Dementia
What is the pathophysiology of Alzheimer’s disease?
Cerebral atrophy
Neurofibrillary tangles and senile plaques
Dementia
What is the most common type of dementia?
Alzheimer’s
Dementia
What are the signs and symptoms of Alzheimer’s dementia?
- Develops after the age of 60
- Onset >6 months
- Early (<2 years) cognitive impairment: memory, planning, reasoning, speech and orientation affected
- As the disease progresses it can affect behaviour , extrapyramidal and cerebellar systems: depression/anxiety/personality change, progressive inability in self-care
Dementia
What is the second most common type of dementia?
Vascular
Dementia
How does vascular dementia present?
- More common in males
- Increased prevelance in those who had a stroke
- Stepwise progression - stability, acute decline, stability
- Vascular risk factors present e.g., diabetes, hypertension
- Atherosclerosis risk factors present e.g., hypertension, hyperlipidaemia, smoking, diabetes
- Mood disturbance and disorders common e.g., psychosis, delusions, hallucinations and paranoia (especially in later stages)
Dementia
How does Lewy body dementia present?
- > 50 years old
- More men than women
- Rapidly progressive
- Visual hallucinations
- Parkinson’s-like symptoms
- Problems multitasking and performing complex cognitive actions
- Sleep disorders and fluctuating cognitive ability
- Impaired attention
- Cognitive impairment develops before Parkinsonism
Dementia
How does frontotemportal dementia present?
Often seen in <65 years old
Presents with behavioural and/or semantic and/or non-fluent symptoms
Behavioural:
* altered emotional responsiveness, apathy, disinhibition, impulsivity
* progressive decline in interpersonal skills
* changes in food preference, more childlike amusements
* obsessions and rituals
Semantic:
* progressive decline in understanding meaning of words
* speech may be fluent, but difficulty in name retrieval and use of less precise terms
* unable to determine meanings of common words when asked
* may develop inability to recognise objects or familar faces (prosopagnosia)
Non-fluent:
* progressive breakdown in the output of language
* speech takes effort and is not fluent
* speech apraxia or disorders of speech sound
* impaired comprehension of sentences and impact on literacy skills
Geriatrics
What are the 5 Ms of geriatric medicine?
Give examples for each
Mind: dementia, delirium, depression
Mobility: falls
Medications: polypharmacy, adverse effects
Multi-complexity: multi-morbidity, biopsychosocial situations
Matters most: individual’s meaningful health outcomes/preferences
Geriatrics
What are the risk factors for falls?
- Previous falls
- Fear of falling
- Balance problems
- Gait and mobility problems
- Pain
- Drugs
- Cardiovascular conditions
- Cognitive impairment
- Urinary incontinence
- Stroke
- Diabetes
Dementia
What medication can be used to treat symptoms of dementia?
Including the type of drug
Donepazil - acetylcholinesterase inhibitor
Delirium
What are the causes of delirium?
PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment
