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Mahathi Neurology > 1b Dementia > Flashcards

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
Q

Which area which has a rich ACh supply will you find extensive neurone loss?

A

nucleus basalis of Meynert (rich in ACh) - therefore lack of supply to the hippocampus, amygdala and neocortex

26
Q

Which chemicals are neuropathic with dementia?

A

Amyloid and Tau

27
Q

How do you measure amyloid and tau?

A

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
Q

What are the differentials for a diagnosis of Dementia?

A

Alzhemiers
Vascular
Lewy Body
FTD
Depression
Delirium
None

29
Q

What are the management options for dementia?

A

Acetylchoinesterase inhibitors
Watch and wait
Treating behavioural and psychological symptoms
OT/Social services
Specialist therapies

30
Q

How does amyloid affect dementia?

A

It is part of the primary event that causes changes in brain structure and specifically, cognition lags

31
Q

Ideally how long should you see successive deterioration in order to be confident in a diagnosis of dementia?

A

6 months - 2 years

32
Q

What is the presentation of Alzheimers described as?

A

Subtle and insidious with amnestic and non-amnestic presentations

33
Q

What is the pattern of decline in vascular dementia?

A

Step wise deterioration

34
Q

What is the development of vascular dementia associated with?

A

CVD

35
Q

What are some symptoms associated with Lewy Body Dementia?

A

Visual Hallucinations
CI before/within 1 year of Parkinsons like symptoms
Fluctuating cognition

36
Q

What symptoms are typical of fronto-temporal dementia?

A

Semantic dementia therefore progressive non-fluent (expressive) aphasia

37
Q

What is the head turning sign?

A

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
Q

What is responsible for episodic memory?

A

Dependent on medial temporal lobes including the hippocampus

39
Q

Features on a scan that are indicative of Dementia?

A

Narrowed gyri

Hippocampal atrophy

Dilated lateral ventricles

40
Q

Which dementia typically involves initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures (entorhinal cortex and hippocampus)?

A

Alzheimers

41
Q

What is the pattern of biomarker decline in alzheimers?

A

As the disease stage progresses:

First, Amyloid
Tau
Changes to brain structures
Lastly, Cognition

42
Q

What are some typical signs / symptoms of Lewy Body Dementia?

A

High Risk of Falls
Visual Hallucinations - Generally people / animals
REM Sleep Disorder
Associated with fluctuating Cognition
Development of Parkinsons like symptoms

43
Q

What is Lewy body dementia generally caused by?

A

The aggregation of alpha synuclein, leading to deposition of Lewy bodies and internal symptoms

44
Q

What are the radiological changes in dementia with Lewy Bodies?

A

Preserved hippocampal volume and median-temporal volume

45
Q

What happens to the caudate and putamen in Lewy Body Dementia?

A

Decreased availability of dopamine transporters in the caudate and putamen

46
Q

What radiological signs do patients with FTD show?

A

Perisylvian volume loss
Volume loss in temporal lobes and frontal opercula

47
Q

What are some signs and symptoms of FTD?

A

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
Q

What is the neuropathology associated with Alzhemiers disease?

A

Extracellular amyloid plaques
Intracellular neurofibullary tangles

49
Q

What are the 5 A’s associated with Alzhemiers Disease?

A

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

Mahathi Neurology (22 decks)

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