CCFP > Dementia > Flashcards

Dementia Flashcards

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1
Q

What is a synonym for “Dementia”?

A

Major neurocognitive disorder

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2
Q

Diagnostic criteria for dementia (4)

A
  1. Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains both subjectively and objectively reported
  2. Deficits interfere with independent functioning
  3. No delirium
  4. No other more probable diagnosis
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3
Q

Name the cognitive domains (6)

A
  1. Complex attention
  2. Executive function
  3. Learning and memory
  4. Language
  5. Perceptual-motor
  6. Social cognition
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4
Q

Name 6 instrumental activities of daily living

A
  1. Dressing
  2. Eating
  3. Ambulating
  4. Toileting
  5. Hygiene
  6. Showering
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5
Q

Name 7 activities of daily living

A
  1. Shopping
  2. Housework
  3. Accounting
  4. Food preparation
  5. Telephone
  6. Transportation
  7. Taking medication
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6
Q

Differential diagnosis for Memory loss

A
  • Major neurocognitive disorder
  • Mild neurocognitive disorder
  • Delirium
  • Depression
  • Stoke/TIA
  • Seizure
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7
Q

Physical exam for patient with memory loss

A
  • Neurological exam
  • Gait assessment
  • Extrapyramidal symptoms assessment
  • Parkinson’s symptoms (cogwheeling, rigidity, tremors)
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8
Q

Investigations

A
  • Memory testing
  • Depression screening
  • HGB
  • WBC
  • Glucose
  • Creatinine
  • Calcium
  • TSH
  • B 12
  • Syphilis
  • CT Head
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9
Q

Name one investigation to do before initiating pharmacotherapy for dementia

A

EKG

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10
Q

Indications for CT head

A 
< 60 yo
Abrupt, rapid decline
Focal neurological symptoms
Urinary incontinence
Gait disorder
Previous malignancy
Trauma
Anticoagulants or history of bleeding disorder
If presence of cerebrovascular disease would change management
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11
Q

List four memory testing tools

A

MMSE
MOCA
Mini-cog (Clock drawing and 3 word recall)
Hopkins Verbal learning test

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12
Q

MMSE score for diagnosis of major neurocognitive disorder

A

<24/30

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13
Q

MoCA Interpretation

A

27-30 Normal
18-26 Mild impairment
10-17 Moderate impairment
<10 Severe impairment

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14
Q

MMSE Interpretation

A 
26 to 30 Normal
20 To 25 Mild cognitive impairment
10 to 18 moderate cognitive impairment 
3 to 9 severe cognitive impairment 
Less than 3 very severe cognitive impairment
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15
Q

Name possible causes of delirium

A 
Infection
Medications
Thyroid dysregulation
Sodium dysregulation
Glucose abnormalities
Vitamin B 12 deficiency
Pain
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16
Q

Name possible medication causes of Delirium

A 
Polypharmacy
Opioids
Cholinergic and anticholinergic
Benzodiazepines
Antidepressants
Antipsychotics
Steroids
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17
Q

Name 6 types of dementia

A 
Alzheimer’s disease
Vascular dementia
Mixed Alzheimer’s and vascular dementia
Lewy body dementia
Frontotemporal dementia
Parkingson’s disease with dementia
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18
Q

Which is the most common type of dementia?

A

Alzheimer’s disease accounts for 50% of dementia

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19
Q

Is the onset of Alzheimer’s disease gradual or abrupt?

A

Gradual onset

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20
Q

What is the initial and most prominent deficit in Alzheimer’s disease?

A

Amnestic impairment: impairment in learning and recall of recently learned information

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21
Q

Describe the evolution of vascular dementia

A

Abrupt onset with stepwise deterioration

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22
Q

Which type of risk factors are associated with vascular dementia?

A

Cardiovascular risk factors (Smoking, hypertension, dyslipidemia, previous myocardial infarction, previous strokes, documented TIAs, strong family history)

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23
Q

True or false. Impairment of executive function is associated with Alzheimer’s disease than with vascular dementia.

A

False: impairment of executive function is more related to vascular dementia.

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24
Q

If patient presents with history of memory loss and focal neurological features, which type of dementia do you suspect?

