Dementia

Question 1

What are the 4 main causes of late-onset dementia, and rank them from the most prevalent to the least?

Answer 1

Alzheimer’s,
Vascular,
Dementia with Lewy Bodies,
Frontotemporal

Question 2

What is the cut-off for young onset dementia and how does the prevalence of causes change?

Answer 2

• under 65
  Frontotemporal more prevalent than Lewy Bodies
  ‘Other’ causes are more common as well

Question 3

What are some potentially reversible causes of dementia?

Answer 3

Depression,
Alcohol related brain Damage,
Endocrine disorders,
HIV/Syphilis,
Inflammation

Question 4

What are rarer irreversible causes of dementia?

Answer 4

MS, Huntigton’s

Question 5

Why is dementia difficult to diagnose in clinic?

Answer 5

Heterogenous course,
most patients are older with multiple co-morbidities

clinical history and function of patient is important for diagnosis

Question 6

Neuro-inflammatory risk factors of dementia

Answer 6

Ageing
brain trauma
infections/ systemic inflammation
oral health
reduced physical activity
genetic factors
midlife obesity

Question 7

What are some of the pathological proteins that may be present in dementia?

Answer 7

Alpha-synuclein, Neuronal tau, Amyloid angiopathy

Question 8

What is the pathway for clinical diagnosis in dementia?

Answer 8

Referral, History, Examination, Investigation, Diagnosis, Management

Question 9

What are the 10 components of the clinical interview?

Answer 9

Memory, Language, Numeracy, Visuospatial, Personality, Sexual Behaviour, Eating, Delusions/Hallucinations, Route Finding, Daily Life

Question 10

How does the cognitive presentation of dementia vary with the cause?

Answer 10

Severe loss of memory and cognitive abilities REGARDLESS of underlying cause

Question 11

What are the components of examination of dementia?

Answer 11

Neurological Mental State Exam -> cranial, spinal nerve testng, focus tests, speech test, thought form, insight

Question 12

What are some of the **investigations **that you would do for dementia?

Answer 12

Neuropsychology tests, Bloods, MRI, PET

Question 13

What is the MMSE?

Answer 13

Mini-Mental State Examination
Examination for orientation, attention, recall, language

Question 14

What are two common tests for neuropsychology?

Answer 14

Mini-Mental State Examination (MMSE), Addenbrooks Cognitive Assessment

Question 15

What are the blood tests you would do for dementia?

Answer 15

FBC, Inflammatory Markers, Renal Function, Liver (Caeruloplasmin - copper carrier), Glucose, B12 & Folate, Syphilis and HIV

Question 16

Structural MRI (sMRI) Alzheimer’s presentation

Answer 16

As disease progresses, AD brain has narrow gyri, widened sulci, ventricles dilated and enlarged, medial temporal volume loss, bilateral hippocampal volume loss. space replaced with CSF showing up as black

Question 17

How can you do PET Scans post-mortem to assess the likelihood of Alzheimer’s?

Answer 17

Inject fluoride, will be taken up by beta-amyloid protein. Uptake of 1.5% and upwards is a high likelihood of Alzheimer’s

Question 18

how are Amyloid PET scans used for diagnosis

Answer 18

areas of the brain containing amyloid light up as they take up the fluorescent marker

Question 19

What are some of the differentials with diagnosing dementia?

Answer 19

4 types of dementia, depression, delirium, or nothing at all

Question 20

What is the main symptomatic medication given for dementia?

Answer 20

Acetylcholinesterase inhibitors, only effective at early stage (MMSE = 1)

Question 21

Why does diagnosis of dementia take a long time?

Answer 21

Clinical process has reiterations to rule out delirium, depression etc. Will take 6 months - 1 year

Question 22

How does Alzheimer’s present?

Answer 22

Subtle, insidious episodic amnesia

Question 23

How does Vascular dementia present?

Answer 23

Stepwise deterioration, associated with strokes
related to cerebrovascular disease

Question 24

How does dementia with Lewy Bodies present?

Answer 24

Fluctuating cognition,
visual hallucinations,
develops into Parkinsonian symptoms
REM sleep disorder
high risk of falls

Question 25

How does Frontotemporal dementia present?

Answer 25

Progressive non-fluent aphasia, anomia, personality changes, semantic dementia

Question 26

What is a sign you can see in Alzheimer’s patients?

Answer 26

Head turning signs - as they look to others for verification after question is asked
(makes a lot of mistakes especially with meds)

Question 27

Episodic memory

Answer 27

• particular episodes in life
• dependent on Medial temporal lobes - hippocampus and entorhinal cortex

Question 28

How does the evolution of amyloid deposition in the brain occur in Alzheimer’s?

Answer 28

Starts in outer cerebral cortex, increases severely, then travels to other brain structures and down brainstem

Question 29

How does the evolution of tau in the brain occur in Alzheimer’s?

Answer 29

Starts in lower temporal lobe, spreads to anterior frontal lobe, then to occipital, then moves up to the top of the brain

Question 30

How can you use CSF to diagnose Alzheimer’s?

Answer 30

CSF from a lumbar puncture, amyloid will be lower than normal and tau will be higher than normal

Question 31

How do Lewy Bodies form in the brain?

Answer 31

Alpha-synuclein monomers bind together and strengthened with neurofilaments, form lewy bodies

Question 32

What will you see on a patient with dementia with Lewy Bodies, compared to Alzheimer’s?

Answer 32

Decreased uptake by dopamine receptors
preserved hippocampal volume, general medial temporal low volume

Question 33

How can you image dementia with Lewy Bodies without MRI?

Answer 33

SPECT (single proton emission computerised tomography) imaging - inject iodine and see uptake

Question 34

relationship between lewy bodies and dopamine

Answer 34

Lewy bodies build and prevent the uptake and transmission of dopamine

Question 35

FTD MRI presentation

Answer 35

Perisylvian volume loss, space at the side of the head
characteristic with behavioural disturbance

Question 36

What is anomia?

Answer 36

Inability to name objects