1b// Dementia Flashcards
What is alzheimers?
neurodegenerative disorder characterised by progressive cognitive, social and functional impairment
Describe the difference between young and old onset dementia?
Common causes of dementia?
Alzheimer’s
Vascular dementia
Frontotemporal dementia
Lewy body dementia
reversible causes of dementia (7)
Depression Alcohol related brain damage Endocrine Vitamin B deficiencies Benign Tumors normal pressure hydrocephalus infections e.g., HIV/ syphilis
what is dementia?
severe loss of memory and other cognitive abilities which leads to impaired daily function (regardless of the underlying cause)
Describe the continuum and realities of cognition of dementia compared to normal.
What is the disease course of dementia?
heterogenous
Why is it hard to accurately diagnose dementia in the clinic?
- 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
Where does the clinical diagnosis of dementia mostly lie?
history taking
What is on the checklist for potential dementia patients?
people they live with
dementia investigations (4)
Neuropsychology
Bloods
MRI
PET
What is MMSE? And what can you do it with?
mini mental state exam
The Addenbrooke’s Cognitive Examination-III (ACE-III)
lasts 15 mins and more memory focused
bloods for dementia
FBC Inflammatory markers Thyroid function biochemistry and Renal function Glucose B12 and folate Clotting
syphilis serology
HIV
caeruloplasmin
sMRI results for alzheimers?
sMRI= structural MRI
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Narrow gyri
Widened sulci
Ventricles dilate
Medial temporal volume loss
Hippocampus volume loss (replaced w/CSF)
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what type of test is this? And how do you analyse the findings for alzheimer’s?
(18F) Florbetapir in vivo and amyloid post-mortem
PET scan lights up amyloid (Amyloid PET)
increased amyloid means increased alzheimers
management for dementia (6)
Acetylcholinesterase inhibitors Watch and wait Treat behavioural symptoms Social Services OT/ social services (anti-depressives)
alzheimers presentation
subtle, insidious amnestic/ non amnestic
amnesia
presentation of vascular dementia
step wise deterioration and multiple infacrt
related to cerebrovascular diseases
lewy body dementia presentation
fluctuations in cognition
Cognitive impairment before/within 1 year of parkinsonian symptoms, visual hallucinations
presentation of frontotemporal dementia
behavioural variant frontotemporal dementia
semantic dementia
progressive non fluent aphasia
What conditions do you want to rule in/ out?
delirium vs dementia vs depression
dementias and atypical variants…
- alzheimer’s
- vasculr dementia
- dementia w/ lewy bodies
- frontotemporal dementia
- rapidly progressing dementias
episodic memory
Memory for a particular life events
Dependent on the medial temporal lobes including the hippocampus
how does lewy body dementia look on MRI
preserved hippocampal volume
what section of ACE may someone wih alzheimers struggle
name address
acute memory
what must be taken into account during an ACE
context of individual - socioeconomic status
educational background
political awareness
social interactions
what may show visuospatial issues within the ACE
drawing
indentifying partial letter
looking at diagrams, counting spots without pointing
What is this MRI most likely showing?
alzheimer’s
enlarged ventricles
some atrophy
atrophy of hippocampus
delirium vs dementia
delirium related to physical condition and acute
dementia long standing, usually unchanging based on environment
what is the head turning sign of alzheimers
looking around to see others’ answers to question as they dont know the answer
What is the spatio-temporal evolution of A and B in dementia according to Thal and Braak?
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.
Describe the pattern of biomarkes in alzheimer’s.
amyloid, tau, brain structure, cognition
CSF results for alzheimers?
CSF taken by lumbar puncture
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
what specific marker on PET scan is there for lewy body dementia
decreased dopamine transporters caudate and putamen
What is hte most common cause of neurodegenerative dementia?
alzheimer’s
What does alzheimer’s disease typically involve?
Typically involves initial episodic memory deficits secondary to dysfunction of medial temporal lobe structures (entorhinal cortex and hippocampus)
Can you have mixed pathology?
YES
what MRI sign can show frontotemporal dementia
loss/atrophy and assymetry of peri-sylvian fissure
what MRI sign can show frontotemporal dementia
loss/atrophy and assymetry of peri-sylvian fissure
What medication is given in treatment of alzheimer’s/ dementia? Can be given before experiencing memory issues, but has hallucinations.
Hallucinations had decreased in response to treatment with the cholinesterase inhibitor rivastigmine, with noted improvement in cognition
cholinesterase inhibitor
What symptoms are associated with Dementia with lewy bodies?
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
Describe the formation of a lewy body.
- a-synuclein monomers join to form a-synuclein oligomers
- a-synuclein oligomers join to form a-synuclein fibril
- a-synucleuin fibril joins with neurofilaments, ubiquitin and ab-crystallin to form lewy body
What is the word for sudden, brief involuntary twitching or jerking of a muscle or group of muscles?
myoclonus
What is the word for when a single peripheral nerve that controls a muscle is overactive, resulting in involuntary muscle movement?
fasciculations
What is anomia?
inability to name objects
How can someone with frontotemporal dementia present?
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.
