Dementia Flashcards
What is cognition?
A mental action of acquiring knowledge, and understanding, through thought, experience and sense.
What is required to diagnose dementia?
Significant decline in atleast 1 domain of cognition which must be to such an extent that independence and ability to carry out everyday activities is impaired.
Is dementia a progressive disorder or is it an acute presentation?
It is a progressive disorder.
Delirium is an acute presentation.
Is age a risk factor for dementia?
Yes, over 65s are more susceptible to dementia.
What is the most common form of dementia?
Alzheimer’s disease
What occurs in AD?
There is deposition of amyloid outside nerve cells, at the neurofibrillary tangles. This disrupts normal nerve function and eventually leads to cell death.
What are produced from new memories?
Synapses
What are early signs of AD?
Forgetfulness
Visuospatial difficulties
Are environmental or genetic factors more important in the development of AD?
Environmental (particular vascular) factors are of more importance.
In which age group is dementia defined as of early-onset?
When it occurs in those aged under 65 years.
Which area of the brain is degenerated in early AD?
The medial hippocampus, and wil later affect the parietal lobes.
Is AD a clinical diagnosis?
Yes
What may an MRI show in those with AD?
Atrophy of the temporal and/or parietal lobes.
What will be seen on a PET scan in an individual suspected to have AD?
Reduced metabolism.
What is low in a CSF sample of an AD patient?
Amyloid.
This is due to it being used up in plaque formation.
How would you treat AD?
Address vascular risk factors.
Give drugs that boost acetylcholine (e.g. cholinesterase inhibitors or NMDA receptor blockers).
What is frontotemporal dementia?
A dementia of early onset, producing character changes and social deterioration, resulting in impaired intellect, memory and language.
It is also known as Pick’s disease.
What is the pathology of FTD?
Protein aggregation, resulting in cell damage. Leads to gliosis, with the development of Pick’s bodies and Pick’s cells.
What protein is most commonly involved in FTD?
Tau
What are features of FTD?
Disinhibition Apathy Loss of empathy Hyperorality Loss of insight
What is disinhibition?
The inability to inhibit inappropriate behaviour.
Is there a genetic link in FTD?
Yes, 25% are linked.
On an MRI, how will FTD present?
Frontotemporal lobe atrophy (this occurs more anteriorly in AD).
What will a CSF tap show in FTD?
Raised tau levels.
Amyloid levels will be normal.
How is FTD treated?
Anti-psychotics
Safety management
Of which onset is vascular dementia most commonly seen?
Usually of late onset.
What is required for a diagnosis of vascular dementia to be reached?
The presence of cerebrovascular disease.
PLUS
A clear temporal relation between the onset of dementia and cerebrovascular disease.
What is the presentation of vascular dementia?
Vascular dementia has a variable presentation.
Can be subcortical.
What are common features of vascular dementia?
Decreased attention
Executive dysfunction
Slowed processing
Which type of vascular event may precede the onset of vascular dementia?
A stroke.
What are the different types of dementia?
Alzheimer's disease (AD) Frontotemporal dementia (FTD) Vascular dementia (VD) Dementia with Lewy bodies (DwLB) Huntington's disease (HD)
How is vascular dementia treated?
Control vascular risk factors.
Similar to the management of AD.
If there is any signs of amyloid deposition, give cholinesterase inhibitors.
Is it common for patients with VD to have co-existent amyloid pathology?
Yes
Which form of late onset dementia is associated with changes in alpha-synuclein protein?
Dementia with Lewy bodies
What is the pathology linked to DwLB?
Aggregation of alpha-synuclein protein, causing cell dysfunction and damage.
Disrupts cholinergic and dopaminergic pathways.
Disruption of cholinergic pathways is associated with what?
Memory issues.
What is disruption of dopaminergic pathways associated with?
Parkinsonian features.
To diagnose DwLB, what is needed?
Fluctuating levels of cognition
Recurrent, well-formed, visual hallucinations
The presence of extrapyramidal features (seen in 75% of cases)
What are examples of extrapyramidal features?
Bradykinesia
Tremor
Postural instability
Are any diagnostic tests required in DwLB?
No it is a clinical diagnosis as it is a parkinsonian syndrome.
A DaT scan can be of benefit, showing reduced levels of dopamine within the presynaptic area.
How is DwLB treated?
Small doses of levodopa and a cholinesterase inhibitor.
What differs between PDD and DwLB?
In DwLB, the patient will have dementia symptoms prior to the onset of motor symptoms.
In PDD, motor symptoms will precede the onset of cognitive impairment by atleast a year.
What is PDD?
A form of late onset dementia (occurs after 65 years of age).
Overlaps with DwLB clinically and pathologically (both affect alpha-synuclein protein).
What is HD?
A form of early onset dementia, caused by expansion of the CAG nucleotide repeat in the huntington gene.
This results in a neurodegenerative protein being produced.
How is PDD managed?
Small dose of levodopa and a cholinesterase inhibitor (the same as DwLB).
Which age group is affected by HD?
30-50 year olds.
Is HD autosomal recessive?
No, it is an autosomal dominant condition.
What is the triad of components involved in HD?
Motor symptoms
Cognitive changes
Emotional issues
How does HD present?
Decline in executive function Slowed speed Chorea Myoclonus Mood alteration Psychosis (at late stage)
What tests can be used to diagnose HD?
Genetic testing
MRI
What does MRI show in an individual with HD?
Loss of caudate heads.
What are features of late stage HD?
Rigidity Bradykinesia Severe chorea Weight loss Inability to walk/speak Impaired muscle control Swallowing issues
How is diagnosis reached in HD?
Mainly clinical, genetic testing can aid this.
How is HD treated?
Mood stabilisers and symptomatic treatment.
