1b// Dementia

Question 1

What is alzheimers?

Answer 1

neurodegenerative disorder characterised by progressive cognitive, social and functional impairment

Question 2

Describe the difference between young and old onset dementia?

Answer 2

Question 3

Common causes of dementia?

Answer 3

Alzheimer’s
Vascular dementia
Frontotemporal dementia
Lewy body dementia

Question 4

reversible causes of dementia (7)

Answer 4

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

Question 5

what is dementia?

Answer 5

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

Question 6

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

Answer 6

Question 7

What is the disease course of dementia?

Answer 7

heterogenous

Question 8

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

Answer 8

• 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

Question 9

Where does the clinical diagnosis of dementia mostly lie?

Answer 9

history taking

Question 10

What is on the checklist for potential dementia patients?

Answer 10

people they live with

Question 11

dementia investigations (4)

Answer 11

Neuropsychology
Bloods
MRI
PET

Question 12

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

Answer 12

mini mental state exam

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

lasts 15 mins and more memory focused

Question 13

bloods for dementia

Answer 13

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

syphilis serology
HIV
caeruloplasmin

Question 14

sMRI results for alzheimers?

Answer 14

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

Question 15

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

Answer 15

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

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

Question 16

management for dementia (6)

Answer 16

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

Question 17

alzheimers presentation

Answer 17

subtle, insidious amnestic/ non amnestic

amnesia

Question 18

presentation of vascular dementia

Answer 18

step wise deterioration and multiple infacrt

related to cerebrovascular diseases

Question 19

lewy body dementia presentation

Answer 19

fluctuations in cognition

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

Question 20

presentation of frontotemporal dementia

Answer 20

behavioural variant frontotemporal dementia
semantic dementia
progressive non fluent aphasia

Question 21

What conditions do you want to rule in/ out?

Answer 21

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

Question 22

episodic memory

Answer 22

Memory for a particular life events

Dependent on the medial temporal lobes including the hippocampus

Question 23

how does lewy body dementia look on MRI

Answer 23

preserved hippocampal volume

Question 24

what section of ACE may someone wih alzheimers struggle

Answer 24

name address

acute memory

Question 25

what must be taken into account during an ACE

Answer 25

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

Question 26

what may show visuospatial issues within the ACE

Answer 26

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

Question 27

What is this MRI most likely showing?

Answer 27

alzheimer's enlarged ventricles some atrophy atrophy of hippocampus

Question 28

delirium vs dementia

Answer 28

delirium related to physical condition and acute | dementia long standing, usually unchanging based on environment

Question 29

what is the head turning sign of alzheimers

Answer 29

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

Question 30

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

Answer 30

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.

Question 31

Describe the pattern of biomarkes in alzheimer's.

Answer 31

amyloid, tau, brain structure, cognition

Question 32

CSF results for alzheimers? | CSF taken by lumbar puncture

Answer 32

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

Question 33

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

Answer 33

decreased dopamine transporters caudate and putamen

Question 34

What is hte most common cause of neurodegenerative dementia?

Answer 34

alzheimer's

Question 35

What does alzheimer's disease typically involve?

Answer 35

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

Question 36

Can you have mixed pathology?

Answer 36

YES

Question 37

what MRI sign can show frontotemporal dementia

Answer 37

loss/atrophy and assymetry of peri-sylvian fissure

Question 38

what MRI sign can show frontotemporal dementia

Answer 38

loss/atrophy and assymetry of peri-sylvian fissure

Question 39

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

Answer 39

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

Question 40

What symptoms are associated with Dementia with lewy bodies?

Answer 40

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

Question 41

Describe the formation of a lewy body.

Answer 41

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

Question 42

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

Answer 42

myoclonus

Question 43

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

Answer 43

fasciculations

Question 44

What is anomia?

Answer 44

inability to name objects

Question 45

How can someone with frontotemporal dementia present?

Answer 45

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.