Dementia 2

Question 1

What do NMDA-antagonists (memantine) do in dementia? When is it most effective?

Answer 1

In early dementia cells often secrete large amounts of glutamate which activates a NMDA receptor. The excess of glutamate overstimulates the receptor, causing connections between nerve cells to be broken/neurons to die.

NMDA antagonists inhibit this process, however, the effect of the drug is limited

Question 2

What are neurological symptoms that stem from vascular disease?

Answer 2

Mental and psychomotor slowing (or losing balance/difficulty walking), executive dysfunction, complex attention and social cognition (personality change?)

Question 3

How does the clinical image of vascular disease differ from Alzheimer’s?

Answer 3

Mental and psychomotor slowing isn’t a prominent symptom in ad (it might be later on) and there is a relatively intact memory and language skills (which they are not in ad)

Question 4

What are 1/4th of the stroke patients diagnosed with after 3-12 months?

Answer 4

dementia/major neurocognitive disorder

Question 5

What is commonly seen in patients with dementia over >75 vs. younger patients?

Answer 5

Older patients usually portray a mixed etiology, so no “pure” alzheimer’s

Question 6

What is small vessel disease?

Answer 6

Umbrella term covering a variety of problems related to the small vessels in the brain

Question 7

What are the major risks of vascular dementia?

Answer 7

Age, history of cardial problems, strokes and vascular dmg (which can happen through a multitude of ways)

Question 8

There are two ways in which vascular dementia can start, which are these?

Answer 8

Suddenly (strategic or multiple minor strokes) or slowly over time (small vessel disease)

Question 9

Alzheimer’s and vascular dementia have a decently different clinical picture, why is it then that sometimes this isn’t actually true?

Answer 9

Similar characteristics as ad can develop after strokes or further progression of small vessel disease

Question 10

What are “general” possible NCDs in frontotemporal neurocognitive disorder (FTD)

Answer 10

Language, social cognition, complex attention and executive function

Question 11

There are two variants of FTD, which are these and how do they differ?

Answer 11

1. Behavioural variant (progressive disturbances in personality, behaviour and emotion)
2. Language variant (gradual impairment of the language which are initial and the most disabling feature)

Question 12

What are some typical abnormal neurobiological patterns observed in the brain with FTD?

Answer 12

Atrophy patterns/signs of hypoperfusion and/or hypometabolism in medial frontal lobes and/or temporal lobes

Question 13

When is FTD usually diagnosed?

Answer 13

before the age of 65

Question 14

What are the main symptoms of behavioural FTD (more specific)

Answer 14

Disinhibition, impulsivity, inertia (do nothing), apathy, loss of empathy/sympathy and preservative, stereotyped behaviour or compulsive/ritualistic behaviour

Question 15

Which three types of language primary progressive aphasia (PPA) are there?

Answer 15

Semantic PPA (loss of word meaning), logopenic PPA (word finding, slow talk) and nonfluent-agrammatic PPA (difficulty in movement of lips and tongue)

Question 16

What is semantic dementia (semantic PPA)?

Answer 16

Deficit in naming low frequency words and later on high frequency words

Impaired (single) word comprehension

Grammar remains intact

Question 17

The slides mention three types of paraphasia’s, which and what are they? What are these common in?

Answer 17

Semantic paraphasia; The intended word is substituted for another (aka orange instead of apple)- the meaning is similar

Neologism; non-real words instead of real ones

phonemic paraphasia; sound distortion, but original word can still be heard (that instead of hat or tephelone instead of telephone)

Question 18

Substance abuse and malnutrition are commonly seen together, which NCDs can these cause?

Answer 18

Wernicke’s (alcohol + thiamine deficiency aka vitamin b1)

Korsakoff (same)

Question 19

What symptoms are associated with Wernicke?

Answer 19

Double vision and cerebellar disturbances (motor coordination)

Question 20

What symptoms are associated with Korsakoff?

Answer 20

Deficits in learning new information, memory retrieval deficits, executive problems and personal changes, confabulation/lack of insight

Question 21

Are NCD due to substance abuse reversible?

Answer 21

Cognitive deterioration can sometimes be stopped/partially reversible when substance is stopped/vitamin deficiency is solved

Question 22

When and how are neuropsychological assessments useful?

Answer 22

Especially in the early stages, but also to keep an eye on progression of deterioration