Dementia Flashcards
most common cause of dementia?
Alzheimers
differences in aetiology between early onset and late onset dementia?
vascular dementia more common in early onset than late, AD still most common in both
most useful tool for diagnosis?
History taking
Focuses on memory, language, executive skills, neglect phenomena, personality and social conduct, sexual behaviour, mood, eating etc.
chronology of each
clinical course of dementia?
gradual decline over years (more exaggerated than natural decline with old age) with pre-clinical, mild cognitive impairment and dementia phases.
possible definition of dementia?
severe loss of memory and other cognitive abilities which leads to impaired daily function
what is examined in dementia patients?
Neurological /mental state
what is an MMSE?
mini mental state examination
involves recall, attention, language, calculation and orientation assessment
What might MMSS be supplemented with
ACE III (Addenbrooke’s Cognitive Examination) → longer and more memory focused
what blood tests might be relevant?
FBC, inflammatory markers, thyroid/renal function, glucose, B12 and folate, clotting factors
also syphilis, HIV, ceruloplasmin (copper transport)
18F florbetapir PET scans → usefulness?
higher scan presence indicates more beta-amyloid (associated with AD pathology)
main causes of dementia
alzheimer’s (subtle,insidious amnestic/non amnestic presentation)
vascular (relates to cerebro vascular disease with multiple infarcts and gets worse progressively)
Lewy body (cognitive impairment within 1 year of parkinsonian symptoms,visual hallucinations and fluctuating cognition)
frontotemporal (behavior variant FTD,semantic dementia,non fluent aphasia)
depression
delirium
signs of dementia with Lewy bodies?
cognitive impairment before/within a year of Parkinsonian symptoms, visual hallucination, fluctuating cognition
signs of FTD?
behavioural variance, semantic dementia, progressive non-fluent aphasia (productive
what is head turning sign?
look at whoever’s accompanying you for support when asked a question
two factors involved in the pathophysiology of AD?
beta-amyloid and tau
which becomes abnormal first?
amyloid then tau (then brain structure then cognition)
AD CSF levels of beta amyloid (1-42)?
lower since it is deposited pathologically in the brain
What about tau
Higher
how does Lewy body dementia differ in presentation
REM sleep disorder → often visual hallucinations and Parkinson’s symptoms, not necessarily memory issues (less hippocampal degeneration)
high risk of falls
how about FTD?
language issues more common, behavioural changes, memory problems still possible
Neuropsychology
Profound impairment of episodic memory in relation to newly learned material
Episodic memory
Memory for particular episodes in life
Depends on medial temporal lobe including hippocampus
what may you see in mri of alzheimers
hippocampal degeneration
what is seen in mri of ftd
atrophy of frontal lobe
does the hippocampus degenerate in lewy body dementia
less severely
Reversible causes of dementia
Depression
Alcohol related brain damage
Endocrine (cushings,hypothyroidism,addisons)
B1/6/12 deficiency
Benign tumours
Normal pressure hydrocephalus
Infections such as hiv syphilis whipples disease
Limbic encephalitis
Inflammatory eg vasculitlis ms sarcoidosis
Rare causes
Progesrrice supranuclear palsy
Mupltipe system atrophy
Corticobasal degeneration
Huntingtons disease
Creytzfeltd Jacob disease
Subacute sclelrising pancephalitis
Leucodystrophies
Neuronal ceroid lipofuscinossi
CADASIL
Mitochondrial encephalopathy
Issues present in Alzheimer’s
Neuronal tau
Ab
TDP-43
a synuclein
Vessel wall pathology
Parenchymal ischaemic changes
What is episodic memory dependant on
Medial temporal lobes including hippocampus
How is a Lewy body formed
a synculcein monomer joins together to form a a synuclein oligmler then an a synuclein fibril then Lewy body via neurofilaments ubiquitin and ab crystallin
Difference in prevalence of causes of dementia in YOD LOD
YOD tend to have more prevalent familial autosomal dominant Alzheimer’s
