Clinical Topic 4: Memory Problems

Question 1

What is the first, second, third, and fourth most common types of Dementia?

Answer 1

• 1st: Alzheimer’s Disease
• 2nd: Vascular Dementia
• 3rd: Mixed (Alzheimer’s and Vascualar)
• 4th: Lewy Body Dementia
• 5th: Other i.e. Frontotemporal

Question 2

What is the pathophysiology of Alzheimer’s disease? Which part of the brain does it affect?

Answer 2

Neurofibrillary tangles - inside neurones
Tau proteins - outside neurones

Primarily affects the cortex

Question 3

What is the main risk factor to Alzheimer’s Disease? What are other risk factors?

Answer 3

Age (main risk factor), head injury, past psychiatric history of severe depression, Down’s syndrome, family history of AD, vascular risk factors (hypertension, smoking, diabetes, hypercholesterolaemia)

Question 4

What gene is heavily implicated in Late-onset Alzheimer’s Disease? What is the role of this gene?

Answer 4

APOE4, which plays a role in repairing neurone sheaths

Question 5

What three genes are heavily implicated in Early-onset Alzheimer’s Disease? Which is the most common one?

Answer 5

PSEN1 (most common)
PSEN2
APP

Question 6

Why does Down’s syndrome confer a greater risk of Alzheimer’s Disease

Answer 6

Down’s syndrome is trisomy 21, which means there are 3 copies of the 21st chromosome. The APP gene is encoded on the 21st chromosome

Question 7

What may be the findings on CT head of a patient with Alzheimer’s Disease?

Answer 7

Widespread cortical atrophy
Widened sulci and narrowed gyri
Enlarged ventricles

Question 8

What sort of onset does Alzheimer’s Disease have compared to Vascular Dementia?

Answer 8

Alzheimer’s Disease - slow, insidious onset

Vascular Dementia - abrupt onset

Question 9

What medications are available to patients with Alzheimer’s Disease?

Answer 9

• AChEIs: Donopezil, Rivastigmine, Galantamine

- NMDAR antagonist: Memantine

Question 10

What are the risk factors for Vascular Dementia?

Answer 10

Older age, male gender, smoking, hypertension, diabetes, hypercholesterolaemia, PMHx of CVD, afro-carribean or South Asian ethnicity

Question 11

How can a clinician differentiate between Alzheimer’s Disease and Vascular Dementia?

Answer 11

Very difficult clinically, however can use the Hachinski Ischaemic Score to determine if there is a vascular component to dementia

Question 12

What are the precipitants to Vascular Dementia?

Answer 12

Arteriosclerosis, emboli, intracranial haemorrhage, amyloid angiopathy

Question 13

What are some of the clinical features of Lewy Body Dementia?

Answer 13

• VISUAL HALLUCINATIONS
• PARKINSONISM
• SLEEP PROBLEMS
• Fluctuating levels of alertness
• Falls
• Mood changes

Question 14

What are the treatment options for patients with Lewy Body dementia?

Answer 14

AChIE’s, for example Rivastigmine

DOPA drugs, for example Levodopa

Question 15

Fronto-temporal dementia occurs in what sorts of patients?

Answer 15

Younger patients, 45-60

Question 16

Regarding the MMSE, what is the:
Maximum score?
Normal score?
Mild dementia?
Moderate dementia?
Severe dementia?

Answer 16

Maximum score? 30
Normal score? 25-30
Mild dementia? 20-24
Moderate dementia? 13-19
Severe dementia? < 12

Question 17

What sort of symptoms are associated with Fronto-temporal dementia?

Answer 17

Disinhibition, loss of insight
Impulsivity
Hyperorality (craving sweet foods)
Emotional blunting, apathy, depression
Echolalia
Perservation
Dysphasia

Question 18

Give one example of Fronto-temporal Dementia?

Answer 18

Pick’s disease

Question 19

Alpha-synuclein deposits are associated with which Dementia?

Answer 19

Lewy Body Dementia