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Neuro > Dementia > Flashcards

Dementia Flashcards

1
Q

dementia

A

global deterioration of intellectual function in the face of unimpaired consciousness
impaired cognition - memory, abstract thinking, judgement, processing/organizing daily lives

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2
Q

assessment

A

general medical and neurological history, neurobehavioural and psychiatric history, toxic/drug history, family history
assess mental state → level of consciousness, orientation, memory, attention + concentration, knowledge, language
MMSE/MOCA - quantification measures decline over time

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3
Q

pathology

A

deficits depend on the initial affected area of brain and the rate of progression

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4
Q

progression of deterioration of intellectual function

A

acute = weeks - encephalitis
subacute = months - CJD
chronic = years - Alzheimer’s disease

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5
Q

frontal lobe

A

motor speech area - speech apraxia

pre-motor cortex - behavioural changes

also: Pick’s, Huntington’s

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6
Q

parietal lobe

A

visuo-spatial orientation
constructional apraxia (inability to draw/copy)
disturbances in cognitive function

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7
Q

dysfunction in frontal lobe

A

lead to abnormal reflexes → primitive

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8
Q

primitive reflexes

A

present as babies but fade → return in dementia

  1. pout reflex - lips pout when tapped
  2. glabellar reflex - cannot inhibit blinking response to stimulation
  3. grasp reflex - stroking palm induces grasp
  4. palmo mental reflex - scratching hand causes contraction of chin muscles
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9
Q

causes

A
  1. degenerative
  2. cerebrovascular
  3. structural
  4. infection
  5. toxic/metabolic
  6. immune/cancer
  7. depression
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10
Q

degenerative cause

A

most common cause (80-85%)
dysfunction + degeneration of neurons and brain cells
age progression
vulnerable regions: parietal, temporal - hippocampus (memory + cognition)
specific targets: Huntington’s = basal ganglia; Parkinson’s = substantia nigra

protein misfolding + abnormal deposition

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11
Q

cerebrovascular cause

A

2nd most common cause
inflammation of blood vessels - CNS vasculitis

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12
Q

laboratory investigations

A

clinical history/exam
blood tests/screens for treatable causes, infections
neuroimaging

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13
Q

Alzheimer’s disease

A

irreversible, progressive - destroys memory + thinking
risk increases with age
disrupts neuron communication, metabolism, + repair

most common cause of dementia

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14
Q

Alzheimer’s clinical features

A

memory impairment
hallucinations
paranoia
cognitive impairment, personality changes, disorientation

motor and gait disturbances
falls
seizures
autonomic dysfunction

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15
Q

etiology of Alzheimer’s

A

familial forms
sporadic (unknown cause) - majority of cases
early onset - 40-50 (usually genetic = APP, presenilin 1 and 2 mutations)

late onset - mostly sporadic; apolipoprotein E4, SORL1, CLU, CR1

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16
Q

amyloid precursor protein

A

membrane protein important for neuronal growth and repair

secreatases cut it into fragments → B-amyloid is sticky fragment - cling together = plaques

17
Q

neuropathology of Alzheimer’s

A

cortical atrophy
synaptic + neuronal loss

neurofibrillary tangles - twisted fibres
B-amyloid plaques - deposition in hippocampus and amygdala
tau proteins

18
Q

neurotransmitter abnormalities in Alzheimer’s

A

decreased acetylcholine in cortex and hippocampus

neurons in the basal forebrain synthesize Ach - project forward into cortex → neurons die = deficiency in Ach

19
Q

Alzheimer’s treatment

A

cholinesterase inhibitors - more Ach
NMDA receptor blockers - glutamate

less effective over time as cells die = no targets

20
Q

imaging

A

CT + MRI - show atrophy in hippocampus
PET scan - visualize amyloid in brain

21
Q

Lewy Body dementia

A

fluctuating cognition
recurrent visual hallucinations
Parkinsonism

lewy bodies contain alpha-synuclein protein

loss of pigmented dopamine neurons in substantia nigra

22
Q

Frontotemporal dementia (Pick’s)

A

bias to females
younger age
frontal and temporal lobe atrophy
Tau pathology
familial forms - gene on chromosome 17

23
Q

vascular dementia

A

10-15%
accumulation of strokes causes progressive loss of function
risk factors: hypertension, diabetes, high cholesterol

Neuro (10 decks)

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