Dementia

Question 1

most common cause of dementia?

Answer 1

Alzheimers

Question 2

differences in aetiology between early onset and late onset dementia?

Answer 2

vascular dementia more common in early onset than late, AD still most common in both

Question 3

most useful tool for diagnosis?

Answer 3

History taking
Focuses on memory, language, executive skills, neglect phenomena, personality and social conduct, sexual behaviour, mood, eating etc.

chronology of each

Question 4

clinical course of dementia?

Answer 4

gradual decline over years (more exaggerated than natural decline with old age) with pre-clinical, mild cognitive impairment and dementia phases.

Question 5

possible definition of dementia?

Answer 5

severe loss of memory and other cognitive abilities which leads to impaired daily function

Question 6

what is examined in dementia patients?

Answer 6

Neurological /mental state

Question 7

what is an MMSE?

Answer 7

mini mental state examination

involves recall, attention, language, calculation and orientation assessment

Question 8

What might MMSS be supplemented with

Answer 8

ACE III (Addenbrooke’s Cognitive Examination) → longer and more memory focused

Question 9

what blood tests might be relevant?

Answer 9

FBC, inflammatory markers, thyroid/renal function, glucose, B12 and folate, clotting factors

also syphilis, HIV, ceruloplasmin (copper transport)

Question 10

18F florbetapir PET scans → usefulness?

Answer 10

higher scan presence indicates more beta-amyloid (associated with AD pathology)

Question 11

main causes of dementia

Answer 11

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)

Question 12

signs of dementia with Lewy bodies?

Answer 12

cognitive impairment before/within a year of Parkinsonian symptoms, visual hallucination, fluctuating cognition

Question 13

signs of FTD?

Answer 13

behavioural variance, semantic dementia, progressive non-fluent aphasia (productive

Question 14

what is episodic memory

Answer 14

memory for episodes in life

dependent on medial temporal lobes

Question 15

what is head turning sign?

Answer 15

look at whoever’s accompanying you for support when asked a question

Question 16

two factors involved in the pathophysiology of AD?

Answer 16

beta-amyloid and tau

Question 17

which becomes abnormal first?

Answer 17

amyloid then tau (then brain structure then cognition)

Question 18

AD CSF levels of beta amyloid (1-42)?

Answer 18

lower since it is deposited pathologically in the brain

Question 19

What about tau

Answer 19

Higher

Question 20

how does Lewy body dementia differ in presentation

Answer 20

REM sleep disorder → often visual hallucinations and Parkinson’s symptoms, not necessarily memory issues (less hippocampal degeneration)

Question 21

how about FTD?

Answer 21

language issues more common, behavioural changes, memory problems still possible

Question 22

Neuropsychology

Answer 22

Profound impairment of episodic memory in relation to newly learned material

Question 23

Episodic memory

Answer 23

Memory for particular episodes in life
Depends on medial temporal lobe including hippocampus