OCTY2105 - dementia

What is dementia?

Brain failure.

What is the pathology of dementia?

Accumulation of abnormal proteins in the brain, reduction in brain mass, reduction in number and function of synapses, reduction in cerebral blood flow, alterations in patterns of brain activity.

What is mild neurocognitive disorder?

A modest decline in level of performance based on Concern of the individual, and modest deficits on objective testing

How far below the norm is mild cognitive disorder?

around 1-2 standard deviations from the norm.

What is major Neurocognitive disorder?

A cognitive decline from a previous level in one or more cognitive domains based on concern from the individual and substancial imparment in cognitive performance in neuropsychological testing, 2 or more standard deviations below the norm.

Assessment of cognitive impairment

Memory imparment, executive dysfunction, aphasia (speech disorder), apraxia (a lack of practice (plan)), agnosia

What are the memory impairment tests?

usually bedside tests, rather than pen and paper, recalling of 3 objects and name and address.

More formal tests are word list learning, logical memory and faces as well as verbal paired associates and family pictures.

How is executive dysfunction tested?

verbal fluency, cognitive estimates, motor sequencing, and similarities and differences.

How is aphasia tested?

Bedside testing includes: naming an object and its parts, reading and writing a sentence, repeating a phrase, following oral or written instructions.

Formal testing includes the Boston naming test, and Boston diagnostic aphasia examination.

How is Apraxia tested?

Bedside tests include: orofacial - asking patient to lick lips or cough etc. Ideomotor includes: asking patient to mime actions such as brushing teeth or using a pair of scissors, Constructional (copying a complex diagram), dressing (can the patient dress and undress)

How is agnosia tested?

Recognition of famous faces, people in the room and common objects or pictures of common objects.

Formal testing includes: Birmingham object recognition battery or the pyramids and palms test.

What are the main causes of dementia?

Alzheimers, cerebrovascular disease, Lewy body disease, frontotemporal lobar degeneration, Wernicke/korsakoff

What are typical symptoms of Alzheimers disease?

Early memory loss, increased apathy, depressive and anxiety symptoms, spatial disorientation, executive dysfunction, apraxia, agnosia, impaired IADL function

What are the drugs for Alzheimers disease?

Donepezil, rivastigmine, galantamine, memantine

What are the most common signs of Vascular dementia?

Complex attention and Fronto-executive function.

What are signs that a patient has Lewy Body disease?

Poor memory and confusion, speech deficits and distractablility.

What are the three subtypes of Frontaltemporal lobe degeneration.

Behaviour, Language, Motor.

What are the symptoms of Language variant of frontaltemporal degeneration?

Progressive non-fluent aphasia

What are teh symptoms of the motor frontal temporal degeneration

Progressive apraxia.

What are the diagnostic criteria for Dementia?

Progressive degeneration of behaviour adn or cognition by observation or history.

And three of the following six symptom clusters.

Early behavioural inhibition, apathy/ inertia, loss of sympathy/empathy, perservative, stereotyped/ compulsive behaviour, hyperorallity/ dietary change and neuropsychological profile.