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Year Two - Neurology System > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia?

A

It is a neurodegenerative syndrome which results in progressive impairment of multiple cognitive domains, resulting in the loss of acquired skills and interference in the patient’s occupational and social roles

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2
Q

What are the four classifications of dementia?

A

Alzheimer’s Disease

Vascular Dementia

Lewy Body Dementia

Frontotemporal Dementia

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3
Q

What is the most common classification of dementia?

A

Alzheimer’s disease

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4
Q

What is Alzheimer’s disease?

A

It is a condition, in which there is cognitive decline related to hyperphosphorylation of the tau protein

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5
Q

What is the function of the tau protein?

A

It interacts with tubulin to stabilise microtubules and promote tubulin assembly into microtubules

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6
Q

What is the macroscopic change seen in Alzheimer’s disease?

A

Cerebral atrophy, involving the temporal neocortex and hippocampus

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7
Q

What are the three microscopic changes seen in Alzheimer’s disease?

A

Type-A beta amyloid protein plaques

Neurofibrillary tangles

Hyperphosphorylation of the tau protein

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8
Q

What are neurofibrillary tangles?

A

They are paired helical filaments composed of tau proteins

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9
Q

What is the biochemical change seen in Alzheimer’s disease?

A

Decreased acetylcholine levels

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10
Q

What four areas of the brain does Alzheimer’s disease tend to affect?

A

Hippocampus

Amygdala

Temporal neocortex

Subcortical nuclei

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11
Q

What are the five risk factors associated with Alzheimer’s disease?

A

White Race

Family History

Down’s Syndrome

Vascular Conditions

Smoking

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12
Q

What are the five genes associated with Alzheimer’s disease?

A

Apolipoprotein E4 (ApoE4)

Amyloid precursor protein (APP)

Presenilin-1 (PSEN1)

Presenilin-2 (PSEN2)

Trisomy 21 (Down’s Syndrome)

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13
Q

What three genes are associated with early onset familiar Alzheimer’s disease?

A

Amyloid precursor protein gene (APP)

Presenilin 1 gene (PSEN1)

Presenilin 2 gene (PSEN2)

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14
Q

What gene is associated with early onset familiar Alzheimer’s disease and Down’s syndrome?

A

Amyloid precursor protein (APP)

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15
Q

What are the five vascular conditions associated with Alzheimer’s disease?

A

Hypertension

Diabetes

Dyslipidaemia

Atrial fibrillation

Wilson’s disease

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16
Q

How long should clinical features be present for before a diagnosis of Alzheimer’s can be obtained?

A

> 6 months

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17
Q

What are the five clinical features associated with Alzheimer’ disease?

A

Dysmnesia

Dysphasia

Dyspraxia

Dysgnosia

Personality Changes

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18
Q

What is dysmnesia?

A

This is defined as memory impairment

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19
Q

What is dysphasia?

A

This is defined as communication impairment

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20
Q

What are the two types of dysphasia?

A

Expressive dysphasia

Receptive dysphasia

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21
Q

What is expressive dysphasia?

A

It is defined as the inability to formulate language - they struggle to get words out or use the wrong words

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22
Q

What is receptive dysphasia?

A

It is defined as the inability to comprehend language

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23
Q

What is dyspraxia?

A

It is defined as motor skill dysfunction

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24
Q

What is dysgnosia?

A

It isdefined as the inability to process sensory information, resulting in an inability to recognise objects, people, sounds, shapes or smells

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25
Q

Which investigation is used to diagnose Alzheimer’s disease - in addition to cognitive function tests and blood tests?

A

SPECT Scan

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26
Q

What is a SPECT scan? What information does it provide?

A

It is a nuclear imaging test involving the injection of a gamma-emitting radioisotope into the patient’s bloodstream

It provides information about the blood flow to tissues and organs

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27
Q

What is a feature of Alzheimer’s disease on SPECT scans?

A

Hypoperfusion within the temporal and parietal lobes of the brain

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28
Q

What is the second most common classification of dementia?

A

Vascular dementia

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29
Q

What is vascular dementia?

A

It is a condition in which there is cognitive decline related to ischaemia or haemorrhage to the cerebral blood vessels

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30
Q

What are the eight risk factors of vascular dementia?

A

Stroke/Transient Ischaemic Attack

Coronary Artery Disease

Hyperlipidaemia

Hypertension

Atrial Fibrillation

Diabetes Mellitus

Smoking

Obesity

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31
Q

How does vascular dementia generally present?

A

The onset is sudden

The progression is stepwise

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32
Q

What are the six clinical features of vascular dementia?

A

Dysmnesia

Dysarthria

Dysphagia

Seizures

Gait Disturbance

Emotional Disturbance

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33
Q

What is dysarthria?

A

It is defined as slowed speech

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34
Q

What investigation is used to diagnose vascular dementia - in addition to cognitive function tests and blood tests?

