OHCM - Dementia Flashcards Preview

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Flashcards in OHCM - Dementia Deck (26):
1

What is dementia?

SYNDROME - Encompassing progressive deficits in several cognitive domains.

2

Initial presentation of dementia?

Memory loss over months or years.

3

Memory loss over DAYS - Think?

Infection or stroke.

4

Memory loss over WEEKS - Think?

Depression.

5

In later stages of dementia ...?

Non-cognitive symptoms such as agitation, aggression, apathy may complicate care, which becomes increasingly difficult requiring specialist input.

6

Dementia - Prevalence per age group:

65 - 5-10%.
>80 - 20%.
>100 - 70%.

7

Dementia - Diagnosis - The key is ...?

A good history both from the patient and someone who knows them well (eg spouse, relatives, or friends).

8

Dementia - History - Ask about the ...

TIMELINE of the progression of their impaired cognition/memory, what was noticed first and what particular aspects of it they have most difficulty with (autobiographical, political, etc).

9

Dementia - History - There may also be ...?

1. Agitation.
2. Aggression.
3. Wandering.
4. Hallucinations.
5. Slow repetitious speech.
6. Apathy.
7. Mood disturbance.

10

Depression is common in dementia, but ...?

Can also cause cognitive impairment.

11

Cognitive testing:

Use a validated dementia screen such as the AMTS, TYM, or similar + Short tests of verbal recall - HVLT, which is more sensitive in MILD impairment.

12

Mental state exam may reveal ...?

1. Anxiety.
2. Depression.
3. Hallucinations.

13

Physical examination:

1. May identify a physical cause of the cognitive impairment.
2. Risk factors (esp. for vascular dementia).
3. Parkinsonism.

14

Dementia - Investigations:

1. FBC, ESR, U/E, Ca, LFTs.
2. TSH.
3. Autoantibodies.
4. B12/Folate.
5. Syphilis serology.
6. CT/MRI - For vascular damage, hemorrhage, or structural pathology.

15

Dementia - Investigations - Consider also:

1. EEG.
2. CSF.
3. Functional imaging (FDG, PET, SPECT).
4. Metabolic, genetic, HIV tests if indicated.

16

Common causes of dementia:

1. Alzheimer.
2. Vascular dementia.
3. Lewy body dementia.
4. Frontotemporal (Pick's) dementia.

17

Other causes of dementia:

1. Alcohol/drug abuse.
2. Repeated head trauma.
3. Pellagra.
4. Whipple's disease.
5. Huntington.
6. CJD.
7. Parkinson.
8. HIV.
9. Cryptococcosis.
10. Familial AD Alzheimer.
11. CADASIL.

18

CADASIL:

Cerebral AD Arteriopathy with Subcortical Infarcts.

19

Ameliorable causes of dementia:

1. Hypothyroidism.
2. B12/Folate.
3. Thiamine.
4. Syphilis.
5. Tumors (meningioma).
6. Subdural hematoma.
7. Parkinson.
8. CNS cysticercosis.
9. HIV (+/- cryptococcosis).
10. NPH.
11. Whipple's disease.
12. Pellagra.

20

Vascular dementia - ...% of all dementias.

25% of all dementias.

21

Vascular dementia - It represents the ...?

Cumulative effects of many small strokes, thus SUDDEN onset + STEPWISE deterioration is characteristic (but often hard to recognize).

22

Vascular dementia - Look for ...?

Evidence of vascular pathology (HTN, past strokes, focal CNS signs).

23

Lewy body dementia - Epidemiology?

3rd MCC of dementia (15-25%) after Alzheimer's and vascular causes.

24

Lewy body dementia - Typically with ...?

1. Fluctuating cognitive impairment.
2. Detailed visual hallucinations (small animals or children).
3. Later parkinsonism.

25

FTD - Genes on chromosome ...?

9 are important, as in MND.

26

FTD - Signs:

1. Executive impairment.
2. Behavioral/personality change.
3. EARLY preservation of episodic memory and spatial orientation.
4. Disinhibition (not ALWAYS bad :P).
5. Hyperorality.
6. Stereotyped behaviour, and emotional unconcern.