**_🧠Neurology🧠 - Dementia Flashcards

1
Q

What is the most common cause of dementia?

A

Alzheimer’s disease

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2
Q

What characterises dementia?

A

Fatal neurodegenerative disease
Progressive cognitive, social and functional impairment

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3
Q

What are the current treatment options for dementia?

A

No cure
Acetylcholinesterase inhibitors have modest symptomatic benefit in early stages (ΔMMSE = 1)

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4
Q

Outline the progression of dementia

A
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5
Q

Why is it hard to accurately diagnose dementia?

A

Follows a heterogenous course - great variety in rate of progression as well as symptoms and severity
Often presents with multiple co-morbidities

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6
Q

What are the cerebral issues that present with dementia?

A

Parenchymal ischaemic changes
Vessel wall pathology

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7
Q

What step of the clinical consultation pathway does the diagnosis most heavily rely on for dementia?

A

History

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8
Q

What is the patient interview checklist for suspected dementia?

A

Cognitive skills
Sensory issues
Behaviour/mood
Chronology of each

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9
Q

What is a functional definition of dementia?

A

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

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10
Q

How can a patient’s cognitive impairment be measured?

A

MMSE (shown below)
+/- ACE III (more memory focused)

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11
Q

What blood test should be done for a patient presenting with dementia like symptoms?

A

Blood tests with aims to eliminate possibilities of alternate diagnoses
FBC
Inflammatory markers
Thyroid function
Glucose
B12 + folate
Clotting
Syphilis serology
HIV
Caeruloplasmin

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12
Q

What are the 4 main types of dementia?

A

Alzheimer’s disease
Vascular dementia
Lewy body dementia
Frontotemporal dementia (FTD)

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13
Q

How does Alzheimer’s present and what is the suspected underlying mechanism?

A

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

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14
Q

How do the beta-amyloid plaques arise in Alzheimer’s?

A

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

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15
Q

How do neurofibrillary tangles arise in Alzheimer’s?

A

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)

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16
Q

How does vascular dementia present and what is the suspected underlying mechanism?

A

Related to cerebrovascular diseases with a classical step-wise deterioration + multiple infarcts
Associated with reduced blood supply to brain and diseased vessels plus multiple infarcts
Atherosclerosis—> vascular occlusion—> TIA/strokes—> deterioration of cognition
Abrupt onset (stroke) or gradual (accumulation of injuries to small vessels)

17
Q

How does Lewy body dementia present and what is the suspected underlying mechanism?

A

Insidious onset, progressive with fluctuations
Cognitive impairment before/within 1 year of onset of Parkinsonian symptoms
Visual symptoms such as hallucinations and fluctuating cognition
Aberrant deposits of alpha-synuclein protein predominantly in primary motor cortex; deposits= Lewy bodies

18
Q

How does FTD present and what is the suspected underlying mechanism?

A

Insidious onset, then rapid progression
Behavioural changes (e.g. disinhibition, socially inappropriate behaviour, poor judgement, apathy etc..)
Frontal and temporal atrophy
Neuronal atrophy of frontal and temporal lobes due to presence of phosphorylated tau or TDP-43 (transactive response DNA-binding protein 43)
Genetic- autosomal dominant
Semantic dementia—> effect on temporal lobe—> impaired understanding of language
Obsessions, diet, lack of interest

19
Q

What disorders/conditions can mimic presentations of dementia?

A

Depression
Delirium
Ageing

20
Q

What does “management” entail, in the context of dementia?

A

Acetylcholinesterase inhibitors
Watch and wait
Treating behavioural/psychological
symptoms
OT/Social services
Specialist therapies

21
Q

What are the most classic signs of Alzheimer’s?

A

Memory problems
Cognition issues
Lack of insight

22
Q

What are the most important parts of the consultation in a patient presenting with dementia-like symptoms?

A

History
Both from patient and collateral from relative

23
Q

Give some typical collateral history for a patient with Alzheimer’s

A

Family says:
* Patient asks the same questions every day,
* Makes mistakes with respect to taking medication
* Still drives, but could not find his way to son’s house last month, even
though going for several years
* Will watch film/TV programme for the second time without realising
* Increasingly irritable

24
Q

What might be evident in a patient with Alzheimer’s upon examination?

A

Head-turning sign - looks to relatives for help with questions
Vague about recent news events and sports results
Not certain about route to hospital
MMSE (Mini Mental State Examination)
ACE (Addenbrooks Cognitive Assessment).
Neuropsychology – profound impairment of episodic memory, particularly in relation to
recently learned material.
Episodic memory:
Memory for particular episodes in life
Dependent on the medial temporal lobes, including the hippocampus

25
Q

How is Alzheimer’s diagnosed?

A

Can only be certain post-mortem
Probable Alzheimer’s on brain MRI
Person is that patient - however disease also takes significant toll on partner/carer/family

26
Q

Where in the brain is most affected by Alzheimer’s in the context of reduced cognition and impaired memory formation?

A

Hippocampus

27
Q

How can Alzheimer’s be effectively diagnosed?

A

CSF beta-amyloid and tau levels

28
Q

How does Lewy body dementia present in clinic?

A

Associated with fluctuating cognition
Different cognitive profile to Alzheimer’s Disease
Often visual hallucinations
REM sleep disorder
Development of symptoms associated with Parkinson’s Disease
High risk of falls

29
Q

How do Lewy bodies form (not essential knowledge)

A
30
Q

How would you expect someone to present in clinic with FTD?

A

Speech issues
Memory problems
Behavioural changes, socially inappropriate behaviour
Lack of self care
Some motor issues with fine movement
MRI will show volume loss in temporal and frontal lobes