A

MRI scan

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35
Q

What are the two features of vascular dementia on MRI scans?

A

Cerebral infarcts

Extensive white matter changes

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36
Q

What criteria is used to diagnose vascular dementia?

A

NINDS-AIREN criteria

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37
Q

What does the NINDS-AIREN criteria state?

A

It states that there must be evidence of a correlation between cognitive decline and cerebrovascular disease…

  • The onset of dementia within three months following a stroke
  • An abrupt deterioration in cognitive functions
  • A stepwise progression of cognitive deficits
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38
Q

What is the third most common classification of dementia?

A

Lewy body dementia

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39
Q

What is Lewy body dementia?

A

It is a condition in which there is cognitive decline related to an accumulation of Lewy bodies within the brain

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40
Q

What are Lewy bodies?

A

They are deposits of alpha synuclein proteins

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41
Q

In what three cerebral locations do Lewy bodies accumulate?

A

Substantia nigra

Paralimbic areas

Neocortical areas

42
Q

What are the triad of clinical features associated with Lewy body dementia?

A

Cognitive Impairment

Visual Hallucinations

Parkinsonism

43
Q

What is a key clinical feature of Lewy body dementia?

A

There are FLUCTUATIONS in cognitive impairment

44
Q

How do we differentiate between Lewy body dementia and Parkinson’s disease?

A

Lewy body dementia = The cognitive impairment present a year before the Parkinsonism

Parkinson’s disease = The motor features present a year before cognitive impairment

45
Q

What is the additional clinical feature associated with Lewy body dementia?

A

Sleep disturbances

46
Q

What are the two investigations used to diagnose Lewy body dementia – in addition to cognitive function tests and blood tests?

A

DIAMOND Screening Test

DAT Scan

47
Q

What is a DIAMOND screening test?

A

It is a series of questions used to identify features of Lewy body dementia

48
Q

What is a DAT scan? What information does it provide?

A

It is a nuclear imaging test involving the injection of a gamma-emitting radioisotope into the patient’s bloodstream – subtype of SPECT scans

It provides information about dopamine transporter levels within the brain

49
Q

Describe the features of a normal DAT scan

A

There is normal re-uptake of the dopamine transporter in the head of the caudate nucleus and putamen, resulting in the shape of a comma

50
Q

How does Lewy body dementia present on DAT scans?

A

There is reduced re-uptake of dopamine in the putamen, resulting in the presentation of a ‘full-stop’ sign

51
Q

What is the fourth most common type of dementia?

A

Frontotemporal dementia

52
Q

What is another term for frontotemporal dementia?

A

Pick’s disease

53
Q

What is the frontotemporal dementia?

A

It is a condition in which there cognitive decline related to atrophy of nerve cells and their connections within the frontal and temporal lobes of the brain

These are the areas generally associated with personality, behaviour and language

54
Q

What is the macroscopic change seen in frontotemporal dementia?

A

Cerebral atrophy in frontal and temporal lobes

55
Q

What are the four microscopic changes seen in frontotemporal dementia?

A

Spherical aggregations of tau proteins (pick bodies)

Gliosis

Neurofibrillary tangles

Senile plaques

56
Q

What are the three clinical features of frontotemporal dementia?

A

Personality Changes

Behavioural Changes

Speech Disorders

57
Q

What are the three key features of frontotemporal dementia?

A

Onset < 65 Years Old

Insidious Onset

A relatively preserved memory and visuospatial skills

58
Q

In general how do we differentiate between a diagnosis of frontotemporal dementia and bipolar, schizophrenia or borderline personality disorder?

A

Frontotemporal dementia tends to present later on in life

59
Q

What investigation is used to diagnose frontotemporal dementia?

A

MRI scan

60
Q

What is a feature of frontotemporal dementia on MRI scans?

A

Focal gyral atrophy with a knife-bade appearance

61
Q

What are three investigations used to diagnose dementia?

A

Cognitive Function Test

Blood Tests

Neuroimaging

62
Q

What are cognitive function tests?

A

These tests involves the patient answering a series of questions and performing simple tasks

They are designed to test various domain functions, including memory, language, visuospatial awareness, emotion, apraxia, agnosia, etc

63
Q

What are the two cognitive function tests recommended in non-specialist settings?

A

10 Point Cognitive Screener (10-CS)

6 Item Cognitive Impairment Test (6CIT)

64
Q

What are the two cognitive function tests recommended in specialist settings?

A

Mini-Mental Screening Examination (MMSE)

Montreal Cognitive Assessment (MOCA)

65
Q

What is the MMSE test?

A

It involves a series of questions designed to test a range of everyday mental skills, focussing on the deficits present in Alzheimer’s disease

66
Q

What MMSE score indicates Alzheimer’s disease?

A

< 24

67
Q

What MMSE score indicates mild Alzheimer’s?

