#passmed 2022 > Dementia > Flashcards

Dementia Flashcards

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1
Q

What is Dementia?

A

Neurodegenerative syndrome w progressive decline in several cognitive domains

(Memory / Concentration / Language / Learning etc)

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2
Q

How is a diagnosis of dementia made? (4 things)

A
  1. History
  2. Cognitive testing
  3. Examination
  4. Medication review
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3
Q

What are the Key Features of the History needed for diagnosing Dementia? (5 things)

A
  1. Patient History
  2. Collateral History
  3. Timeline of decline
  4. Cognitive domains affected
  5. Non-cognitive symptoms
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4
Q

What Non-Cognitive symptoms suggest LATE disease dementia? (3 things)

A
  1. Agitation
  2. Aggression
  3. Apathy (lack of interest / enthusiasm)
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5
Q

What Cognitive Testing should you do for sus Dementia pt? (3 things)

A
  1. AMTS (Dementia screen test)
  2. Function and language tests
  3. Mental State Examination (to identify anxiety / depression / hallucinations)
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6
Q

What does Examination help identify in sus Dementia? (3 things)

A
  1. Physical causes
  2. Risk factors (e.g for Vascular dementia)
  3. Parkinsonism
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7
Q

What is the use of Medication Review in sus Dementia?

A

To exclude drug-induced cognitive impairment

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8
Q

What investigations should you do for sus Dementia? (4 things)

A
  1. Look for Reversible / Organic causes
  2. PET / SPECT
  3. EEG
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9
Q

What investigation can you do for other causes of Dementia? (8 things)

A
  1. FBC - anaemia
  2. ESR & CRP - infection / vasculitis
  3. T4 and TSH - hypothyroidism
  4. U&Es - renal failure / electrolyte disturbances (high / low Ca)
  5. B12 / B9 (folate) - vitamin deficiencies
  6. LFT – alcohol related / encephalopathy
  7. Coagulation screen + Albumin - assess liver function
  8. Glucose
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10
Q

What will an MRI show you in sus Dementia? (3 things)

A
  1. Underlying vascular damage
  2. Structural pathology
  3. Identifies other reveresible pathologies:
  • Subdural haematomas
  • Normal-pressure Hydrocephalus
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11
Q

What scan should you do when Dementia diagnosis is unclear / to confirm subtype?

A

PET / SPECT

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12
Q

When should you do a EEG for sus Dementia? (4 things)

A

When sus:

  1. Delirium
  2. Frontotemporal Dementia
  3. CJD (degenerative brain disorder that leads to dementia)
  4. Seizure disorder
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13
Q

What are the Subtypes of Dementia? (4 things)

A
  1. Alzheimer’s disease (AD)
  2. Vascular dementia
  3. Lewy body dementia
  4. Fronto-temporal dementia
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14
Q

What are the causes of Dementia? (8 things)

A

Diabetes

Ethanol

Medication

Environment (CO poisoning)

Nutritional

Trauma

Infection

Alzheimer’s (most common cause)

DEMENTIA

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15
Q

What are the CF of Dementia? (7 things)

A
  1. Memory loss / can’t retain new info
  2. Language impairment
  3. Concentration loss
  4. Poor judgment
  5. Apraxia (inabilty to perform an action)
  6. Behavioural disturbance
  7. Personality change
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16
Q

What is the pathophysiological steps of Alzheimer’s? (2 + 5 things)

A
  1. Amyloid Precusor Protein (APP) degrades into –> Beta-Amyloid Peptide
  2. Beta-Amyloid Peptide accum results in:
    1. Progressive neuronal damage (cortex + hippocampus)
    2. Neurofibrillary tangles
    3. Beh Amyloid plaques
    4. Loss of ACh
    5. Vascular Fx
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17
Q

What are the parts of the brain most vulnerable to neuronal loss in Alzheimer’s? (4 things)

A
  1. Hippocampus
  2. Amygdala
  3. Temporal neocortex
  4. Subcortical nuclei
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18
Q

What are the Risk Factors for Alzheimer’s? (5 things)

A
  1. Age (60+, risk doubles every 5 yrs)
  2. FHx
  3. Down’s syndrome (inevitable) (40 yrs old +)
  4. Apolipoprotein-E e4 alleles
  • ApoE usually breaks down B-amyloid, but the ApoE-e4 allele version is less effective
    1. Vascular (HTN / Diabetes / AF)
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19
Q

What are the MACROSCOPIC pathological changes in Alzheimer’s?

