1b Dementia Flashcards
What is the most commonest form of dementia?
Alzheimers Disease
What is Dementia?
A fatal neurodegenerative disorder which is characterised by progressive cognitive, social and functional impairment
What has the most modest symptomatic benefit in early stages?
Acetylcholinesterase inhibitors
What two forms of dementia are most likely to occur together?
Vascular and Alzheimers
What are the stages of dementia on the continuum scale?
Preclinical -> MCI -> Dementia
Which of B1, B6 and B12 deficiencies can particularly reduce cognitive function?
B12
What occurs in the preclinical stage of declining cognitive function?
Deterioration of someone’s cellular function without clinical manifestation
Eg. Increase in Amyloid
Increase in Tau B
Neuroinflammation
Give examples of some of the endocrine causes of dementia?
Hypothyroidism - thyroid hormones induce changes in amyloid precursor processing or deposition of amyloid-beta
Cushing’s
Addison’s
Why is it hard to accurately diagnose dementia in clinic?
The disease follows a heterogenous course
In old age the disease presentation is of multiple co-morbidities
Are younger patients or older patients more typical in dementia?
Younger patients are more typical
Why is it harder to diagnose Dementia with older aged patients?
In old age the disease presentation includes a lot of different co-morbidities
What does the clinical diagnosis of Dementia lie most in?
History Taking
Dementia risk factors?
Ageing
Brain trauma
Oral health
Genetic factors
Midlife obesity
Reduced physical activity
Infections or systemic inflammation
What aspect of memory is impaired in dementia?
Short term memory
What is the checklist of things to ask patients and collateral in the interview?
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
Why is it important for physicians to interview collateral as well as the patient?
Typically patients will deny any symptoms and say that their decline is normal for someone of their age
What is the definition of dementia?
Severe loss of memory and cognitive abilities which leads to impaired daily function (regardless of the underlying cause)
Which examination should be done for dementia?
Neurological Mental State
Which investigations should you do for Dementia?
Neuropsychology
Bloods
MRI
PET
When is a PET scan useful to conduct?
When the patient is not likely to have Alzheimer’s disease but a scan is still needed to rule it out
What is a straightforward cognitive test example?
MMSE (Mini mental state examination) and ACE III (Addenbrooke’s cognitive examination)
What would you take from bloods in an investigation of dementia?
Full blood count
Inflammatory markers
Thyroid function
Biochemistry and renal function
Glucose
B12 and folate
Clotting factors
Which conditions would you test for in the bloods of a dementia patient to rule them out?
Syphilis serology
HIV
Caeruloplasmin
Describe changes which you would see on a sMRI of a patient with dementia?
- Narrow gyri and wider sulci
- Dilated / enlarged ventricles
- Tissue replaced with CSF
- Medio-temporal volume loss, Hippocampal volume loss, cerebro-cortical atrophy
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
Which chemicals are neuropathic with dementia?
Amyloid and Tau
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
What are the differentials for a diagnosis of Dementia?
Alzhemiers
Vascular
Lewy Body
FTD
Depression
Delirium
None
What are the management options for dementia?
Acetylchoinesterase inhibitors
Watch and wait
Treating behavioural and psychological symptoms
OT/Social services
Specialist therapies
How does amyloid affect dementia?
It is part of the primary event that causes changes in brain structure and specifically, cognition lags
Ideally how long should you see successive deterioration in order to be confident in a diagnosis of dementia?
6 months - 2 years
What is the presentation of Alzheimers described as?
Subtle and insidious with amnestic and non-amnestic presentations
What is the pattern of decline in vascular dementia?
Step wise deterioration
What is the development of vascular dementia associated with?
CVD
What are some symptoms associated with Lewy Body Dementia?
Visual Hallucinations
CI before/within 1 year of Parkinsons like symptoms
Fluctuating cognition
What symptoms are typical of fronto-temporal dementia?
Semantic dementia therefore progressive non-fluent (expressive) aphasia
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
What is responsible for episodic memory?
Dependent on medial temporal lobes including the hippocampus
Features on a scan that are indicative of Dementia?
Narrowed gyri
Hippocampal atrophy
Dilated lateral ventricles
Which dementia typically involves initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures (entorhinal cortex and hippocampus)?
Alzheimers
What is the pattern of biomarker decline in alzheimers?
As the disease stage progresses:
First, Amyloid
Tau
Changes to brain structures
Lastly, Cognition
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
What is Lewy body dementia generally caused by?
The aggregation of alpha synuclein, leading to deposition of Lewy bodies and internal symptoms
What are the radiological changes in dementia with Lewy Bodies?
Preserved hippocampal volume and median-temporal volume
What happens to the caudate and putamen in Lewy Body Dementia?
Decreased availability of dopamine transporters in the caudate and putamen
What radiological signs do patients with FTD show?
Perisylvian volume loss
Volume loss in temporal lobes and frontal opercula
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
What is the neuropathology associated with Alzhemiers disease?
Extracellular amyloid plaques
Intracellular neurofibullary tangles
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
