**_🧠Neurology🧠 - Dementia Flashcards
What is the most common cause of dementia?
Alzheimer’s disease
What characterises dementia?
Fatal neurodegenerative disease
Progressive cognitive, social and functional impairment
What are the current treatment options for dementia?
No cure
Acetylcholinesterase inhibitors have modest symptomatic benefit in early stages (ΔMMSE = 1)
Outline the progression of dementia
Why is it hard to accurately diagnose dementia?
Follows a heterogenous course - great variety in rate of progression as well as symptoms and severity
Often presents with multiple co-morbidities
What are the cerebral issues that present with dementia?
Parenchymal ischaemic changes
Vessel wall pathology
What step of the clinical consultation pathway does the diagnosis most heavily rely on for dementia?
History
What is the patient interview checklist for suspected dementia?
Cognitive skills
Sensory issues
Behaviour/mood
Chronology of each
What is a functional definition of dementia?
Severe loss of memory and other cognitive abilities which
leads to impaired daily function (regardless of the underlying cause)
How can a patient’s cognitive impairment be measured?
MMSE (shown below)
+/- ACE III (more memory focused)
What blood test should be done for a patient presenting with dementia like symptoms?
Blood tests with aims to eliminate possibilities of alternate diagnoses
FBC
Inflammatory markers
Thyroid function
Glucose
B12 + folate
Clotting
Syphilis serology
HIV
Caeruloplasmin
What are the 4 main types of dementia?
Alzheimer’s disease
Vascular dementia
Lewy body dementia
Frontotemporal dementia (FTD)
How does Alzheimer’s present and what is the suspected underlying mechanism?
Subtle, insidious presentations
Cerebral-cortical atrophy
Beta-amyloid plaques - form toxic aggregates between nerve cells
Synaptic deterioration and neuronal cell death
Neurofibrillary tangles found in brain cells - protein called tau
How do the beta-amyloid plaques arise in Alzheimer’s?
APP normally cleaved by alpha secretases. AD—> Aberrant cleavage by beta + gamma secretases—> amyloid beta—> aggregates into insoluble amyloid plaques—> interfere with neuronal communication—> inflammation
How do neurofibrillary tangles arise in Alzheimer’s?
Tau protein usually involved in microtubule assembly - essential for neuronal growth and development
Amyloid beta plaques trigger tau hyperphosphorylation—> oligomerisation—> aggregate in NFT—> disrupt microtubular system—> impaired neuronal growth, transport and communication—> reduced neuronal function and apoptosis (⇒ atrophy especially in hippocampus and temporal regions) & degeneration of cholinergic nuclei (low acetylcholine)