A

Widespread cerebral atrophy (esp cortex + hippocampus)

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20
Q

What are the MIROSCOPIC pathological changes in Alzheimer’s? (2 things)

A
  1. Amyloid plaques
  2. Neurofibrillary tangles (bc abn aggregation of Tau prot)
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21
Q

What investigations should you do for sus Alzheimer’s?

A
  1. CT / MRI
  2. MMSE
  3. Neuropsychological testing (to confirm cogn imp)
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22
Q

What’s the use of a CT / MRI in sus Alzheimer’s? (2 things)

A
  1. To check for Cerebral atrophy (esp Cortex + Atrophy) = AD
  2. To exclude other dementia causes
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23
Q

What medications can you give for MILD - MODERATE Alzheimer’s?

Study These Flashcards
A

AcetylcholinEsterase inhibitors (Donepezil / Rivastigmine / Galantamine)

24
Q

What medications can you give for MODERATE - SEVERE Alzheimer’s?

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A

NMDA receptor antagonist (Memantine)

25
What is Vascular Dementia? (2 things)
1. 2nd most common cause of dementia 2. Results from cerebrovascular events / chronic ischaemia
26
What are the main subtypes of Vascular Dementia? (3 things)
1. Stroke related VD (multi/single infarct dementia) 2. Subcortical VD (caused by small vessel disease) 3. Mixed dementia (VD + AD)
27
What is the speed of onset / deterioration in Vascular Dementia?
* Sudden onset * Step-wise deterioration
28
What are the risk factors for Vascular Dementia? (6 things)
1. Stroke / TIA Hx 2. AF 3. Smoking 4. HTN 5. DM 6. Hyperlipidaemia
29
What are the causes of Vascular Dementia? (4 things)
1. Cerebral artery atherosclerosis 2. Carotid artery embolization 3. Chronic HTN --\> Cerebral arterioles sclerosis 4. Vasculitis
30
What do the CF of Vascular Dementia depend on?
Area of brain that's damaged
31
What are the CF of Vascular Dementia where the FRONTAL part of the brain is affected?
Executive dysfunction (frontal) (attention, problem solving, creativity, emotional regulation)
32
What are the CF of Vascular Dementia where the LEFT PARIETAL part of the brain is affected? (3 things)
1. Aphasia (language / speech problem) 2. Apraxia (inability to perform an action) 3. Agnosia (can't recognise objects / faces / voices)
33
What are the CF of Vascular Dementia where the RIGHT PARIETAL part of the brain is affected? (3 things)
1. Hemineglect (neglecting one side) (see pic) (+ will only draw half a clock like in The Good Doctor) 2. Confusion 3. Agitation
34
What are the CF of Vascular Dementia where the TEMPORAL part of the brain is affected? (3 things)
Anterograde amnesia (unable to create new memories)
35
What CF will you have in Vascular Dementia caused by SUBCORTICAL infarcts? (5 things)
1. Personality / mood changes 2. Mild memory deficit 3. Gait disturbance 4. Urinary frequency / urgency 5. Improvements occur between cerebrovascular events
36
What investigations should you do for Vascular Dementia? (2 things)
1. MRI / CT scan 2. Neuropsychological testing
37
What might you see on a MRI / CT scan of Vascular Dementia? (2 things)
1. Cortical / Subcortical infarcts 2. White matter changes
38
What investigations should you do after you see a infarct on a MRI / CT of Vascular Dementia? (4 things) What will these investigations reveal?
1. Carotid Doppler US - Reveal carotid plaques 2. Echocardiogram - Reveal cardiogenic emboli 3. ECG - Reveal arrhythmias 4. Risk factor screening (investigations to find the cause of the infarct)
