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Neurology Year 3 > Dementia > Flashcards

Dementia Flashcards

1
Q

What is the most common type of dementia?

A

Alzheimer’s disease

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2
Q

what tests are performed for diagnosis of dementia in the non-specialist setting?

A

General practitioner assessment of cognition (GPCOG) and the mini-mental state examination (MMSE)

A MMSE score of 24 or less out of 30 suggests dementia

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3
Q

What management has to be done before diagnosis of dementia?

A

in primary care, a blood screen is usually sent to exclude reversible causes (e.g. Hypothyroidism).

In secondary care, neuroimaging is performed* to exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus)

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4
Q

What are some reversible causes of dementia?

A

Hypothyroidism, Subdural haematoma, normal pressure hydrocephalus, vitamin B12 deficiency, alcohol

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5
Q

What drugs can cause dementia?

A

Alcohol and barbiturates (e.g. phenobarbitol)

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6
Q

What is the 2nd most common cause of dementia?

A

Vascular dementia

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7
Q

What is the cause of vascular dementia?

A

Confusion, lack of ability for learning and memory, and lack of concentrating caused by different mechanisms causing ischemia or hemorrhage secondary to cerebrovascular disease

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8
Q

What is a major risk factor for vascular dementia?

A

Stroke - doubles the risk of vascular dementia

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9
Q

What are the three sub types of vascular dementia

A

Stroke-related VD, Sub cortical VD and mixed dementia

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10
Q

What is sub cortical vascular dementia?

A

Dementia caused by small vessel disease

From the thickening and narrowing (atherosclerosis) of arteries that supply blood to the sub cortical areas of the brain.

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11
Q

What are the other smaller risk factors for vascular stroke?

A

Atrial fibrillation, Hypertension, Diabetes mellitus, Hyperlipidaemia, Smoking, Obesity, Coronary heart disease

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12
Q

What are some of the features of vascular dementia?

A

Visual disturbance, sensory or motor symptoms,

The difficulty with attention and concentration

Seizures, Memory disturbance, Gait disturbance

Speech disturbance, Emotional disturbance

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13
Q

How is vascular dementia diagnosed?

A

Formal screen for cognitive impairment – Addenbrookes, MMSE, MoCa test,

Medical review to exclude medication cause of cognitive decline

MRI scan – may show infarcts and extensive white matter changes

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14
Q

When would you consider AChE inhibitors or Memantine in Dementia?

A

People with vascular dementia if they have suspected co morbid Alzheimer’s disease, Parkinson’s disease dementia or dementia with Lewy bodies.

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15
Q

What is Lewy body dementia?

A

Disease associated with abnormal deposits of a protein called alpha-synuclein in the brain.

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16
Q

Lewy bodies are seen in two diseases; what are the two diseases?

A

Alzheimer’s disease and Parkinson’s disease

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17
Q

What are the features of Lewy body dementia?

A

Progressive cognitive impairment

Parkinsonism

Visual hallucinations

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18
Q

What drugs can be used for Lewy body dementia?

A

Both acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine

19
Q

What is frontotemporal lobe degeneration

A

Progressive damage and loss of nerve cells in the frontal and temporal lobes of the brain

20
Q

What are the three types of FTLD?

A

Frontotemporal dementia (Pick’s disease)

Progressive non fluent aphasia (chronic progressive aphasia, CPA)

Semantic dementia

21
Q

What are the macroscopic changes seen in Pick’s disease?

A

Atrophy of the frontal and temporal lobes

22
Q

What are the microscopic changes seen in Pick’s disease?

A

Pick bodies - spherical aggregations of tau protein
Gliosis
Neurofibrillary tangles
Senile plaques

23
Q

What is Gliosis?

A

A nonspecific reactive change of glial cells in response to damage to the CNS.

24
Q

What is Semantic dementia?

A

Progressive cognitive and language deficit, primarily involving comprehension of words. These patients lose the meaning of words, usually nouns, but retain fluency, phonology, and syntax.

25
Q

What is Progressive non fluent aphasia?

A

A person may experience symptoms like: Slow or hesitant speech e.g. speaking in shorter sentences. Comprehension is normal.

26
Q

Are drugs used in FTDL?

A

NICE DO NOT recommend that AChE inhibitors or memantine be used

27
Q

What is Mild cognitive impairment (MCI)?

A

An early stage of memory loss or other cognitive ability loss (such as language or visual/spatial perception) in individuals who maintain the ability to independently perform most activities of daily living.

28
Q

What are the two types of Mild Cognitive Impairment?

A

Amnestic MCI & Nonamnestic MCI

29
Q

What is Amnestic MCI?

A

MCI that primarily affects memory. A person may start to forget important information that he or she would previously have recalled easily, such as appointments, conversations or recent events.

30
Q

What is Non-amnestic MCI?

A

MCI that affects thinking skills other than memory, including the ability to make sound decisions, judge the time or sequence of steps needed to complete a complex task, or visual perception.

31
Q

What are the 3 stages of cognitive decline?

A

Acute, sub-acute and gradual

32
Q

What are the causes of acute cognitive decline?

A

Focal injury such as viral encephalitis, head injury and stroke deficits

33
Q

What are the two types of amnesia in acute cognitive decline disorders?

A

Transient global amnesia

Transient epileptic amnesia

34
Q

What is Transient epileptic amnesia?

A

Forgetful repetitive questioning and can carry out complex activities with no recollection of events. Short-lived and is associated with temporal lobe seizures.

35
Q

What is Transient global amnesia?

A

Abrupt onset of antegrade to retrograde amnesia, preserved knowledge of self, always transient – 4-6 hours and less than 24hours. Usually affects over 50-year-olds, Triggering factors is emotions and changes in temperature.

36
Q

What is antegrade amnesia?

A

A decreased ability to retain new information.

37
Q

What is retrograde amnesia?

A

Affects memories that were formed before the onset of amnesia.

38
Q

What are the causes of sub-acute cognitive decline?

A

Toxins, alcohol, CO, Infections, inflammatory disorders like encephalitis, metabolic disorders such as B12, calcium and thyroid disorders, neurodegenerative disorders such as CJD.

39
Q

What is the most common cause of prion disease in humans?

A

Creutzfeldt-Jakob disease

40
Q

What are the 4 subtypes of CJD?

A

Sporadic, variant, Iatrogenic, Genetic

41
Q

What is Limbic encephalitis?

A

A type of encephalitis associated with underlying malignancy or autoimmune disease.

42
Q

What are the signs of Limbic encephalitis?

A

Inflammatory/ antibody mediated; short term memory deficits +/- seizures +/- behavioural changes.

43
Q

What are the causes of gradual onset cognitive decline?

A

Dementia disorders

44
Q

What are the different types of dementia disorders?

A 
Alzheimer’s disease
Frontotemporal dementia
Vascular dementia
Lewy body dementia 
Parkinson’s disease dementia
Huntington's disease dementia

Neurology Year 3 (22 decks)

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