DEMENTIA

Question 1

what is dementia?

Answer 1

an umbrella term for a range of progressive conditions affecting the brain and disturbing higher cortical function without clouding conciousness

Question 2

what are the 5 most common types of dementia?

Answer 2

alzheimers
vascular disease
dementia with lewy bodies
frontotemporal dementia
mixed dementia

Question 3

how do we distinguish dementia from normal ageing?

Answer 3

the symptoms must be worse than normally expected in someone of their age in dementia and must be severe enough to impair ADLs

Question 4

what is young onset dementia?

Answer 4

when it starts before the age of 65

Question 5

what are the symptoms of dementia?

Answer 5

memory loss
difficulty communicating or finding words
difficulty with visual and spatial abilities
difficulty reasoning or problem solving
difficulty handling complex tasks
difficulty with planning and organization

Question 6

whats the most common type of dementia?

Answer 6

alzheimers disease

Question 7

whats the cause of alzheimers disease?

Answer 7

plaques - beta amyloid clumps together and disrupt cell to cell communciation
tangles - tau proteins change shape and organize themselves into neurofibrillary tangles which disrupt the transport system and are toxic to cells

Question 8

whats it called when beta amyloid plaques deposit around blood vessels in the brain?
what is the result of this?

Answer 8

amyloid angiopathy

weakens blood vessel walls and increases risk of haemorrhage

Question 9

what forms neurofibrillary tangles in alzheimer disease?

Answer 9

abnormal accumulations of tau protein inside neurones

Question 10

what are the 2 types of alzheimers disease?

Answer 10

sporadic and familial

Question 11

what is sporadic alzheimers?

Answer 11

late onset type where the exact cause isnt very well defined but is probably a combination of genetic and environmental risk factors

Question 12

whats a gene thats been identified as possible contributing to an increased alzheimers risk?

Answer 12

APOE-e4 gene
APOE genes helps break down beta-amyloid but the e4 allele is less effective than other alleles so people are more likely to develop beta-amyloid plaques.

Question 13

what is familial alzheimers disease?

Answer 13

cases where some dominant gene was inherited and speeds up the progression of the disease
its usually earlier onset w

Question 13

what is familial alzheimers disease?

Answer 13

cases where some dominant gene was inherited and speeds up the progression of the disease
its usually earlier onset w

Question 14

what is familial alzheimers disease?

Answer 14

cases where some dominant gene was inherited and speeds up the progression of the disease
its usually earlier onset w

Question 15

which type of alzheimers is more common?

Answer 15

sporadic

Question 16

what mutations have been linked to early onset alzheimers?

Answer 16

PSEn-1 and PSEN-2 on chromosomes 14 or 1
mutations in these can change the location where amyloid precursor protein gene is chopped, producing different length beta amyloid molecules which have a tendancy to clump and form plawues

Question 17

why is trisomy 21 also a genetic cause of familial alzheimers?

Answer 17

the gene responsible for producing APP is on chromosome 21 so those with down syndrome have an extra APP gene and so increases the amount of amyloid plaque build up

Question 18

what age does familial alzheimers disease often progress by?

Answer 18

40

Question 19

outline the symptoms of alzheimers?

Answer 19

starts with short-term memory loss
then loss of motor skills and language becomes difficulty
eventually they lose long term memory and become more and more disorientated

Question 20

what causes death in alzheimers?

Answer 20

often an infection such an pneumonia as they are bed ridden

Question 21

how do we diagnose alzheimers?

Answer 21

by excluding all other causes of dementia

Question 22

what are the treatment options of alzheimers?

Answer 22

acetylcholinesterase inhibitors e.g. donepezil, rivastigmine and galantamine
memantine

Question 23

how does memantine work at treating dementia?

Answer 23

memantine binds mmore effectively than Mg2+ ions at the NMDA receptor, effectively blocking the prolonged influx of Ca2+ through the channel whilst preserving transient phsyiological activation of the channels by higher concentrations of synaptically released glutamate. therefore it protects against chronically elevated glutamate concentrations

Question 24

how does donepezil work for treating dementia?

