Dementia Flashcards
What is dementia?
Syndrome encompassing progressive deficits in several cognitive domains
What are 2 causes of dementia?
Ameliorable
neurodegenerative
How do you diagnose dementia?
Loss of semantic & episodic knowledge
What is episodic memory?
activities of daily life & ability to cope with daily tasks
What is semantic memory?
Autobiographl memory
What metabolic causes induce ameliorable demetntia?
VitB1/3/12 deficiency
T4 reduction
What are space occupying causes of ameliorable dementia?
tumours
subdural haematoma
normal pressure hydrocephalus
What are 4 infectious causes of ameliorable dementia?
Syphilis
CNS cysticercosis
HIV
Whipple’s disease
What is a type of neurodegenerative dementia?
Alzheimers
What are 5 earliest signs of alzheimers?
impairment of recent memory, function , attention
failure of language skills, visual-spatial orientation, abstract thinking & judgement
What is a second type of NGD dementia?
Vascular dementia
What does vascular dementia represent?
Cumulative effects of many small strokes
What are 3 signs for vascular pathology of vascular dementia?
High BP
past strokes
focal CNS signs
What is a third type of NGD dementia?
Lewy body dementia
What are symptoms of Lewy body dementia/
cognitive impairment
visual hallucinations
parkinsonism
Lewy bodies in brainstem & neocortex
What is the fourth type of NGD dementia?
Fronto-temporal (PIcks’s) dementia
What are symptoms of Fronto-temporal (PIcks’s) dementia?
Frontal & temporal atrophy without alzheimers histology
exectutive impairment
behavioural/personality change
disinhibitoon
What is the 5th NGD dementia?
Huntington’s disease
What are symptoms of Huntington’s disease?
movement disorders
mood swings
depression
progressive decline in memory, concentrating
What is chronic traumatic encephalopathy?
Repeated head trauma leading to NGD dementia
What is the most popular cognitive testing/
Montreal cognitive assessment (MOCA)
What are 2 other dementia assesments?
Mental state & physical examination
What sex is alzheimers more prevalent in?
Female
What are 3 principal histopathology of alzheimers?
Neurofibrillary tangles
amyloid plaques
diffuse loss of neurons
enlargement of ventricles
Can Alzheimer’s be genetic?
Yes
Inherited in an autosomal dominant pattern in a small fraction
What are 5 presentations in alzheimers?
Dysfunction of:
visuo-spatial skills
sematic & episodic memory
verbal abilities
executive function
anosognosia
What are 4 symptoms of alzheimers that present at later stages?
irritability
mood disturbance
behavioral change
agnosia
What are features of Alzheimer’s disease patholohy?
environmental & genetic factors
deficit in clearance of beta amyloid peptide
altered microglial expression
neuronal loss
proliferation of astrocytes
shrinkage of hippocampus
What are risk factors for alzheimers?
1st degree relative with AD
Down syndrome
homozygosity for ApoE
mutations in PICALM, CL1, CLU
High Bp
depression, loneliness
reduced physical activity
alcohol?
smoking
How can Alzheimer’s be prevented?
detect changes in CSF beta amyloid seen ~25yrs before onset of symptoms
detection of CSF tau protein & atrophy (15yrs before)
cerebral hypometabolism & impaired episodic memory
PUFA, folic acid & B vitamins can help
How can Alzheimer’s disease be managed?
Acetylcholinesterase inhibitors eg. Donepezil
What does aceytlcholineesterase inhibition cause?
enhances cholinergic transmission
slows down progression of alzheimers
What are 3 types of acetylcholinesterase inhibitors?
Donepezil
Rivastigmine
Galantamine
What are S/Es of acetylcholinesterase inhibitors?
cramps, incontinence, exacerbates peptic ulcer disease, hypotension, bradycardia
What is an antiglutamergic treatment?
Memantine (NDMA anatgonist)
effective in late stage
How is beta amyloid targeted for AD treatments?
Humanized monoclonal IgG1 antibody directed against mid-domain of Abeta peptide
How can folic acid & B vitamins helpful in AD treatment?
decreases mild cognitive impairment
decreases rate of MRI brain atrophy in MCI
