Week 5 Dementia Flashcards
Define DEMENTIA
umbrella term for a large number of disorders, which can affect thinking and memory - not a specific disease.
“Dementia refers to acquired intellectual
deterioration in an adult” – Bennett & Aggarwal
(2004)
List some TYPES of Dementia
- Mild Cognitive Impairment (MCI) – not dementia
- Alzheimer’s disease (AD) – MC, 50-60% of all dementias.
- Vascular dementia – 15-20% of patients, often occur with AD.
- Combination of which is called “mixed dementias”.
- Parkinson’s Disease
List some other conditions affecting thinking and memory
- Normal pressure hydrocephalus
- Hypothyroidism
- Vitamin B1 and B12 deficiency
- Normal pressure hydrocephalus
- Subdural haematoma
- Drug intoxication
- Alcohol intoxication
- Cerebral vasculitis
- Heavy metal poisoning
- Brain neoplasia
- Chronic infections:
- Syphilis
- Menningitis
Name some RISK FACTORS for Dementia
- Age
- Genetics
- Smoking
- Alcohol use
- Atherosclerosis
- Diabetes
- Mild cognitive impairment
- Down syndrome
What are the presenting symptoms of EARLY DEMENTIA?
- Anomia = difficulty finding the words to say
- Agnosia = difficulty identifying objects
- Apraxia = in ability to execute voluntary motor movement
- difficulty performing otherwise familiar tasks = driving, cooking, finances
-
personality changes
- mood swings
- uncharacteristic behaviors
- forgeting names; losing things
- poor judgement - inabillity to reason
- decrease in function- but can follow home routine
- confusion in unfamiliar surroundings >>wandering to find the familiar = gets lost
What are the presenting symptoms of INTERMEDIATE DEMENTIA?
- Worsened early symptoms - less able to compensate.
- Needs help carrying out ADLs
- Disrupted sleep and frequent napping during the day.
- Difficulty learning and retaining new information.
- Becoming confused and disorientated in familiar surroundings.
- Increased risk of falls due to poor judgment and confusion.
- Behaviour – paranoid delusions, aggressive, agitation, inappropriate sexual behaviour.
- Hallucinations
- Confabulation (fabricated, distorted or misinterpreted memories about oneself or the world, without meaning to deceive).
- Inattention, poor concentration, loss of interest in outside world.
- Abnormal moods – depression, anxiety.
What are the presenting symptoms of SEVERE DEMENTIA?
- Worsening of previous symptoms.
- Complete dependence for ADLs
- May be unable to walk or move from place to place unassisted.
- Impairment of swallowing – malnutrition, choking, aspiration.
- Complete loss of short and long term memory – unable to recognise even close friends and relatives.
- Complications – dehydration, malnutrition, bladder control, infections, aspirations, seizures, pressure sores, injuries from accidents or falls.
What process would to go through when compiling a DDx and eliminating to a working Dx?
-
Clinical Presentation
- Carer feedback can be important (AD8)
-
Cognitive assessment
- MMSE, MiniCog, CDT
- Diagnosis by exlusion
AD8 = Alziemers Disease 8 = 8 questions the carer answers to screen
MMSE = Mini-Mental State Examination - questionairre
CDT = Clock Drawing Test
MiniCog = 3 item recall + CDT
How do you quantify/assess COGNITIVE IMPAIRMENT?
MMSE = total score out of 30
- Orientation (place and time)
- Attention & calculation
- Registration and recall
- Construction
- Language
MiniCOG
CDT + 3 word recall
Scoring
- Recall and clock performance
- Recall 3= not impaired
- Recall 1-2 + normal clock = not impaired
- Recall 1-2 + abnormal clock = impaired
- Recall 0 = impaired
According to Diagnostic & Statistical Manual (DSM) of mental disorders what is the criteria for ALZEIMER’S DISEASE?
- Impairment of long or short term memory
- Impairment of at least one higher cortical function
- Aphasia
- Agnosia
- Apraxia
- Loss of judgment
- Impairment reflects decline and impacts social function
- Patient has normal consciousness
What are some common symptoms of ALZEIMER’S DISEASE?
- reversal of sleep cycle
- Pts unaware of cognitive decline - relatives seek help
- progressivly develop apraxic gait
- speech difficulties - Aphasia = cant name objects
- advanced = cant independantly care for themselves nee help with ADL’s
What is the Course of ALZEIMER’S DISEASE?
- Difficulty with episodic memory
- Other disorders of cognition
- Communication
- Inability to recognise family members
- Agitation, hallucinations, delusions
- Physical decline
- Incontinence
What is the medical management of ALZEIMER’S DISEASE?
Varies depending on diagnosis -Treat cause if possible
- Relieve and slow down the progress of symptoms, behaviour changes, and complication
- Minimise risk factors
- Treat co-morbidities
- Healthy lifestyle
- Symptom management
- Carer support
what are the cardinal signs needed for the diagnosis of PARKINSON’S DISEASE as well as other symptoms
To diagnose need cardinal signs:
- distal resting tremor of 3 to 6 Hz,
- rigidity,
- bradykinesia, and
- asymmetrical onset.
Other symptoms
- late-onset postural instability,
- decreased olfaction, and
- micrographia.
a progressive neurodegenerative disorder with an estimated prevalence of 0.3 percent in the generalpopulation.
- The prevalence increases to 4-5% in those older than 85 years.
What is the etiology of NORMAL PRESSURE HYDROCEPHALUS (NPH) & some associated pathologies?
Cause = UNKNOWN
Associated Pathology:
- meningitis,
- head trauma,
- subarachnoid hemorrhage,
- Paget’s disease of the skull,
- mucopolysaccharidosis of the meninges.
- Systemic hypertension is also associated with NPH.
