Dementia

Question 1

Cognitive screening

Answer 1

6 questions which test function
First 3: year?month? tests for temporal orientation
Time.count back tests for attention
Repeat address tests for short term memory

Question 2

Dementia

Answer 2

Several aspects of cognitive function impaired accompanied by changes in emotional control social behavior depression and co morbidity
Worsens with age

Question 3

Alzheimer’s

Answer 3

Most common type
Gradual onset
Starts with memory and progresses to mood problems social
Treated with ach inhibitors and memantine

Question 4

Vascular dementia

Answer 4

Step by step progression associated with strokes and blockage of blood vessels
Gait disturbance
Personality changes
Bladder problems
Associated with cardiovascular issues such as diabetes and hypocholesterolaemia

Question 5

Lewy body dementia

Answer 5

Visual hallucinations
Parkinsonian symptoms
Sleep disorder
Fluctuating awareness and attention
Memory problems appear later in disease
Caused by Lewy body deposits in brain (alpha synuclein deposits)
Treated with acetylcholinesterase inhibitors

Question 6

Frontal temporal dementia

Answer 6

Group of disorders that cause degradation of frontal and temporal lobes due to presence of phosphorylation tau or TDP-43
Has autosomal dominant inheritance
Effects speech
Lack of empathy
Behavioral inappropriateness
Disinhibition

Question 7

CTE- chronic traumatic encephalopathy

Answer 7

Linked to multiple concussions
Form of dementia

Question 8

Neuronal death

Answer 8

Mistakes within genes lead to proteins in the cell being the wrong shape. This damages the cells in the brain which causes the cells in the brain to die

Question 9

Amyloid plaque

Answer 9

Amyloid precursor protein is usually cleaved by alpha-secretase.

In plaque formation, it is cleaved improperly by beta and gamma secretases.

This results in an excessive amount of amyloid-beta peptides.

The AB peptides form oligomers and fibrils with beta-pleated sheet structures.

These fibrils become deposited in insoluble plaques outside neurons (extracellular).

Question 10

Amyloid plaque arguments for and against

Answer 10

Genes involved in early onset Alzheimer’s include genes involved in generation metabolism and movement of amyloid

These genes are the genes for amyloid precursor protein, presenilin 1, presenilin 2 and ApoE genes

However amount of plaque doesn’t correlate with severity of impairment

Question 11

Neurofibrillary tangles

Answer 11

Tau is a protein involved in the formation of microtubules.

Microtubules are important in neurone shape, development, transport of molecules within the cell and communication between neurones.

When tau is hyperphosphorylated, it forms oligomers.

The oligomers aggregate into filamentous neurofibrillary tangles (NFTs) inside the neurones (intracellular).

NFTs disrupt the microtubular system, resulting in impaired neurone growth, transport and communication between neurones.

Question 12

Where are NFTs deposited

Answer 12

• Hippocampus
• Medial temporal lobe
• Frontal cortices (covers frontal lobe)
• Lateral parietotemporal region

Question 13

Acetylcholine deficiency

Answer 13

There is particular loss of neurones in the nucleus basalis of Meynert.

These neurones are particularly rich in acetylcholine, which they supply the hippocampus, amygdala and neocortex with.

Therefore neuronal death in this region leads to acetylcholine deficit in these areas.

Acetylcholine is involved in memory

Acetylcholinesterase inhibitors such as donezapil prescribed

Question 14

Serotonin deficiency

Answer 14

Death of neurones in the brainstem’s median raphe results in a decrease in serotonin levels.

Question 15

Noradrenaline deficiency

Answer 15

Death of neurones in the locus coeruleus results in a decrease in noradrenaline levels.

Sertotonin and noradrenaline deficiencies contribute to the mood and sleep effects of Alzheimer’s.

Question 16

Synaptic deterioration

Answer 16

Synapses lost so fewer connections

Question 17

Cerebro cortical atrophy

Answer 17

Shrinkage of brain associated with loss of neurons in the nucleus of basalis of meynert which also decreases ach

Question 18

Limbic system

Answer 18

First area affected
Regulates emotion behavior and memory
Posterior cingulate cortex,hippocampus and anterior thalamus affected

Question 19

Posterior cingulate cortex

Answer 19

Involved in orientation awareness of time and space

Question 20

Hypothalamus

Answer 20

Involved in short term memory

Question 21

Anterior thalamus

Answer 21

Involved in attention

Question 22

MDT

Answer 22

Physiotherapist

• Social workersIdentify practical needs, and what kind of additional social care services Mrs Wilkins might need. Eg: if she progresses and needs carers
• Community mental health nursesVisit the home and provide advice on to the patient and carers on optimizing health and quality of life.
• District nursesHelp with dressings, medications, etc.
• Optometrists and AudiologistsOptimize sensory input to minimize confusion and isolation.
• Speech and language therapists
• DieticiansAssess dietary intake.Provide advice on poor appetite, what sort of diet a patient can follow and what sort of food a patient can prepare themselves.
• Continence nursesAid with any continence issues (ability to control bladder and bowel).
• Volunteers

Question 23

Mental capacity act

Answer 23

Does the person have an impairment
Does the impairment mean the person can’t make a specific decision
If yes then team decides if no then patient decides

Question 24

Mental health act

Answer 24

If decision is concerned with disorder of the mind itself then patients can be treated without agreement if at risk of harm to themselves

Question 25

Mild cognitive impairment

Answer 25

Cognitive decline beyond expected for age and education without interfering with normal function
Of memory loss occurs known as amnestic MCI

Question 26

MCI vs dementia

Answer 26

MCI:associated with normality of ageing,no underlying pathophysiology,doesn’t interfere with normal activity,no treatment
Dementia:not normal,chronic from pathophysiologies,interferes with daily life,many drug treatments such as cholinesterase inhibitors

Question 27

When is referral made

Answer 27

0-7 is normal
8-9 mild cognitive impairment
10-28 severe cognitive impairment

Question 28

Similarities between MCI and dementia

Answer 28

Don’t impact consciousness
Impact cognitive inability

Question 29

Types of loss

Answer 29

Amnesia is short term memory loss
Anomia is the inability to name objects
Apraxia is the loss of dexterity
Agnosia is the inability to recognize things
Aphasia is the inability to talk