Alzheimers and Dementia

Question 1

Vascular Dementia

Answer 1

Blood supply to the brain is disrupted, reduced perfusion, thromboembolism, bleeding in brain
Confirmed lesions

Question 2

Dementia with lewy bodies

Answer 2

alpha-synuclein in dopaminergic neurons of substantial nigra. Fluctuating cognition, hallucinations

Question 3

Parkinson’s disease dementia

Answer 3

preceding onset of movement disorder by 1 year

Question 4

Symptomatic treatment
cognitive -
motor -
psychiatric -

Answer 4

cognitive - cholinesterase inhibitors (donepezil and rivastigmine) NMDA receptor blocker (memantine)
motor - levodopa
psychiatric - antipsychotics are contraindicated

Question 5

Frontal-temporal dementia

Answer 5

reasoning, judgement, personality etc

mutation in TAU protein. Disrupts normal nerve cell processes

Question 6

What are the two distinguishable features

Answer 6

1) beta-amyloid plaques

2) neurofibrillary tangles

Question 7

Describe the genetic factors

Answer 7

Mutation on amyloid precursor protein gene
Autosomal dominant mutations in chromosome 14,1,21
apolipoprotein E, made in brain and liver and involved in lipid metabolism and tissue repair

Question 8

Sample questions of MMSE

Answer 8

1) Orientation to time
2) Registration
3) Naming
4) Reading

Question 9

How do we treat cognitive symptoms

Answer 9

Cholinesterase inhibitors, slow down acetylcholine breakdown

Donepazil, rivastigmine, galantamine

Question 10

How does memantine work

Answer 10

NMDA receptor blocker, protects brain nerve cells against glutamate, released in excess by damaged cells

Question 11

What antidepressants should be used

Answer 11

SSRI’s first line - citalopram

SNRI - venlafaxine if ineffective