Answer 24

reversible inhibition of acetylcholinesterase, leading to an increase in ACh at cholinergic synapses, enhancing cholinergic function

Question 25

what are alzheimers risk factors?

Answer 25

age
family history
APOE e4 gene 
down syndrome
being female (only because they often live longer so prevalence is higher)
mild cognitive impairment 
head trauma
air pollution
excessive alcohol consumption
poor sleep patterns
heart disease risk factors
low education levels and low social engagement q

Question 26

what is mild cognitive impairment?

Answer 26

a decline in memory or other thinkng skills that is greater than normal for a persons age, but the decline doesnt prevent a person from functioning in social environments

Question 27

what is vascular dementia also known as?

Answer 27

multi-infarct dementia

Question 28

what is vascular dementia?

Answer 28

progressive loss of brain function caused by long term poor blood flow to the brain (typically because of a series of strokes)

Question 29

what are the symptoms of vascular dementia?

Answer 29

they depend on where the stroke occured in the brain e.g. if temporal lobe then they may have difficulty with memory or if parietal lobe they may have aphasia
Symptoms appear suddenly and brain function decreases with each stroke

Question 30

how do we diagnose vascular dementia?

Answer 30

neuropsychological tests

then brain imaging, usually CT or MRI which would show atrophy of the brain cortex, confirming ischaemia

Question 31

how do we treat vascular dementia?

Answer 31

focus on reducing risk of recurring strokes e.g. lowering bp, stopping smoking, controlling diabetes etc

Question 32

what causes lewy body dementia?

Answer 32

misfolded alpha synuclein which aggregates to form lewy bodies which accumulate

Question 33

what are the symptoms of lewy body dementia?

Answer 33

early signs are usually cognitive:
difficulty focussing, poor memory, visual hallucinations, disorganized speech and depression

later sigsn are usually motor:
resting tremors, stiff and slow movements, reduced facial expressions

note: some people have sleeping disorders too

Question 34

how do we diagnose lewy body dementia?

Answer 34

pattern of symptoms and confirmed with a brain autopsy which shows lewy bodies in neurones

Question 35

whats the treatment for lewy body dementia?

Answer 35

motor symptoms respond to drugs used to treat parkinsons e.g. levodopa
cognitive symptoms respond to drugs for alzheimers e.g. donepezil

Question 36

what is frontotemporal dementia?

Answer 36

a degeneration of frontal and temporal lobes of the brain which affects behaviour, personalty, language and movement

Question 37

what causes frontotemporal dementia?

Answer 37

abnormal tau protein inclusions form in the cytoplasm or nuclei of neurones. This damages the neurones so they undergo apoptosis. the brain now atrophies and the gyri get narrower and sulci get wider. The ventricles also expand as the brain shrinks.

Question 38

what are symptoms of frontotemporal dementia?

Answer 38

if frintal lobe is affeted we get personality and behaviour changes - most common
when temporal lobe is affected we may get semantic variant primry progressive aphasia or non-fluent variant primary progressive aphasia
as atrophy dveelops a person may struggle with memory, concentration and ability to learn neew things

Question 39

what is semantic variant primary progressive aphasia

Answer 39

difficulty finding the right words

Question 40

what is nonfluent variant primary progressive aphasia?

Answer 40

difficulty speaking while knowing the meanings of individual words

Question 41

how do we diagnose frontotemporal dmeentia?

Answer 41

mental status changes
imaging studies to see changes in frontal and temporal lobes
brain biopsy after death is the onyl real definitive test

Question 42

what are the types of frontotemporal dementia?

Answer 42

behavioral variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and movement disorders.

Question 43

what is picks disease?

Answer 43

behavioural variant frontotemporal dementia

Question 44

what are the symptoms of picks disease?

Answer 44

personality changes
apathy
proressive decline in socially appropriate behaviour, judgement, self control
and empathy

Question 45

at what age does frontotemporal dmeentia usually start showing symptoms?

Answer 45

between 40 and 65