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BRS NEUROLOGY > 1b// Dementia > Flashcards

1b// Dementia Flashcards

1
Q

What is alzheimers?

A

neurodegenerative disorder characterised by progressive cognitive, social and functional impairment

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2
Q

Describe the difference between young and old onset dementia?

A
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3
Q

Common causes of dementia?

A

Alzheimer’s
Vascular dementia
Frontotemporal dementia
Lewy body dementia

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4
Q

reversible causes of dementia (7)

A 
Depression
Alcohol related brain damage
Endocrine
Vitamin B deficiencies
Benign Tumors
normal pressure hydrocephalus 
infections e.g., HIV/ syphilis
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5
Q

what is dementia?

A

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

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6
Q

Describe the continuum and realities of cognition of dementia compared to normal.

A
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7
Q

What is the disease course of dementia?

A

heterogenous

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8
Q

Why is it hard to accurately diagnose dementia in the clinic?

A
  • The disease follows a heterogenous course
  • In old age the disease presentation is of multiple co-morbidities
  • Lots of mixed and uncertain pictures
  • Younger patients are more typical
  • Clinical history, the function of the patient and how they change is paramount
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9
Q

Where does the clinical diagnosis of dementia mostly lie?

A

history taking

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10
Q

What is on the checklist for potential dementia patients?

A

people they live with

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11
Q

dementia investigations (4)

A

Neuropsychology
Bloods
MRI
PET

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12
Q

What is MMSE? And what can you do it with?

A

mini mental state exam

The Addenbrooke’s Cognitive Examination-III (ACE-III)

lasts 15 mins and more memory focused

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13
Q

bloods for dementia

A 
FBC
Inflammatory markers
Thyroid function
biochemistry and Renal function
Glucose
B12 and folate
Clotting

syphilis serology
HIV
caeruloplasmin

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14
Q

sMRI results for alzheimers?

A

sMRI= structural MRI
~~~
Narrow gyri
Widened sulci
Ventricles dilate
Medial temporal volume loss
Hippocampus volume loss (replaced w/CSF)
~~~

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15
Q

what type of test is this? And how do you analyse the findings for alzheimer’s?

A

(18F) Florbetapir in vivo and amyloid post-mortem

PET scan lights up amyloid (Amyloid PET)
increased amyloid means increased alzheimers

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16
Q

management for dementia (6)

A 
Acetylcholinesterase inhibitors
Watch and wait
Treat behavioural symptoms
Social Services
OT/ social services
(anti-depressives)
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17
Q

alzheimers presentation

A

subtle, insidious amnestic/ non amnestic

amnesia

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18
Q

presentation of vascular dementia

A

step wise deterioration and multiple infacrt

related to cerebrovascular diseases

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19
Q

lewy body dementia presentation

A

fluctuations in cognition

Cognitive impairment before/within 1 year of parkinsonian symptoms, visual hallucinations

20
Q

presentation of frontotemporal dementia

A

behavioural variant frontotemporal dementia
semantic dementia
progressive non fluent aphasia

21
Q

What conditions do you want to rule in/ out?

A

delirium vs dementia vs depression
dementias and atypical variants…
- alzheimer’s
- vasculr dementia
- dementia w/ lewy bodies
- frontotemporal dementia
- rapidly progressing dementias

22
Q

episodic memory

A

Memory for a particular life events

Dependent on the medial temporal lobes including the hippocampus

23
Q

how does lewy body dementia look on MRI

A

preserved hippocampal volume

24
Q

what section of ACE may someone wih alzheimers struggle

A

name address

acute memory

25
Q

what must be taken into account during an ACE

A

context of individual - socioeconomic status
educational background
political awareness
social interactions

26
Q

what may show visuospatial issues within the ACE

A

drawing
indentifying partial letter
looking at diagrams, counting spots without pointing

27
Q

What is this MRI most likely showing?

A

alzheimer’s
enlarged ventricles
some atrophy
atrophy of hippocampus

28
Q

delirium vs dementia

A

delirium related to physical condition and acute

dementia long standing, usually unchanging based on environment

29
Q

what is the head turning sign of alzheimers

A

looking around to see others’ answers to question as they dont know the answer

30
Q

What is the spatio-temporal evolution of A and B in dementia according to Thal and Braak?

A

amyloid(A) and tau (B)
Alzheimer’s disease is thought to be caused by the abnormal build-up of 2 proteins called amyloid and tau

Braak stages I and II are used when neurofibrillary tangle involvement is confined mainly to the transentorhinal region of the brain, stages III and IV when there is also involvement of limbic regions such as the hippocampus, and V and VI when there is extensive neocortical involvement.

31
Q

Describe the pattern of biomarkes in alzheimer’s.

A

amyloid, tau, brain structure, cognition

32
Q

CSF results for alzheimers?

CSF taken by lumbar puncture

A

high Tau proteins
low amyloid

In CSF, the changes observed include a 50% reduction of Ab42 as consequence of amyloid deposition in the brain

higher Tau proteins

33
Q

what specific marker on PET scan is there for lewy body dementia

A

decreased dopamine transporters caudate and putamen

34
Q

What is hte most common cause of neurodegenerative dementia?

A

alzheimer’s

35
Q

What does alzheimer’s disease typically involve?

A

Typically involves initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures (entorhinal cortex and hippocampus)

36
Q

Can you have mixed pathology?

A

YES

37
Q

what MRI sign can show frontotemporal dementia

A

loss/atrophy and assymetry of peri-sylvian fissure

38
Q

what MRI sign can show frontotemporal dementia

A

loss/atrophy and assymetry of peri-sylvian fissure

39
Q

What medication is given in treatment of alzheimer’s/ dementia? Can be given before experiencing memory issues, but has hallucinations.

A

Hallucinations had decreased in response to treatment with the cholinesterase inhibitor rivastigmine, with noted improvement in cognition

cholinesterase inhibitor

40
Q

What symptoms are associated with Dementia with lewy bodies?

A

Associated with fluctuating cognition
Often visual hallucinations
REM sleep disorder
Development of symptoms associated with Parkinson’s Disease
High risk of falls

* Different cognitive profile to Alzheimer’s Disease

41
Q

Describe the formation of a lewy body.

A
  1. a-synuclein monomers join to form a-synuclein oligomers
  2. a-synuclein oligomers join to form a-synuclein fibril
  3. a-synucleuin fibril joins with neurofilaments, ubiquitin and ab-crystallin to form lewy body
42
Q

What is the word for sudden, brief involuntary twitching or jerking of a muscle or group of muscles?

A

myoclonus

43
Q

What is the word for when a single peripheral nerve that controls a muscle is overactive, resulting in involuntary muscle movement?

A

fasciculations

44
Q

What is anomia?

A

inability to name objects

45
Q

How can someone with frontotemporal dementia present?

A

Blood tests all normal . MRI showed extensive volume loss in temporal lobes and frontal opercula

anomia

He could blow a kiss but his cough was weak and he was unable to yawn on command. He had difficulty copying hand gestures with both hands and also made several digit substitutions when miming brushing his teeth and combing his hair.

On examination spontaneous conversation was extremely limited and dysfluent.

Speech was agrammatical with frequent paraphasic errors and neologisms. He also had significant anomia.

BRS NEUROLOGY (22 decks)

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