236: Alzheimers Flashcards
Dementia Diagnostic criteria
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.
What is gnosis?
ability to interpret sensory information.
Alzheimer indicators
gradual deterioration, amyloid plaques and neurofibrillary tangles, cholinergic deficit, age, female, cerebral atrophy with ventricle dilation
Vascular Dementia Indicators
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
Lewy Body dementia indicators
vivid visual hallucinations, mild parkinsonian features, repeated falls. memory loss not marked at first.
Fronto-Temporal Dementia indicators
Apathy, reduced motivation, self neglect, socially inappropriate/disinhibited, prominent language difficulties, often male
Alzheimer’s and lewy body treatment - mild to moderate
anticholinesterase
Alzheimer’s and lewy body treatment - moderate to advanced
memantine
memantine mechanism of action
n-methyl -D-aspartate (NMDA) receptor antagonist…glutamate blocked on post synapse neurone
name some anticholinesterases
rivastigmine, donepezil, galantamine.
treatment of vascular dementia
consider low dose aspirin, statin, mange blog pressure and glucose, lifestyle advice ( smoking, fat)
what is retrograde amnesia?
loss of memories from before the occurrence of trauma/event
what is anterograde amnesia?
inability to form new memories
what is transient global amnesia?
transient between retrograde and anterograde ( e.g. concussion) doesn’t usually last.
what is korsakoff’s syndrome?
irreversible damage to the medial thalamus and/or mamillary bodies. e.g. Vit b deficiency of alcoholics both antero and retrograde amnesia plus confabulation.
whats confabulation?
confusion between memories and imagination
Job of the medial temporal lobe in memory?
process information and send to mamillary body
Damage to temporal lobe causes what type of memory loss?
anterograde
what does the occipital lobe do?
processes visual information
what does the parietal cortex do?
attending to external stimuli ( where is it)
what does the temporal cortex do?
identify the nature of the of the stimuli ( what is it?)
what does the frontal cortex do?
select and plan appropriate response ( what should i do about it?)
how does hemineglect happen
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)
what is sensory neglect?
incoming sensory info (from the contralateral hemispace) is ignored by the parietal cortex
what is hemiasomatognisia?
patient denies that affected side of their body belongs to them.
Damage to inferior temporal cortex causes
visual agnosia (patient can see but not identify)
Damage to the middle temporal cortex causes?
movement agnosia. ( can’t distinguish between moving and stationary)
Frontal cortex damage causes?
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.
what is aphasia?
speech disorder ( processing speech)
what is dysarthria?
difficulty moving muscle used for speech ( mechanical speech problem)
area involved in speech?
Parietal - who is talking; temporal- this is what he is saying; frontal - what to say back.
where is Wernick’s area and what does it do?
in the temporal lobe and understands speech
where is broca’s area and what does it do?
frontal lobe - makes speech
damage to Wernicke’s area - symptoms.
(they don’t understand the question) speech is fluent but makes no sense in context.
damage to Broca’s area - symptoms?
( they understand but cannot produce speech) speech is halted, repetitive, disordered in syntax and grammar.
what is the Papez Circuit do?
controls emotional expression.
what is the dorsal stream?
the posterior parietal cortex summating how and where ( from visual and sensory inputs) to give a coherent sense of your body in space.
what is the ventral stream?
the temporal cortex associating ‘what’
