Cognitive disorders of old age

Question 1

What are the prinicpal clinical features of disorders of old age?

Answer 1

Dementia and delirium

Question 2

List the types of dementia

Answer 2

• AD
• fronto-temporal dementia
• vascular dementia
• Lewy body dementia
  Creutzfeld-Jakob disease
• Prion disease

Question 3

Describe a normal aging brain

Answer 3

Reduction in white and slow loss of integrity of white matter, but no neuronal loss
Decline in mental agility and motor skills, changes in sleep patterns
decline of long term and working memory, verbal fluency

Question 4

Describe changes with dementia

Answer 4

Decline in declarative and short-term memory, impaired word-finding and reason as weel as visual and spatial perception and personality alterations

Question 5

Risk factors for dementia

Answer 5

• women = greater risk for AD, men = greater risk of vascular dementia
• stroke, hypertension, diabetes
• genetic

Question 6

Describe physical changes that occur in the brain during AD

Answer 6

1. sucli = wider, gyri = narrow, ventricles = enlarged, brain weight = reduced
2. beta amyloid plaques
3. tau tangles
4. evidence also to suggest AD results from loss of ACh from the basal forebrain cholinergic system

Question 7

What do tau proteins normally play a role in?

Answer 7

Intracellular transport and stabilising microtubules

Question 8

Describe tau in AD

Answer 8

accumulation of hyperphosphorylated tau isomers in cell bodies and proximal dendrites has been implicated in disease progression

Question 9

Describe the cholinergic system in AD and how this may be targetted for treatment

Answer 9

Brains from AD patients also show degeneration of cholinergic neurons of the basal forebrain. Acetylcholinesterase inhibitors, e.g. donepezil, are therefore employed fairly unsuccessfully to reduce the rate at which ACh is broken down. This combats the loss of ACh caused by the death of cholinergic neurons. These drugs have side effects that include nausea, vomiting (linked to cholinergic excess), muscle cramps, bradycardia, weight loss and increased gastric acid production.

Question 10

When does vascular demetia occur?

Answer 10

After a series of small strokes

Antiplatelet drugs for treatment

Question 11

What is Lewy body dementia characterised by?

Answer 11

Presence of Lewy bodies - clumps of alpha synuclein and ubiquitin proteins
Simiilar to PD (also loss of DA neurons in substantial nigra)