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Y2 NEUROLOGY > Dementia > Flashcards

Dementia Flashcards

1
Q

what is dementia?

A

a fatal neurodegenerative disorder that is characterized by progressive cognitive, social and functional impairment

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2
Q

what is the most common cause of dementia?

A

alzheimers disease

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3
Q

What is the cure for dementia?

A

There is no current cure, with acetylcholinesterase inhibitors having
modest symptomatic benefit in early stages

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4
Q

what are the four most common causes of dementia?

A

Alzheimer’s disease, vascular dementia, frontotemporal dementia, dementia with Lewy bodies

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5
Q

List some of the potentially reversible causes of dementia

A

depression, alcohol related brain damage, endocrine causes, B1/B12/B6 deficiency, infection, inflammation

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6
Q

How does cognitive function decline due to dementia in comparison with normal aging?

A

general decrease with age. With dementia: preclinical deterioration in cellular function until clinical manifestation with mild cognitive impairment leading to dementia

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7
Q

why is dementia hard to diagnose?

A

The disease follows a heterogenous
course
* In old age the disease presentation is of
multiple co-morbidities
* Lots of mixed and uncertain pictures
* Younger patients are more typical
* Clinical history, the function of the patient
and how they change is paramount

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8
Q

what are the two most important molecules in the pathology of dementia?

A

amyloid, tau

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9
Q

when interviewing a suspected dementia patient what are the most important things to check?

A

memory, language, numerical skills, executive skills, personality, sexual behaviour, mood, delusions and hallucinations along with the chronology of each

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10
Q

outline the general process for diagnosis of dementia?

A

referral, history, examination, investigation, diagnosis, management

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11
Q

what do dementia examinations include?

A

neurological mental state, focus tests, limb functions, appearance, behaviour, insight and speech

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12
Q

what investigations are done when diagnosing dementia?

A

Neuropsychology, bloods, MRI, PET

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13
Q

list three cognitive tests that may be undertaken in the diagnosis of dementia

A

MMSE, Addenbrookes, Montreal cognitive assessment

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14
Q

What are the management options for dementia?

A

Acetylcholinesterase inhibitors
Watch and wait
Treating behavioural/psychological
symptoms
OT/Social services
Specialist therapies

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15
Q

what are the three most important considerations for cognitive impairment?

A

Delirium, dementia, depression

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16
Q

How does the progression of Alzheimer’s show on an MRI?

A

gyri narrow, sulci widen, ventricles become more dilated, loss of medio temporal volume and hippocampal volume

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17
Q

How does Alzheimer’s present?

A

subtle, insidious onset with amnestic presentation. symptoms of anomia, agnosia, aphasia.

18
Q

what is anomia?

A

inability to name objects

19
Q

How does vascular dementia present?

A

Classical step-wise deterioration, associated with cerebrovascular diseases. symptoms include slower thinking, personality changes, movement problems and bladder problems

20
Q

What are Lewy bodies

A

aberrant deposits of alpha-synuclein protein in the brain.

21
Q

How does dementia with Lewy bodies present?

A

cognitive impairment with 1 year of parkinsonian symptoms, visual hallucinations and fluctuating cognition. progressive and insidious onset over time

22
Q

How does frontotemporal dementia present?

A

speech problems, behavioral changes, emotional problems and disinhibition. can cause semantic dementia, progressive non-fluent aphasia

23
Q

What causes the neuronal atrophy of the frontal and temporal lobes associated with frontotemporal dementia (FTD)?

A

presence of abnormal proteins, predominately phosphorylated tau

24
Q

what are the distinct biomarker patterns associated with Alzheimers?

A

amyloid is the primary event, followed by tau, then changes to brain structure that affect cognition

25
Q

How is CSF used in Alzheimers diagnosis?

A

CSF taken via a lumbar puncture. beta-amyloid is lower in someone with Alzheimer’s. CSF tau is higher

26
Q

How does dementia with Lewy bodies appear on an MRI?

A

preserved hippocampal volume and medial temporal lobe volume on a DaTscan

27
Q

what is a DaTscan?

A

dopamine transporter level scan

28
Q

outline the role of amyloid plaques in the pathophysiology of Alzheimer’s disease

A

insoluble beta-amyloid peptide deposits as senile plaques or beta-pleated sheets in the hippocampus, amyglada and cerebral cortex. increased density in advanced disease

29
Q

outline the role of neurofibrillary tangles (NFTs) in the pathophysiology of alzheimers disease

A

consist of phosphorylated tau protein and are found in the cortex, hippocampus,and substantia nigra (NFTs are also found in normal aging)

30
Q

alzheimers can result in a loss of up to ___% of neurons and synapses in __________

A

50% loss in the cortex and hippocampus

31
Q

what four genes are implicated in Alzheimers disease?

A

chromosome 21
chromosome 19
chromosome 14
chromosome 1

32
Q

why is chromosome 21 implicated in alzheimers disease?

A

the gene for amyloid precursor protein (APP) is found in the long arm

33
Q

why is chromosome 19 implicated in Alzheimers disease?

A

codes for apolipoprotein E4,presence of these alleles increases risk of AD

34
Q

why is chromosome14 implicated in Alzheimers disease?

A

codes for presenilin 1 (implicated in B-amyloid peptide)

35
Q

what does the cholinergic hypothesis suggest?

A

suggests that dysfunction of ACh containing neurons in the brain contributes substantially to the cognitive decline seen in old age and AD

36
Q

per the cholinergic hypothesis, dysfunction of ACh containing neurones leads to pathological changes that result in what?

A

degeneration of cholinergic nuclei in the basal forebrain (nucleus basalis of Meynert)

37
Q

tha pathological changes that lead to degeneration of cholinergic nuclei in the basal forebrain results in what?

A

reduced cortical acetylcholine

38
Q

what two types of drugs form the primary bases of pharmalogical treatment of AD?

A

acetylcholinesterase inhibitors and NMDA receptor antagonists

39
Q

what does the term confabulation mean?

A

fabrication of events to fill in gaps in memory
can add credence to paranoid beliefs and exacerbates psychotic phenomena like psychosis

40
Q

what behavioural disturbances can AD patients present with?

A

aggression
wandering
explosive temper
sexual disinhibition
incontinence
excessive eating
searching behaviour

Y2 NEUROLOGY (10 decks)

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