What is the CAM used for?
Assessment to differentiate between delirium and dementia
CAM stands for Confusion Assessment Method.
What are the pathophysiological features of lewy body dementia?
- Alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra
- Paralimbic areas
- Neocortical areas
These inclusions are characteristic of lewy body dementia.
List the clinical features of lewy body dementia.
- Progressive cognitive impairment (typically occurs before parkinsonism)
- Parkinsonism
- Visual hallucinations
- Other features: delusions and non-visual hallucinations
These features help in diagnosing lewy body dementia.
What investigation is increasingly used for lewy body dementia?
Single-photon emission computed tomography (SPECT)
It is commercially known as a DaTscan, using 123-I FP-CIT as the radioisotope.
What is the management for lewy body dementia?
Acetylcholinesterase inhibitors e.g. rivastigmine
These medications help manage symptoms of lewy body dementia.
What is the 1st line pharmacological management for Alzheimer’s disease?
Acetylcholinesterase inhibitor e.g. donepezil, rivastigmine, galantamine
These are the first-line treatments for Alzheimer’s disease.
What is the 2nd line pharmacological management for Alzheimer’s disease?
NMDA receptor antagonist e.g. memantine
This is used when first-line treatments are not sufficient.
What are the contraindications to donepezil?
- Bradycardia
- AV block
These conditions may worsen with the use of donepezil.
What is a common adverse effect of donepezil?
Insomnia
Patients may experience sleep disturbances while on donepezil.
What is the pharmacological management of delirium if non-pharmacological measures fail?
Haloperidol 0.5mg
Alternative medications for parkinson’s disease include lorazepam, quetiapine, or clozapine.
Name the three types of frontotemporal lobar degeneration.
- Frontotemporal dementia (Pick’s disease)
- Progressive non-fluent aphasia (chronic progressive aphasia, CPA)
- Semantic dementia
These types are classified based on their clinical features.
What are the clinical features of frontotemporal lobar dementias?
- Onset <65 years
- Insidious onset
- Relatively preserved memory and visuospatial skills
- Personality change and social conduct problems
These features help differentiate frontotemporal lobar dementias from other types.
What are the brain imaging findings in Pick’s disease?
Focal gyral atrophy with knife blade appearance
This imaging characteristic is indicative of Pick’s disease.
What are the macroscopic changes seen in Pick’s disease?
- Atrophy of frontal lobes
- Atrophy of temporal lobes
These changes are observed during examination of the brain.
What are the microscopic changes seen in Pick’s disease?
- Pick bodies - spherical aggregations of tau protein (silver-staining)
- Gliosis
- Neurofibrillary tangles
- Senile plaques
These microscopic features are crucial for diagnosis.
What is a clinical feature specific to chronic progressive aphasia (CPA)?
Non-fluent speech → short utterances that are agrammatic
Comprehension is relatively preserved in CPA.
What is a clinical feature specific to semantic dementia?
Fluent progressive aphasia
Speech is fluent but conveys little meaning.
What is the management of a pressure ulcer with minimal exudate?
Hydrocolloid dressing
This type of dressing helps maintain a moist environment for healing.
What is the management of a deep pressure ulcer with moderate-heavy exudate?
Alginate dressing
Alginate dressings are effective for managing heavier exudate.
