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Week 13 - neurology > Dementia > Flashcards

Dementia Flashcards

1
Q

What is the definition of dementia?

A

•Progressive cognitive decline
•The cognitive or behavioural impairment involves a minimum of two of the following:
- memory
- executive function
- language
- apraxia/visuospatial
•Interferes with the ability to function at work or at usual activities and represents a decline from previous levels of functioning and performing
•Is not explained by delirium or major psychiatric disorder
•In summary, severe, acquired and must involve more than one brain region

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2
Q

What are the mimics of dementia?

A
  • Vascular disease including stroke
  • Trauma
  • Cancer
  • major mental health issues
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3
Q

What comes under ‘memory’ in a cognitive history?

A

•Impaired ability to acquire and remember new information
•Symptoms include:
- Repetitive questions or conversations
- misplacing personal belongings
- forgetting events or appointments
- getting lost on a familiar route

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4
Q

What comes under ‘executive function’ in a cognitive history?

A

•Impaired reasoning and handling of complex tasks, poor judgement
•Symptoms include:
- poor understanding of safety risks
- inability to manage finances
- poor decision making ability
- inability to plan complex or sequential activities

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5
Q

What comes under ‘visuospatial’ in a cognitive history?

A

•Impaired visuospatial abilities
•Symptoms include:
- inability to recognise faces or common objects or to find objects in direct view despite good acuity
- inability to operate simple implements or to orient clothing to the body

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6
Q

What comes under ‘language’ in the cognitive history?

A

•Impaired language functions (speaking, reading, writing)
•Symptoms include:
- difficulty thinking of common words while speaking
- hesitations
- speech
- spelling
- writing errors

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7
Q

Name 2 cognitive assessments

A
  • Folstein MMSE (30)

* Addenbrookes cognitive assessment (100)

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8
Q

What does addenbrookes examine?

A
  • Executive function
  • Memory
  • Language
  • Visuospatial
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9
Q

What is the purpose of addenbrookes?

A
  • Assess severity

* Assess pattern of impairment

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10
Q

What are the facets of executive function?

A
  • Behaviour aspect- orbitofrontal
  • Attention/working memory - dorsolateral prefrontal cortex
  • Motivation/goal driven - anterior cingulate
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11
Q

What are the symptoms of dementia affecting the orbitofrontal cortex?

A
  • disinhibited

* Loss of social awareness

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12
Q

What is the dorsolateral prefrontal cortex responsible for?

A
  • Working memory
  • Cognitive estimates
  • Planning
  • Understanding proverbs
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13
Q

What is attention/concentration?

A

Component of consciousness which allows filtering of information to allow one to focus on a particular stimuli

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14
Q

How can you test attention/concentration/orientation?

A
  • Orientation: day/date/month/year/season, which building/floor/town/county/country
  • 3 words, repeat back and memorise and ask again 5 minutes later
  • serial 7s
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15
Q

How can you test executive function?

A
  • Trail making
  • look for regional atrophy on MRI
  • Proverbs, verbal fluency, estimates and planning
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16
Q

What are the types of memory

A

•Declarative (explicit) memory is split into:

  • episodic
  • semantic
  • working
17
Q

What pathological processes affect episodic memory?

A
  • Alzheimers

* Limbic encephalitis

18
Q

Where does Alzheimers start and how does it spread

A
  • Classically starts in the temporal lobe

* Spreads to parietal and frontal lobes

19
Q

How do you test semantic memory?

A

Ask general knowledge questions

20
Q

What is the sign of impaired semantic memory on addenbrookes CE?

A
  • Marked reduction in the category verbal fluency (list of animals in one minute)
  • Impairment of irregular words (dyslexia) e.g. pint
  • loss of knowledge = semantic memory
21
Q

What does ‘visuospatial’ involve?

A
  • Visual processing - what and where

* Accurately localise objects

22
Q

What are the signs of reduced visuospatial awareness?

A
  • Inability to recognise faces or common objects in direct view despite good acuity
  • Inability to operate simple implements, or orient clothes to the body
23
Q

Explain the anatomy of visual processing

A
  • dorsal stream = Where pathway in the occipital parietal region, position of object in space and picking an object from a scene
  • Ventral stream = What pathway to temporal lobe: object recognition, facial recognition
24
Q

How does the Addenbrookes cognitive exam test visuospatial-parietal lobe function?

A
  • Pentagons
  • Cubes
  • 3D letters
  • dots counting
25
Q

How is language tested in addenbrookes?

A
  • naming
  • Repetition
  • 3 stage command (comprehension)
  • Reading
26
Q

What are the 3 main patterns of summary language disorders?

A
  • Semantic variant
  • Logopenic variant
  • Non-fluent variant
27
Q

Explain semantic variant of summary language disorder

A
  • Poor confrontation naming
  • impaired single word comprehension
  • Poor object/person recognition, surface dyslexia
28
Q

Explain logopenic variant of language disorders

A
  • Impaired single word retrieval (thinking of right word)

* Impaired repetition, speech sound errors, spared object/person recognition, single word recognition

29
Q

Explain non fluent variant of language disorders

A
  • Effortful, halting speech
  • Phenomic errors
  • Spared object/person recognition, single word recognition
30
Q

What language disorder pattern is as a result of semantic dementia?

A

Semantic variant

31
Q

What language disorder is seen in Alzheimers?

A

Logopenic

32
Q

What type of language disorder is seen in progressive non fluent aphasia?

A

Non fluent variant

33
Q

What score of addenbrookes excludes dementia?

A

> 88

34
Q

What score of addenbrookes supports a diagnosis of dementia?

A

<83

35
Q

What is the likely disorder if there is a deficit in episodic memory in ACEr?

A

Alzheimers

36
Q

What is the likely disorder if there is a deficit in semantic memory in ACEr?

A

Semantic dementia

37
Q

What is the likely disorder if there is a deficit in attention/concentration in ACEr?

A

Delirium

38
Q

What is the likely disorder if there is a deficit in fluency in ACEr?

A

Non fluent aphasia

39
Q

What is the likely disorder if there is a deficit in visuospatial in ACEr?

A

Parkinsons plus syndrome or variants Alzheimers disease

Week 13 - neurology (12 decks)

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