Mental health > Dementia > Flashcards

Dementia Flashcards

(35 cards)

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1
Q

Define mild cognitive impairment

A
  • Focal cognitive impairment
  • Not severe enough to interfere with daily life and function
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2
Q

What is dementia?

A

A syndrome characterised by:

  • Progressive global cognitive deficits
  • Compared to baseline
  • Significant impairment of normal functioning
  • Definite Dx: symptoms lasting 6+ months
  • Tentative Dx: symptoms lasting less than 6 months
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3
Q

What is included in the routine dementia screen?

A
  • TFTs
  • Vit B12; folate
  • FBC; ESR; CRP: anaemia and vasculitis
  • LFTs; U+Es
  • Glucose
  • CT head
  • Neurosyphilis test
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4
Q

What are the cognitive deficits seen in dementia?

A
  • Memory impairment
  • Impaired executive function
  • Dysphagia
  • Agnosia
  • Apraxia (loss of motor function)
  • Personality disintegration
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5
Q

What is executive function?

A

A set of cognitive processes that enable planning, organisation, and completion of tasks.

e.g. Problem solving, abstraction, reasoning, decision making, judgement, planning, organisation, processing

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6
Q

Name four risk factors for Dementia

A
  • Older age
  • Mild cognitive impairment
  • Intellectual difficulties
  • Genetics; FHx of young-onset dementia
  • CVD risk factors; stroke
  • Parkinson’s disease
  • Depression; Alcohol abuse
  • Low educational attainment; low social engagement/support
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7
Q

Name four protective factors for Dementia

A
  • Diet: Vitamin E and C
  • Exercise
  • Mental and social activity
  • More complex work ➔ reduced hippocampal atrophy
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8
Q

What are the common causes of dementia?

A
  • Alzheimer’s disease (50-60%)
  • Vascular dementia (20-25%)
  • Mixed dementia
  • Lewy body dementia (10-15%)
  • Frontal-temporal dementia (7%)
  • Other e.g. CJD, AIDS dementia, Alcohol dementia (3%)
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9
Q

List three behavioural and psychological symptoms of dementia (BPSD)

A
  • Psychosis: delusions and/or hallucinations
  • Agitation; emotional lability
  • Depression; anxiety
  • Withdrawal; apathy
  • Disinhibition: social or sexually inappropriate behaviour
  • Motor disturbance: wandering; restlessness
  • Sleep cycle disturbance; insomnia
  • Echolalia (tendency to repeat phrases or questions)
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10
Q

What differential diagnoses must be excluded for a diagnosis of dementia?

A
  • Delirium
  • Depression
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11
Q

Name three reversible causes of dementia

A
  • Subdural haematoma
  • Normal pressure hydrocephalus
  • Chronic alcohol misuse
  • Metabolic
    • Vitamin B12 deficiency
    • Hypothyroidism
    • Hypoglycaemia
  • Neurosyphilis
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12
Q

What is the characteristic of fronto-temporal cortical dementia?

A

Prominent personality change

May manifest as frontal lobe syndrome: damage of higher functioning processes eg. motivation, planning, behaviour

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13
Q

What is Alzheimer’s disease?

A
  • Commonest form of dementia
  • Degenerative disease of the brain
  • Prominent cognitive and behavioural impairment.
  • Significantly interferes with social and occupational function
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14
Q

List three risk factors for Alzheimer’s disease

A
  • Increasing age
  • FHx of AD or early-onset AD
  • Down’s syndrome
  • FHx of Down’s syndrome
  • Previous head injury
  • Hypothyroidism
  • Parkinson’s disease
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15
Q

What is the association between Alzheimer’s disease and Down’s syndrome

A

Chromosome 21:

  • AD: gene for amyloid precursor protein ➔ amyloid plaques
  • DS: Down’s syndrome have an extra Chromosome 21 ➔ accelerated production of amyloid plaques ➔ earlier dementia
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16
Q

What are the three symptomatic domains of Alzheimer’s disease?

