Dementia 2

Question 1

AD Risk factors

Answer 1

increasing age, females, family history of dementia, low education, low income, low occupational status, depression, head injury, low folate/B12, high homocysteine, presence of apolipoprotein E4 allele, postop delirium, alcohol abuse

Question 2

Early symptoms of AD

Answer 2

cognitive symptoms: trouble keeping appointments, difficulty finding words, misplacing objects
functional symptoms: diff driving, diff selecting clothes, missing appointments, problems at work
Behavioral symptoms: subtle changes in personality, social withdrawal, depression

Question 3

patients with depression vs. dementia

Answer 3

patients with depression demonstrate less motivation during cognitive testing. express cognitive complaints that exceed measured deficits. maintain language and motor skills.

Question 4

when do you image brain?

Answer 4

focal findings on exam. rapid onset/decline. falls/head trauma.

Question 5

treatment for frontotemporal dementia

Answer 5

no role for cholinesterase inhibitors. careful use of atypical antipsychotics. divalproex for behavioral control. SSRIs for irritability, depression, impulsive behaviors.

Question 6

pharmacotherapy for alzheimer’s disease

Answer 6

cholinergic therapy, NMDA receptor antagonists, investigational agents, treatment of neuropsychiatric symptoms

Question 7

why do anticholinesterases work?

Answer 7

degeneration of basal nucleus of Meynert results in acetylcholine deficiency. this contributes to memory deficits. anticholinesterases block degradation of acetylcholine.

Question 8

4 acetylcholinesterase inhibitors

Answer 8

Tacrine (obsolete), donepezil (approved for all stages of AD), rivastigmine, galantamine

Question 9

memantine

Answer 9

targets excitotoxicity, which may cause neuronal damage. glutamate NMDA receptor blocker.

Question 10

first approach if someone has neuropsychiatric disturbances in AD

Answer 10

find the trigger for disturbances and avoid them. if that doesnt work, antipsychotics, antidepressants, anxiolytics.

Question 11

vascular dementia

Answer 11

multi-infarct dementia. cerebral amyloid angiopathy. hypertension related small vessel disease. stepwise progression. usually seen with cardiovasc risk factors

Question 12

hypertensive small vessel disease and progressive cognitive impairment

Answer 12

arteriosclerosis of small arteris supplying deep grey and white matter. lacunar infacts. subcortical leukoencephalopathy. Subcortical dementia: cognitive slowing, impaired problem solving, visuospatial abnormalities, disturbances of mood and affect

Question 13

what does hypertension particularly affect?

Answer 13

small vessels such as the lenticulostriate. these supply deep structures such as the basal ganglia and internal capsule

Question 14

treating vascular dementia

Answer 14

focus on controlling cardio risk factors. max blood pressure control, statins, stop smoking, control blood sugar, mental and physical exercise, diet. treat with cholinesterase inhibitors

Question 15

lewy body dementia

Answer 15

intracellular, fibriller deposits of a presynaptic terminal protein called alpha synuclein. sporadic disorders. parkinson’s and dementia with lewy bodies are most common

Question 16

parkinson’s disease

Answer 16

sporadic. resting tremor, difficulty initiating movement, slowed movement, rigidity, shuffling gait, postural instability. dopaminergic deficit. responsive to L-Dopa treatment. pallow of the substantia nigra. degeneration and loss of pigmented dopaminergic neurons of substantia nigra. often contain lewy bodies.

Question 17

pathogenesis of Parkinsons

Answer 17

mutations in alpha synuclein gene. lewy bodies are composed of fibriller aggregates of alpha synuclein. pesticide exposure may be risk factor. oxidative stress, impaired axonal transport, inhibition of oxidative phosphorylation implicated in pathogenesis

Question 18

dementia with lewy bodies

Answer 18

sporadic, late onset. memory less frequently effected compared to AD. frontal and subcortical features (attention deficit and alertness) common. pronounced fluctuations and variations in symptoms. vivid hallucinations, delusions. sleep disorders common. acting out dreams

Question 19

neuropathology of lewy body dementia

Answer 19

nigral pallor. significant atrophy of limbic areas. cortical type lewie bodies in frontal, temporal, and insular cortex, and in limbic areas. nigral lewy bodies. lewy neurites. Usually plaques and tangles.

Question 20

lewy body dementia treatment

Answer 20

cholinesterase inhibitors may provide symptomatic support. trial of carbidopa/levodopa for movement symptoms. AVOID antipsychotics, as they make parkinson symptoms a lot worse. clonazepam for sleep disorders

Question 21

what are first areas to show lewy bodies in LBD

Answer 21

amygdala and cingulate gyrus

Question 22

LBD vs Parkinson dementia

Answer 22

LBD: onset of dementia within 12 months of parkinsonism. movement disorder usually second.

parkinson dementia: onset of dementia more than 12 months after diagnosis of parkinsons. movement disorder usually first