1b Dementia Flashcards

1
Q

What is the most commonest form of dementia?

A

Alzheimers Disease

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2
Q

What is Dementia?

A

A fatal neurodegenerative disorder which is characterised by progressive cognitive, social and functional impairment

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3
Q

What has the most modest symptomatic benefit in early stages?

A

Acetylcholinesterase inhibitors

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4
Q

What two forms of dementia are most likely to occur together?

A

Vascular and Alzheimers

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5
Q

What are the stages of dementia on the continuum scale?

A

Preclinical -> MCI -> Dementia

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6
Q

Which of B1, B6 and B12 deficiencies can particularly reduce cognitive function?

A

B12

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7
Q

What occurs in the preclinical stage of declining cognitive function?

A

Deterioration of someone’s cellular function without clinical manifestation

Eg. Increase in Amyloid
Increase in Tau B
Neuroinflammation

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8
Q

Give examples of some of the endocrine causes of dementia?

A

Hypothyroidism - thyroid hormones induce changes in amyloid precursor processing or deposition of amyloid-beta

Cushing’s

Addison’s

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9
Q

Why is it hard to accurately diagnose dementia in clinic?

A

The disease follows a heterogenous course

In old age the disease presentation is of multiple co-morbidities

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10
Q

Are younger patients or older patients more typical in dementia?

A

Younger patients are more typical

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11
Q

Why is it harder to diagnose Dementia with older aged patients?

A

In old age the disease presentation includes a lot of different co-morbidities

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12
Q

What does the clinical diagnosis of Dementia lie most in?

A

History Taking

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13
Q

Dementia risk factors?

A

Ageing

Brain trauma

Oral health

Genetic factors

Midlife obesity

Reduced physical activity

Infections or systemic inflammation

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14
Q

What aspect of memory is impaired in dementia?

A

Short term memory

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15
Q

What is the checklist of things to ask patients and collateral in the interview?

A

Memory

Language - communicate how they feel and for diagnosis

Numerical skills - calculating finances and pay bills

Executive skills

Visuospatial skills - acidentally backing into other people’s cars

Neglect phenomena

Visual perception

Route finding and landmark identification

Personality and social conduct - knowing personality before symptoms start

Sexual behaviour - as alzheimers and temporal dementia develop they feel less-inhibited

Eating

Mood

Motivation/Apathy

Anxiety/Agitation

Delusions

Activities of daily living

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16
Q

Why is it important for physicians to interview collateral as well as the patient?

A

Typically patients will deny any symptoms and say that their decline is normal for someone of their age

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17
Q

What is the definition of dementia?

A

Severe loss of memory and cognitive abilities which leads to impaired daily function (regardless of the underlying cause)

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18
Q

Which examination should be done for dementia?

A

Neurological Mental State

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19
Q

Which investigations should you do for Dementia?

A

Neuropsychology
Bloods
MRI
PET

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20
Q

When is a PET scan useful to conduct?

A

When the patient is not likely to have Alzheimer’s disease but a scan is still needed to rule it out

21
Q

What is a straightforward cognitive test example?

A

MMSE (Mini mental state examination) and ACE III (Addenbrooke’s cognitive examination)

22
Q

What would you take from bloods in an investigation of dementia?

A

Full blood count
Inflammatory markers
Thyroid function
Biochemistry and renal function
Glucose
B12 and folate
Clotting factors

23
Q

Which conditions would you test for in the bloods of a dementia patient to rule them out?

A

Syphilis serology

HIV

Caeruloplasmin

24
Q

Describe changes which you would see on a sMRI of a patient with dementia?

A
  1. Narrow gyri and wider sulci
  2. Dilated / enlarged ventricles
  3. Tissue replaced with CSF
  4. Medio-temporal volume loss, Hippocampal volume loss, cerebro-cortical atrophy
25
Which area which has a rich ACh supply will you find extensive neurone loss?
nucleus basalis of Meynert (rich in ACh) - therefore lack of supply to the hippocampus, amygdala and neocortex
26
Which chemicals are neuropathic with dementia?
Amyloid and Tau
27
How do you measure amyloid and tau?
Florbetapir in Vivo is given to a cannulated patient and this is a contrast to light up areas in brain with tau and amyloid
28
What are the differentials for a diagnosis of Dementia?
Alzhemiers Vascular Lewy Body FTD Depression Delirium None
29
What are the management options for dementia?
Acetylchoinesterase inhibitors Watch and wait Treating behavioural and psychological symptoms OT/Social services Specialist therapies
30
How does amyloid affect dementia?
It is part of the primary event that causes changes in brain structure and specifically, cognition lags
31
Ideally how long should you see successive deterioration in order to be confident in a diagnosis of dementia?
6 months - 2 years
32
What is the presentation of Alzheimers described as?
Subtle and insidious with amnestic and non-amnestic presentations
33
What is the pattern of decline in vascular dementia?
Step wise deterioration
34
What is the development of vascular dementia associated with?
CVD
35
What are some symptoms associated with Lewy Body Dementia?
Visual Hallucinations CI before/within 1 year of Parkinsons like symptoms Fluctuating cognition
36
What symptoms are typical of fronto-temporal dementia?
Semantic dementia therefore progressive non-fluent (expressive) aphasia
37
What is the head turning sign?
Ask the patient a questions and the patient turns to face their partner as they are unsure of the answer / dont know or need verification
38
What is responsible for episodic memory?
Dependent on medial temporal lobes including the hippocampus
39
Features on a scan that are indicative of Dementia?
Narrowed gyri Hippocampal atrophy Dilated lateral ventricles
40
Which dementia typically involves initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures (entorhinal cortex and hippocampus)?
Alzheimers
41
What is the pattern of biomarker decline in alzheimers?
As the disease stage progresses: First, Amyloid Tau Changes to brain structures Lastly, Cognition
42
What are some typical signs / symptoms of Lewy Body Dementia?
High Risk of Falls Visual Hallucinations - Generally people / animals REM Sleep Disorder Associated with fluctuating Cognition Development of Parkinsons like symptoms
43
What is Lewy body dementia generally caused by?
The aggregation of alpha synuclein, leading to deposition of Lewy bodies and internal symptoms
44
What are the radiological changes in dementia with Lewy Bodies?
Preserved hippocampal volume and median-temporal volume
45
What happens to the caudate and putamen in Lewy Body Dementia?
Decreased availability of dopamine transporters in the caudate and putamen
46
What radiological signs do patients with FTD show?
Perisylvian volume loss Volume loss in temporal lobes and frontal opercula
47
What are some signs and symptoms of FTD?
Increased behavioural disturbances Agitation, Anger and Rudeness Impaired Speech - dysfluent, agrammatic, paraphrasic errors, anomia (Unable to name everyday objects), neologisms (joining words together to make new words which do not exist) Difficulty doing gesture Obsessive Behaviours
48
What is the neuropathology associated with Alzhemiers disease?
Extracellular amyloid plaques Intracellular neurofibullary tangles
49
What are the 5 A's associated with Alzhemiers Disease?
Amnesia - memory loss Anomia - lack of ability to recall the names of things Aphasia - lack of ability to speak Agnosia - Lack of ability to recognise things Apraxia - difficulty in simple mobility