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A
  • Cognitive
  • Functional: ADLs
  • Neuropsychiatric
    • Mood/affect disturbances
    • Aggression
    • Anxiety
    • Psychosis
    • Sleep disturbances
17
Q

Describe the memory problems in Alzheimer’s disease

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A
  • Early impairment of immediate and short-term memory
    • Due to atrophy of the hippocampus.
  • Long-term (remote) memory declines with progression
  • Common to also have disorientation of time and place
18
Q

List three early symptoms of Alzheimer’s disease

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A
  • Impaired immediate and short-term memory
  • Disorientation of time and place
  • Muddled efficacy with ADLs
  • Spatial dysfunction
  • Behavioural: Wandering, irritability
19
Q

List three middle symptoms of Alzheimer’s disease

Study These Flashcards
A
  • Intellectual and personality deterioration
  • Aphasia
  • Apraxia
  • Agnosia (inability to process sensory information)
  • Impaired executive function
  • Impaired visuospatial skills: getting lost, impaired driving
20
Q

List three late symptoms of Alzheimer’s disease

Study These Flashcards
A
  • Fully dependent
  • Physical deterioration
  • Incontinence
  • Gait abnormalities
  • Spasticity Seizures (3%)
  • Tremors
  • Extrapyramidal signs
21
Q

How does early-onset Alzheimer’s disease differ from typical AD?

Study These Flashcards
A
  • More aphasia and apraxia
  • Rapid course with severe intellectual decline
  • Poor survival rate
22
Q

Request four investigations for Alzheimer’s disease

Study These Flashcards
A
  • Cognitive testing: Clock drawing test, MMSE
  • FBC
  • TFTs
  • Haematinics: B12; folate
  • Neurosyphilis screen
  • LFT, U+Es, TSH, HIV
  • CT head:
    • Cortical atrophy esp in medial temporal lobes (hippocampus), ventricular enlargement
23
Q

Outline the management of Alzheimer’s disease

Study These Flashcards
A
  • Promoting cognition, independence and wellbeing:
    • Group cognitive stimulation therapy
    • Cognitive rehabilitation; occupational therapy
  • Medication:
    • AChEi: donepezil; galantamine; rivastigmine
    • Memantine
24
Q

What are the indications for Memantine?

Study These Flashcards
A
  • Moderate Alzheimer’s disease
    • AChEi contraindicated or not tolerated
  • Severe Alzheimer’s disease
25
Name three risk factors for Vascular dementia
* Male * PMH or FHx of cardiovascular disease * CV risk: smoking, diabetes, HTN, hyperlipidaemia
26
List three characteristics suggestive of Vascular dementia
* Sudden onset * Stepwise deterioration * Cardiovascular risk factors
27
How can the presentation of vascular dementia be categorised?
* Cognitive deficits following a single stroke * Deficits depend on site of infarct * Multi-infarct dementia * Stepwise deterioration in cognitive function * Relative stability between strokes * Binwangers disease: progressive small-vessel disease * Gradual intellectual decline * Generalised slowing * Motor problems
28
List four presenting features of Vascular dementia
* Acute onset; may follow a stroke * Early: * Emotional and personality changes * Cognitive deficits - fluctuate * Behavioural slowing and anxiety * Depression with affective lability and confusion, esp at night * Physical signs of arteriovascular disease * Neurological impairment
29
Outline the management of Vascular dementia
* **Manage modifiable risk factors**: * Diet; exercise * Smoking cessation; reduce alcohol intake * Medication: * Aspirin * Clopidogrel * Statins * ACEi * Anti-hyperglycaemics if needed
30
When may a CXR be indicated when investigating dementia?
Indication of **malignancy**, esp of small-cell lung cancer Paraneoplastic syndromes resembling neurological deficits in dementia
31
Name one infectious cause of reversible dementia
* HIV * **Syphilis** * TB * Meningitis
32
Outline pathophysiology of Lewy body dementia
Accumulation of Lewy bodies (alpha-synuclein and ubiquitin) in the cerebrum and substantia nigra.
33
Name two characteristic clinical features of Lewy body dementia
* **Fluctuating cognitive impairment** * **Spontaneous parkinsonism** * **Vivid visual hallucinations** * *Additional: REM sleep disturbance - treated with clonazepam*
34
Why should antipsychotics be avoided in Lewy body dementia?
Antipsychotics can: * **Precipitate irreversible parkinsonism** * Preceipitate autonomic dysregulation * similar to neuroleptic malignant syndrome * Reduce consciousness * Increases mortality rates (2-3x)
35
Differentiate dementia from delirium
Delirium has altered consciousness and attention Dementia: * Gradual onset (months to years); progressive * Normal consciousness; late perceptional disturbances * Normal sleep-wake cycle Delirium: * Acute onset (hours to weeks); fluctuating course * Impaired consciousness; perceptional disturbances often * Disrupted sleep-wake cycle.
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