Dementia

Question 1

What are the common types of dementia?

Answer 1

Alzheimer’s disease
Vascular dementia
Frontotemporal dementia
Lewy body dementia

Question 2

What potentially reversible causes of dementia are there?

Answer 2

Depression
Alcohol related brain damage
Endocrine
B deficiencies

Question 3

Why is it hard to accuratley diagnose dementia in clinic?

Answer 3

The disease follows a heterogenous course

in old age the disease presentation is of multiple co-morbidites

Clinical history is vital

Question 4

WHat brain pathology occurs in a px with alzheimers disease?

Answer 4

Paranchymal ischaemic changes

Vessel wall pathology

a-synuclein

TDP-43

ABeta

Neuronal Tau

Question 5

What checklists is used to get a history?

• also get some collateral

Answer 5

Memory
language
numerical skills
visuospacial
Neglect
route perception

personality and social
sexual behaviour
motivation and apathy
anxiety agitation
delusuons/hallucinations
AODL

Question 6

What is dementia?

Answer 6

severe loss of memory and other cognitive abilities which

leads to impaired daily function (regardless of the underlying cause)

Question 7

What examination is done post the dementia history?

Answer 7

Neurological mental state

Question 8

What is tested in the blood test?

Answer 8

F.B.C

inflammatory markers

thyroid function

biochemistry and renal

glucose

B12

• infection e.g.
  syphilis
  HIV
  caeruloplasmin

Question 9

What other differentials may there be?

Answer 9

Delirium
Dementia
Depression

Question 10

What is the diagnosis for:

• 70 yr old man
• GP referral due to memory
• px asks family same questions daily
• still drives
• irritable
• mistakes with medication
• was not sure about route to hospital

Answer 10

Alzheimers

• diagnosis certainty can only be made post mortem

Question 11

What is the diagnosis for:

• 70 yr old man
• GP referral due to memory
• px asks family same questions daily
• still drives
• irritable
• mistakes with medication
• was not sure about route to hospital

Answer 11

Alzheimers

• diagnosis certainty can only be made post mortem but can no asses through vivo pathology

Question 12

What may be noticed in an MRI of a alzheimers px?

Answer 12

• medial temporal volume loss
• enlarged ventricles
• space replaced with CSF- more black spaces
• More sulcis widening, narrow gyrus
• hippocampus atrophy

Question 13

What is the spatio-temporal evolution of amyloid and tau?

Answer 13

• Amyloid spreading from allocorticol across and down brainstem

Tai spreads from near brainstem to isocortex

Question 14

What biomarker patterns are seen in alzheimers?

Answer 14

Abeta Amyloid

Tau mediated neuronal injury and dysfunction

Brain structure

Cognition

• all become more abnormal as MCI becomes dementia

Question 15

How is dementia diagnosed?

Answer 15

CSF through lumbar puncture

shows beta amyloids and tau levels

Amyloid will be lower and tau will be higher

Scans
history

Question 16

How are amyloid PET scans conducted for dementia?

Answer 16

Use a tracer 18-flometa

to look at amyloid plaque levels

if levels are negative : little likliehood of alzheimers

Question 17

What is the diagnosis:

• 78 yr old
• disorientated some days
• memory not an issue
• aware of recent news
• no evidence of latered behaviour
• MMSE 28/30 erros on ‘attention’
• hallucinations daily of people walking in the room or blocking the stairs
• developed shuffled gait and reduced facial expression
• hallucinations decreased with cholinesterase inhibitor iivastigmine ?

Answer 17

Dementia with lewy bodies

Question 18

How are lewy bodies deposited?

Answer 18

aggregation of alpha-synuclein monomer

creates fibrils and depositions

Question 19

Difference in alzherimers vs Lewy bodies MRI?

Answer 19

DLB = preserved hippocampus volume and medial temporal volume

1,2,3 iodine images dopamine transporter . Decreased availblity of transporter in DLB compared with alzheimers in DAT scan

Question 20

diagnose the following:

• 72 yr old an
• memory
• speech detoriated, uses wrong words
• difficulty understanding speech
• forgets what he ate earlier
• angry and frustrated
• rude in social settings
• neglect with washing
• significant anomia
• can recognise faces

Answer 20

• Frontal temporal lobe Dementia

MRi shows extensive volume loss of temporal lobes and frontal opercula

Suggestive of FTLD