A

Vascular dementia

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25
What are the main features of frontotemporal dementia?
Behavioural problems such as disinhibition and loss of social awareness Language impairment
26
How do you differentiate between Louis body dementia and Parkinson disease with dementia?
In Lewy body dementia, dementia occurs at the same time as parkinsonian signs or dementia occurs before parkinsonian signs. In Parkinson disease, dementia occurs more than one year after the appearance of parkinsonian signs.
27
A patient with Parkinson disease can develop dementia with what type of impairments?
Impaired executive function and visual-spatial function
28
What are the core features of Lewy body dementia? (4)
Fluctuating cognition Detailed visual hallucinations REM sleep behaviour disorder Parkinsonism
29
Name five parkinsonian signs
``` Bradykinesia Tremor Rigidity Postural instability Shuffling gait Masked faeces Micrographia Dystonia ```
30
What are the major components of management in dementia?
``` Lifestyle management Pharmacotherapy Management of Behavioural and psychological symptoms of dementia Referral Genetic testing Driving assessment Caregiver assessment ```
31
When do you refer in dementia?
Rapidly progressive dementia Young patient Frontotemporal, Lewy body or Parkinson dementia
32
When do you suspect it genetic causes for Alzheimer’s disease?
In patients with early onset disease and a Mendelian pattern of transmission
33
Which proportion of the general population above 55 years old happy first-degree relative with dementia?
25%
34
What is the lifetime risk of dementia in the general population?
10%
35
What is the lifetime risk of dementia in those with a family history?
20%
36
How do you assess for unsafe driving?
``` Memory testing with MMSE of 24 or less Self restricted driving Family concerns Multiple tickets Accidents Aggressive or impulsive behaviour History of feeling lost on the road ```
37
Which tool can you use to assess risk of driving?
Clinical dementia rating scale
38
Patient with dementia presents with severe agitation and violent behavior. What are the possible underlying causes?
Physical: Pain, constipation, infection Environmental: set routines, sounds and lights, position, daytime activities Psychiatric conditions: depression Medications
39
Name some environmental interventions for behavioural and psychological symptoms of dementia
Relaxation techniques Social contact Sensory interventions such as music and aromatherapy Increased services and care
40
Which medications can be considered for behavioural and psychological symptoms of dementia?
Newer anti-psychotics | Risperidone, olanzapine, Seroquel
41
What are the possible adverse outcomes of the use of antipsychotics in the geriatric patient with dementia?
``` Increased risk of death CVA EPS Falls Somnolence Weight gain Diabetes ```
42
Name three acetylcholine esterase inhibitors
Donepezil Rivastigmine Galantamine
43
In which patients do you consider treatment with Donepezil?
In patient with mild to moderate Alzheimer’s disease
44
What are the possible adverse effects of Acetylcholine esterase inhibitors?
G.I.: nausea, diarrhoea, vomiting Cardiac: bradycardia, hypotension, dizziness, syncope Sleep: insomnia QT prolongation and torsades de point
45
What is the class and generic name for a medication used in severe Alzheimer’s disease?
Memantine, NMDA receptor antagonist
46
Which medications can be used to manage frontotemporal dementia?
SSRI: Paroxetine or trazodone
47
True or false. There is evidence for the use of acetylcholine esterase inhibitors in frontotemporal dementia and vascular dementia.
False
48
How do you manage vascular dementia differently?
Manage hypertension, diabetes, smoking, dyslipidaemia
49
What is the risk of using antipsychotics and Lewy body dementia?
It may cause neuroleptic malignant syndrome
50
When can you consider using an acetylcholinesterase inhibitor?
Alzheimer’s disease Lewy body dementia Parkinson disease with dementia
51
Name five lifestyle management points that you should bring up with patients and their families when dealing with dementia
Creating a will, power of attorney, personal directives Safety issues at home and on the road Healthy diet Smoking cessation Exercise program Eliminating medications Alternative therapies such as aromatherapy, multi sensory stimulation, music therapy, animal assisted therapy, massage therapy
52
Name community resources to which you can refer the patient with dementia and their family
The Alzheimer Society Occupational therapy Social services Home care services
53
How often should you follow up with a patient with mild neurocognitive disorder?
Follow up every 3 to 6 months.
54
Define mild neurocognitive disorder
Decline reported by patient informant or clinician with an objective findings of deficits in one or more domain typically memory, with preserved function
55
What is the risk of conversion of mild neurocognitive disorder into Alzheimer’s disease on a yearly basis?
15% of patients with mild neurocognitive disorder will convert into Alzheimer’s disease every year
56
What is severe neuroleptic sensitivity?
Increased risk of neuroleptic malignant syndrome seen in patients with Lewy body dementia
57
What are the features of neuroleptic malignant syndrome?
``` Parkinsonism Drowsiness Falls Hyperthermia Autonomic instability ```
58
A patient presents with fluctuating cognition and newly onset parkinsonism as well as postural instability and hypersomnia. What is the most likely cause of his dementia?
Lewy Body dementia
59
A patient with dementia presents with autonomic dysfunction and depression. What is the most likely cause of his dementia?
Lewy body dementia
60
A patient with dementia presents with worsening function, what should you do?
Do not assume the dementia is worsening. | Look for other possible causes such as depression, infection or medications.
61
How do you disclose the diagnosis of dementia?
Disclose the diagnosis of dementia compassionately, and respect the patients right autonomy, confidentiality, and safety.
62
In patients with dementia assess ________, in order to see whether they can make their own decisions or not.
Competency
63
In patients with dementia, how do you follow up?
Assess function and cognition on an ongoing basis
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