A

20-24

68
Q

What MMSE score indicates moderate Alzheimer’s?

A

13-20

69
Q

What MMSE score indicates severe Alzheimer’s?

A

<12

70
Q

What is the MOCA test?

A

It involves a series of questions designed to test a range of everyday mental skills

71
Q

What is the first line cognitive function test in a secondary care setting?

A

MOCA

72
Q

What MOCA score indicates a diagnosis of dementia?

A

< 26

73
Q

What is the investigation used to investigate dementia in a primary care setting?

A

Blood tests

74
Q

How are blood tests used to diagnose dementia?

A

They are used to exclude reversible causes of dementia – such as hypothyroidism, Addison’s disease, vitamin B12 deficiency, folate deficiency, thiamine deficiency

75
Q

What are the nine blood tests used to diagnose dementia?

A

Full Blood Count

Urea & Electrolytes

Liver Function Tests

Thyroid Function Tests

CRP/ ESR Levels

Glucose Levels

Vitamin B12 Levels

Folate Levels

Bone Profile

76
Q

What is the investigation used to investigate dementia in a secondary care setting?

A

Neuroimaging

77
Q

How is neuroimaging used to diagnose dementia?

A

It is used to exclude reversible causes of dementia - such as subdural haematomas and normal pressure hydrocephalus

78
Q

What are the twelve differential diagnoses of dementia?

A

Hypothyroidism

Addison’s disease

Vitamin B3 deficiency

Vitamin B12 deficiency

Folate deficiency

Thiamine deficiency

Syphillis

Brain tumour

Normal pressure hydrocephalus

Subdural haematoma

Depression

Chronic drug use

79
Q

How do we conservatively manage dementia?

A

It involves providing the patient and their families with adequate social and physical support

This may involve the use of dementia services, occupational therapists, social workers or care home admission

80
Q

What occurs when dementia patients are exposed to new surroundings?

A

Delirium

81
Q

What two classes of dementia can be managed pharmacologically?

A

Alzheimer’s disease

Lewy body dementia

82
Q

What are the two pharmacological management options available for dementia?

A

Acetylcholinesterase Inhibitors

NDMA Antagonists

83
Q

What is the first line pharmacological management option of dementia?

A

Acetylcholinesterase inhibitors

84
Q

What are the mechanism of acetylcholinesterase inhibitors?

A

They are drugs that inhibit the normal breakdown of acetylcholine, thus increasing its levels within the brain

This slows the progression of disease

85
Q

Name three acetylcholinesterase inhibitors used to treat dementia

A

Donepezil

Galantamine

Rivastigmine

86
Q

What is a contraindication of donepezil?

A

Bradycardia

87
Q

What is a side effect of donepezil?

A

Insomnia

88
Q

What is the second line management option of dementia?

A

NDMA antagonists

89
Q

In which three circumstances do we administer NDMA antagonists to manage dementia?

A

In moderate Alzheimer’s disease and Lewy body disease, in which individuals have an intolerance or contraindication to acetylcholinesterase inhibitors

In moderate to severe Alzheimer’s disease and Lewy body dementia, as an add on drug to acetylcholinesterase inhibitors

In severe Alzheimer’s disease, as monotherapy

90
Q

What are the mechanism of NDMA antagonists?

A

They are drugs that inhibit the N-Methyl-D-aspartate receptor

91
Q

Name an NDMA antagonist used to manage dementia

A

Memantine

92
Q

Can antidepressants be used to manage dementia?

A

It is recommended by NICE that antidepressants are not used to treat mild to moderate depression in dementia

93
Q

Which drug class should be considered with caution in dementia, due to its significant increase in mortality rate?

A

Antipsychotics

94
Q

When can antipsychotics be used to manage dementia?

A

It is recommended by NICE that antipsychotics should only be used for patients at risk of harming themselves or other, OR when the agitation, hallucinations or delusions are causing severe distress

95
Q

Which drug class should be considered with caution in dementia, due to its side effect of cognitive impairment?

A

Tricyclic Antidepressants

96
Q

In which dementia classification should neuroleptics be avoided? Why?

A

Lewy body dementia

It can cause irreversible Parkinsonism

97
Q

Do individuals need to notify the DVLA of a dementia diagnosis?

A

Yes

98
Q

How do we differentiate between dementia and delerium?

A

Delirium is indicated by the following features…

  • Acute onset
  • Impaired consciousness
  • Fluctuating symptoms
  • Abnormal perceptions (hallucinations, illusions)
  • Agitation
  • Delusions
99
Q

How do we differentiate between dementia and depression?

A

Depression is indicated by the following features…

  • A short history, rapid onset
  • Biological features, such as weight loss and sleep issues
  • The patient is worried about poor memory
  • A variable cognitive test result
  • A global memory loss
100
Q

What memory loss is associated with dementia?

A

Recent memory loss

Year Two - Neurology System (25 decks)

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