Dementia

Question 1

risk factors for alzheimer’s ?

Answer 1

5% of cases are inherited as an autosomal dominant trait
mutations in the amyloid precursor protein (chromosome 21)

Down’s syndrome

increasing age

Question 2

what are the pathological macroscopic changes seen alzheimer’s ?

Answer 2

cerebral atrophy, particularly involving the cortex and hippocampus

Question 3

what are the pathological microscopic changes seen alzheimer’s ?

Answer 3

cortical plaques due to deposition of type A-Beta-amyloid protein and intraneuronal neurofibrillary tangles

caused by abnormal aggregation of the tau protein

hyperphosphorylation of the tau protein has been linked to AD

Question 4

biochemical changes ?

Answer 4

deficit of acetylcholine from damage to an ascending forebrain projection

Question 5

Diagnosis of dementia

Answer 5

10-point cognitive screener (10-CS), 6-Item cognitive impairment test (6CIT)

assessment tools not recommended by NICE

in primary care, a blood screen is usually sent to exclude reversible causes

in secondary care, neuroimaging is performed* to exclude other reversible conditions (e.g. Subdural haematoma, normal pressure hydrocephalus) and help provide information on aetiology to guide prognosis and management

Question 6

x

Answer 6

x

Question 7

x

Answer 7

x

Question 8

x

Answer 8

x

Question 9

first line management of Alzheimer’s disease mild to moderate

Answer 9

Patients with Alzheimer disease have reduced production of choline acetyl transferase

three acetylcholinesterase inhibitors donepezil, galantamine and rivastigmine

Question 10

second line managemnet of Alzheimer’s disease in mild to moderate

or who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors?

Answer 10

memantine- NMDA receptors

Question 11

mono therapy in severe Alzheimer’s?

Answer 11

memantine (an NMDA receptor antagonist)

Question 12

side effects and contra of donepezil?

Answer 12

insomnia

contra : in bradycardia, AV block (sick sinus syndrome)

Question 13

cholinesterase inhibitors helps in what way ?

Answer 13

improve some cognitive function and improvement in activities of daily living. There is no role for cholinesterase inhibitors in advanced Alzheimer’s disease.

Question 14

x

Answer 14

x

Question 15

What is LEWY BODY DEMENTIA

Answer 15

abnormal deposits of a protein called alpha-synuclein in the brain

Question 16

clinical features of lewy body dementia

Answer 16

contrast to Parkinson’s disease, where the motor symptoms typically present at least one year before cognitive symptoms

parkinsonism - slow movement s , Reduced facial expression, Shuffling walk , tremor in arms and legs at rest

in contrast to Alzheimer’s, early impairments in attention and executive function

visual hallucinations / delusions

Question 17

diagnosis of lewy body dementia ?

Answer 17

Montreal Cognitive Assessment score low due to cognitive impairment

usually clinical
single-photon emission computed tomography (SPECT)

Question 18

what should be avoided in levy body dementia ?

Answer 18

neuroleptics - extremely sensitive and may develop irreversible parkinsonism.

Question 19

Mx of lewy body dementia ?

Answer 19

both acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine

Question 20

Cause of VD ?

Answer 20

causing ischaemia or haemorrhage secondary to cerebrovascular disease.

stroke doubles the risk of developing dementia.

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Vascular risk factors : Hypertension
Diabetes mellitus
Hyperlipidaemia
Smoking
Obesity
Coronary heart disease
A family history of stroke or cardiovascula

Question 21

What are the 3 main subtypes of vascular dementia ?

Answer 21

Stroke-related VD – multi-infarct or single-infarct dementia

Subcortical VD – caused by small vessel disease

Mixed dementia – the presence of both VD and Alzheimer’s disease

Question 22

VD has what kind of deterioration ?

Answer 22

sudden or stepwise deterioration of cognitive function.

Question 23

Symptoms and the speed of progression vary but may include VD

Answer 23

Focal neurological abnormalities e.g. visual disturbance, sensory or motor symptoms

The difficulty with attention and concentration

Seizures

Memory disturbance

Gait disturbance

Speech disturbance

Emotional disturbance

Question 24

X

Question 25

X

Question 26

X

Question 27

Non-pharmacological management ?

Answer 27

Tight control of vascular risk factors

Include: cognitive stimulation programmes, multisensory stimulation, music and art therapy, animal-assisted therapy

Managing challenging behaviours e.g. address pain, avoid overcrowding, clear communication