39
How does Vascular Dementia compare to Alzheimer's in Neuropsychological Testing?
* Similar: Language / Memory deficits * Vascular has MORE impared executive functioning
40
What is the aim of treatment in Vascular Dementia? (2 things)
1. Mainly symptomatic 2. Addressing CVS problems and slowing progression * Anti-HTN drugs / anti-diabetic drugs / statins / antiplatelet drugs
41
When should AcetylcholinEsterase Inhibitors and Memantine ONLY be considered for Vascular Dementia?
When they have comorbid Alzheimer's If they dont have AD, DON'T give dem da drugs
42
What is Lewy Body Dementia?
Is a cause of Dementia characterised by Lewy bodies in Substantia Nigra + Paralimbic + Neocortical areas (--\> cause damage to nerve cells)
43
What are the CF of Lew Body Dementia? (3 things)
1. Progressive + Fluctuating Cognitive Impairment 2. Visual hallucinations 3. Parkinsonism (late)
44
How is are the CF of Lewy Body Dementia different to other types of Dementia? (2 things)
1. Has early impairments in **Attention** + **Executive Function** not just memory loss like in AD 2. Cognition may be **fluctuating** (unlike other types of Dementia)
45
What investigations should you do for sus Lewy Body Dementia? (4 things)
1. SPECT scan (90% sensitivity) (increasingly used) 2. Neuropsychological Testing 3. MMSE 4. (Post-autopsy brain **biopsy** after death to see Lewy Bodies in cortical neurons)
46
What medications can you give for Lewy Body Dementia? (2 things)
1. AcetylcholinEsterase Inhibitors + Memantine (like for AD) --\> for Cognitive symptoms 2. Dopamine analogue --\> for Motor symptoms
47
What medications SHOULD YOU NOT GIVE for Lewy Body Dementia? Why? (2 things)
Antipsychotics 1. Pt are extremely sensitive to their Side Fx 2. They can develop irreversible Parkinsonism
48
What are the Complications of Lewy Body Dementia? (5 things)
1. Persistent symptoms, esp Visual Hallucinations 2. Depression 3. Complete debilitation --\> dependence on others 4. Infection --\> death 5. Parkinsonism (from antipsychotics)
49
What is FrontoTemporal Dementia? (2 things)
Dementia characterised by 1. Frontal and Temporal lobe Atrophy 2. Loss of 70+% of Spindle neurons
50
What age does FrontoTemporal Dementia usually occur at?
Before 65 Memory loss usually occurs LATER (2nd most common cause of Dementia before 65 yrs)
51
What are the CF of FrontoTemporal Dementia? (5 things)
1. Behavioural changes (early) (e.g loss of empathy) 2. Speech difficulties (early) 3. Cognitive Impairment (late) 4. Executive Functioning Impairment (concentration + planning) (late) 5. Memory problems (late)
52
What investigations should you do for FrontoTemporal Dementia? (4 things)
1. MRI 2. PET / SPECT 3. Neuropsychological Test 4. MMSE
53
What may a MRI show you in FrontoTemporal Dementia? (2 things)
1. Frontal / Temporal lobe atrophy 2. Ventricle enlargement
54
What may PET / SPECT scans show you in FrontoTemporal Dementia? (2 things)
1. Hypometabolism 2. Hypoperfusion (in affected lobe)
55
What is the basis of management for FrontoTemporal Dementia?
NO disease modifying treatment currently recommended So just supportive care + symptom management
56
What are the management options for Symptom control of FrontoTemopral Dementia? (5 things)
1. Non-pharma: Group therapy / support groups 2. Benzodiazepines (for agitation / distress) 3. SSRI (for depression / anxiety) 4. Antipsychotics (low doses and only as last resort) 5. Oxytocin (for empathy problems) (fairly new studies)
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