Dementia

• Define dementia

  Clinical syndrome characterised by deterioration in mental function -> impairs AoDL
• How many different types of dementia are there?

  Alzheimers

  Vascular

  Dementia with Lewy bodies (DLB)

  Parkinson's disease dementia (PDD)

  Frontotemporal
• What is Alzheimer's dementia?


  Progressive neurodegenerative disorder
• What is Alzheimer's characterised by?


  Amyloid beta plaques and tau neurofibrillary tangles
• How long do you have to have a confusion history before dementia can be diagnosed?


  6 months
• What are some examples of supportive care and care packaged in dementia?


  Planning and educating

  Safeguarding

  Emotional support

  Support with AoDL

  Advanced directives
• What is vascular dementia?


  Cognitive decline due to neuronal death from disrupted blood flow
• What are some causes of vascular dementia?

  Ischaemic injury

  Anoxia/hypoxic brain damage

  Haemorrhage (subarachnoid/intracerebral)

  Small vessel disease (CVD -> atherosclerosis)
• What are types of vascular dementia?


  Stroke related

  Subcortical

  Mixed
• What is an example of subcortical vascular dementia?


  Caused by small vessel disease
• What is mixed dementia?


  Alzheimer's and vascular
• How does vascular dementia progress?


  Stepwise
• What are some signs and symptoms of vascular dementia?


  Cognitive impairment

  Mood disorders

  Sleep cycle disturbances

  Seizures

  Gait disturbances

  Focal neurological signs
• What are some risk factors for vascular dementia?


  Stroke/TIA Hx/FHx

  Hypertension

  AFib

  Diabetes

  Hypercholesterolaemia
• What are some bedside investivations for vascular dementia?


  Comprehensive history

  Neuro exam

  Med review

  Cognitive assessment
• WHat blood tests are done for vascular dementia?


  Confusion screen
• What scans are done for vascular dementia?


  CT/MRI head
• Where does vascular dementia normally affect?


  White matter

  Grey nuclei

  Thalamus

  Striatum
• How is vascular dementia managed pharmacologically?


  EOL care

  BPSD management

  Address CV risk factors

  AChEis if mixed dementia
• How is vascular dementia managed conservatively?


  Advanced care planning

  Screen for CV risk factors

  BPSD management

  Programmes to maintain cognitive function
• What type of dementia causes widespread cerebral atrophy?


  Alzheimer's disease
• What does alzheimer's disease typically present with?


  Progressive memory loss

  Confusion

  Impaired cognitive function