Dementia Flashcards
What is the continuum of dementia
Why is it hard to identify dementia in clinic?
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
What are the molecular and cellular changes associated with dementia
What is the commonest cause of dementia? Define it.
Alzheimer’s disease- This fatal neurodegenerative disorder is characterised by progressive
cognitive, social and functional impairment.
What is the cure for Alzheimer’s?
Can Alzheimer’s be diagnosed in life?
There is no current cure, with acetylcholinesterase inhibitors having
modest symptomatic benefit in early stages
Diagnosis in life is only probable however this is changing
causes of dementia
Alzheimer’s
Vascular dementia
Frontotemporal dementia
Lewy body dementia
reversible causes of dementia
Depression
Alcohol related brain damage
Endocrine
Vitamin B deficiencies
Benign Tumors
what is dementia
severe loss of memory and other cognitive abilities which leads to impaired daily function (regardless of the underlying cause)
Dementia interview checklist
Memory
Language
Numerical Skills
Executive skills
Visuospatial skills
Neglect phenomena
Visual perception
Route finding and landmark
identification
*
Personality and social conduct
Sexual behaviour
Eating
Mood
Motivation/Apathy
Anxiety/Agitation
Delusions/Hallucinations
Activities of daily living
+ Chronology of each
What tools are used for mental state examination?
MMSE
ACE III
(15 minutes, and
more memory
focussed)
Dementia examinations
Neurological
Mental state
dementia investigations
Neuropsychology
Bloods
MRI
PET
bloods for dementia
FBC
Inflammatory markers
Thyroid function
Renal function
Glucose
B12 and folate
Clotting
MRI results for alzheimers
Narrow gyri
Widened sulci
Ventricles dilate
Medial temporal volume loss
Hippocampus volume loss
What substance is used for in vivo PET scanning for dementia?
What do we look at post mortem
18F Florbetapir in vivo
Amyloid post portem
Dementia differential diagnoses
Alzheimer’s
Vascular
Lewy Body
FTD
Atypical dementias
Depression
Delirium
None
management for dementia
Acetylcholinesterase inhbitors
Watch and wait
Treat behavioural and psychological symptoms
OT/ Social Services
Specialist therapies
alzheimers presentation
subtle, insidious onest amnestic/non amnestic presentations
Biomarker patterns in Alzheimer’s
presentation of vascular dementia
classical step wise deterioration +/-multiple infarcts
related to underlying CV disorder
lewy body dementia presentation
Cognitive impairment before/within 1 year of parkinsonian symptoms, risk of falls
visual hallucinations, REM sleep disorder
fluctuations in cognition
presentation of frontotemporal dementia
behavioural variant FTD
semantic dementia
progressive non fluent aphasia
What is episodic memory?
What parts of the brain does this rely on?
Memory for a particular life events
Dependent on the medial temporal lobes including the hippocampus and enterorhinal cortex
What are lewy bodies composed of
Alpha synuclein
how does lewy body dementia look on MRI
preserved hippocampal volume
what section of ACE may someone with alzheimers struggle in terms of memory
name, address
(acute memory)
what must be taken into account during an ACE
context of individual - socioeconomic status
educational background
political awareness
social interactions
what may show visuospatial issues within the ACE
drawing
indentifying partial letter
looking at diagrams
counting spots without pointing
delirium vs dementia
delirium related to physical condition and acute
dementia long standing, usually unchanging based on environment
what is the head turning sign of alzheimers
looking around to see others’ answers to question as they dont know the answer
CSF results for alzheimers
lower amyloid
higher Tau proteins
what specific marker on PET scan is there for lewy body dementia
decreased dopamine transporters caudate and putamen
what MRI sign can show frontotemporal dementia
loss/atrophy and assymetry of peri-sylvian fissure
