Psychiatry- Dementia Flashcards
(31 cards)
What is Alzheimer’s disease
• Cerebral atrophy due to neuronal loss
◦ Extracellular beta-amyloid protein plaques form
‣ Intracellular tau neurofibrillary tangle formation
• Cholinergic loss
What part of brain affected in Alzheimer’s disease
• Hippocampi in temporal lobe affected
Onset and progression of Alzheimer’s disease
• Insidious onset
• Slow progression of cognitive decline with gradual loss of function
What are 4 A’s of Alzheimer’s disease
4 A’s:
◦ Amnesia: Recent memories lost first (immediate recall spared in early disease)
◦ Aphasia: Difficulty finding right words (Broca’s), speech muddled
◦ Agnostic: Typically visual (prosopagnosia- recognising faces)
◦ Apraxia: Typically dressing (skilled tasks, despite initial normal motor functioning)
Investigations for Alzheimer’s disease
• MMSE
(ACE-III is the most detailed)
MoCA
AMTS cut off is 8 (max score is 10)
• Dementia/delerium screen: TFTs, FBC, U&Es, LFTs, CRP/ESR, HbA1c, B12, Folate
• MRI: grey matter atrophy, wide ventricles and suicidal, temporal lobe atrophy
MMSE cut offs (no impairment, MCI, SCI)
‣ >24= no impairment
‣ 18-23= mild cognitive impairment
‣ <18= severe cognitive impairment
Alzheimer’s referral
• Referral to memory clinic
Mild or moderate Alzheimer’s disease management
1) Acetylcholinesterase inhibitors:
◦ DONEPEZIL
◦ Galantamine
◦ Rivastigmine
◦ Can cause cholinergic side effects: nausea, vomiting, diarrhoea, urinary incontinence, bradycardia
◦ Contraindicated in prolonged QTc
Moderate to severe Alzheimer’s disease management
1) Memantine:
• NMDA antagonist
Psychological support for Alzheimer’s disease
• Social support: orientate the patient with clocks, calendars. Help with ADLs. Can refer for structural group cognitive stimulation sessions
• Follow-up every 6 months
What is vascular dementia
• Dementia precipitated by a cerebrovascular event (e.g stroke)
Causes of vascular dementia
‣ Thromboembolism
‣ Atherosclerotic disease of large arteries
‣ Cerebral small vessel disease
Presentation of vascular dementia
• Sudden onset: typically after cerebrovascular event
• Stepwise decline of cognitive function
• Emotional and minor personality changes:
◦ Lability emotion
• Neuro symptoms:
◦ Upgoing plantars
Vascular dementia investigations
• CT: can show lacunary infarcts
Vascular dementia management
• Daily Aspirin:
• Indicated if cerebrovascular event or AF risk
• Reduce risk factors (exercise, HTN management, diet, smoking cessation etc)
What are Lewy bodies
• Eosinophilic intracytoplasmic inclusions (Lewy Bodies) that contain alpha-synuclein
Where are Lewy bodies found
• Found in the brain stem, cingulate gurus and neocortex
◦ In Parkinson’s, only found in brain stem
Lewy body dementia presentation
• TRIAD:
‣ Fluctuating cognitive impairment:
◦ Marked variations in alertness levels
◦ Associated with lucid intervals
‣ Hallucinations: ‣ Typically visual ‣ Lilliputian hallucinations (animals or people) ‣ Parkinsonism: ‣ Shuffling gait ‣ Bradykinesia ‣ Tremor ‣ Rigidity ‣ Anosmia (early sign of Parkinson’s)
• Worsened by antipsychotics
• Frequent falls
• Rapid Eye Movement (REM) sleep behaviour disorder: can cause sleep walking
Management of Lewy body dementia
1) Acetylcholinesterase inhibitors:
◦ Donepezil
◦ Rivastigmine
• Melatonin or Clonazepam for sleep disturbances
• DO NOT offer antipsychotics
What is frontotemproal dementia
• Atrophy of fronto-temporal regions
Age of onset of frontotemporal dementia
• Occurs in mid-life:
◦ 45-65 years old
Two types of frontotemporal dementia
2 Pathologies, but no difference in presentation:
◦ Tau Positive: Presence of Pick’s bodies (Pick’s disease)
◦ Tau Negative
Presentation of frontotemporal dementia
• Personality and Behaviour changes:
• Hallmark feature
• Disinhibition:
◦ Socially inappropriate behaviour
◦ Invade personal space
◦ Make offensive remarks
◦ Lack of social awareness
• Apathy + Loss of empathy: ◦ Losing interest and/or motivation for activities and social relationships ◦ Cold or unfeeling towards others ◦ Lack of filter ◦ Aggression • Compulsive behaviours: ◦ Hoarding, checking, cleaning ◦ Simple repetitive movements
• Altered food preferences and binge eating
• Most lack insight
• Memory affected much later
Pharmacological management of frontotemporal dementia
• Antidepressants: To treat frontal lobe syndrome
• Short-acting Benzodiazepines: to treat aggression, restlessness or agitation (Lorazepam)
