236: Alzheimers

Question 1

Dementia Diagnostic criteria

Answer 1

memory impairment for 6 months or more plus one or more cognitive domains (executive functioning language, praxis, gnosis). overall impairment has to be enough to impact daily living.

Question 2

What is gnosis?

Answer 2

ability to interpret sensory information.

Question 3

Alzheimer indicators

Answer 3

gradual deterioration, amyloid plaques and neurofibrillary tangles, cholinergic deficit, age, female, cerebral atrophy with ventricle dilation

Question 4

Vascular Dementia Indicators

Answer 4

sudden onset with a stepwise deterioration, focal neurological deficits, mood/behaviour change, insight preserved, athersclorosis, thrombotic/embolic infarct. smoking, diabetes ..blah, male. gait and continence problems

Question 5

Lewy Body dementia indicators

Answer 5

vivid visual hallucinations, mild parkinsonian features, repeated falls. memory loss not marked at first.

Question 6

Fronto-Temporal Dementia indicators

Answer 6

Apathy, reduced motivation, self neglect, socially inappropriate/disinhibited, prominent language difficulties, often male

Question 7

Alzheimer’s and lewy body treatment - mild to moderate

Answer 7

anticholinesterase

Question 8

Alzheimer’s and lewy body treatment - moderate to advanced

Answer 8

memantine

Question 9

memantine mechanism of action

Answer 9

n-methyl -D-aspartate (NMDA) receptor antagonist…glutamate blocked on post synapse neurone

Question 10

name some anticholinesterases

Answer 10

rivastigmine, donepezil, galantamine.

Question 11

treatment of vascular dementia

Answer 11

consider low dose aspirin, statin, mange blog pressure and glucose, lifestyle advice ( smoking, fat)

Question 12

what is retrograde amnesia?

Answer 12

loss of memories from before the occurrence of trauma/event

Question 13

what is anterograde amnesia?

Answer 13

inability to form new memories

Question 14

what is transient global amnesia?

Answer 14

transient between retrograde and anterograde ( e.g. concussion) doesn’t usually last.

Question 15

what is korsakoff’s syndrome?

Answer 15

irreversible damage to the medial thalamus and/or mamillary bodies. e.g. Vit b deficiency of alcoholics both antero and retrograde amnesia plus confabulation.

Question 16

whats confabulation?

Answer 16

confusion between memories and imagination

Question 17

Job of the medial temporal lobe in memory?

Answer 17

process information and send to mamillary body

Question 18

Damage to temporal lobe causes what type of memory loss?

Answer 18

anterograde

Question 19

what does the occipital lobe do?

Answer 19

processes visual information

Question 20

what does the parietal cortex do?

Answer 20

attending to external stimuli ( where is it)

Question 21

what does the temporal cortex do?

Answer 21

identify the nature of the of the stimuli ( what is it?)

Question 22

what does the frontal cortex do?

Answer 22

select and plan appropriate response ( what should i do about it?)

Question 23

how does hemineglect happen

Answer 23

sensory info from hippocampus is processed in the parietal cortex…if parietal cortex is damage there may be missing a section of information (e.g. missing quarter of picture/clock face)

Question 24

what is sensory neglect?

Answer 24

incoming sensory info (from the contralateral hemispace) is ignored by the parietal cortex

Question 25

what is hemiasomatognisia?

Answer 25

patient denies that affected side of their body belongs to them.

Question 26

Damage to inferior temporal cortex causes

Answer 26

visual agnosia (patient can see but not identify)

Question 27

Damage to the middle temporal cortex causes?

Answer 27

movement agnosia. ( can’t distinguish between moving and stationary)

Question 28

Frontal cortex damage causes?

Answer 28

loss of working memory( can’t concentrate on task in hand) , personality changes (loss of spontaneous interaction; flexibility in thought; abulia (apathy); socially inappropriate); hemiplegia.

Question 29

what is aphasia?

Answer 29

speech disorder ( processing speech)

Question 30

what is dysarthria?

Answer 30

difficulty moving muscle used for speech ( mechanical speech problem)

Question 31

area involved in speech?

Answer 31

Parietal - who is talking; temporal- this is what he is saying; frontal - what to say back.

Question 32

where is Wernick’s area and what does it do?

Answer 32

in the temporal lobe and understands speech

Question 33

where is broca’s area and what does it do?

Answer 33

frontal lobe - makes speech

Question 34

damage to Wernicke’s area - symptoms.

Answer 34

(they don’t understand the question) speech is fluent but makes no sense in context.

Question 35

damage to Broca’s area - symptoms?

Answer 35

( they understand but cannot produce speech) speech is halted, repetitive, disordered in syntax and grammar.

Question 36

what is the Papez Circuit do?

Answer 36

controls emotional expression.

Question 37

what is the dorsal stream?

Answer 37

the posterior parietal cortex summating how and where ( from visual and sensory inputs) to give a coherent sense of your body in space.

Question 38

what is the ventral stream?

Answer 38

the temporal cortex associating ‘what’