality and behavioural change Speech and communication problems Reduced attention span

FTD - what are the 3 different syndromes

Behavioural variant Primary progressive aphasia Semantic dementia

FTD - behavioural variant

``` Behaviour changes Disinhibition Impulsivity Loss of social skills Obsessions ```

FTD - primary progressive aphasia

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

FTD - semantic dementia

Impaired understanding of meaning of words | Fluent but empty speech

FTD - what investigation is best for diagnosing this condition?

SPECT | - fronto-temportal reduction in tracer uptake

Lewy body dementia - what condition is it associated with?

Parkinson's disease

Lewy body dementia - definition

Parkinsonism + cognitive impairment

Lewy body dementia - clinical features

Two of the following must be present: - visual hallucinations - fluctuating cognition - parkinsonism features - REM sleep behaviour disorder

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

At onset or within 1 year of symptoms

Lewy body dementia - investigations

DAT scan | SPECT - look for occipital changes

Lewy body dementia - neuropathology

Abnormal clumps of lewy bodies | Degeneration of the substantial nigra

Dementia in parkinson disease is common. True or false?

True

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

15-20

Pseudo dementia - definition

Lack of neurodegenerative dementia

Pseudo dementia - clinical features

Fluctuating loss of memory Consistently depressed mood Not progressive

Which type of dementia typically has a quick decline? - Alzheimers disease - Vascular dementia - Fronto temporal dementia - Dementia with lewy bodies

Fronto temporal dementia

Which type of dementia has fluctuating severity on a daily basis? - Alzheimers disease - Vascular dementia - Fronto temporal dementia - Dementia with lewy bodies

Lewy body dementia

Which type of dementia has a stepwise decline? - Alzheimers disease - Vascular dementia - Fronto temporal dementia - Dementia with lewy bodies

Vascular dementia | - accumulation of multiple infarcts

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

Alzheimers

Dementias Flashcards

(64 cards)