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NEUROLOGY > Dementia 2.0 > Flashcards

Dementia 2.0 Flashcards

1
Q

When is diagnosed with Dementia?

A
  • evidence of cognitive decline (in at least 1 cognitive domain)
  • deficits INTERFERE with independence in everyday activities
  • no ddx(esp. delirium)
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2
Q

How is the course of Dementia?

A
  • progressive and worse with time

- a/w neurodegeneration

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3
Q

Name acute cognitive disorders of the brain. (3)

A
  • viral encephalitis
  • head injury
  • stroke
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4
Q

How does viral encephalitis bring about cognitive impairment?

A

-fronto-temporal problems

>memory, behavioural changes, language

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5
Q

DIstinguish Antegrade from Retrograde amnesia

A
  • Antegrade: inability to make new memories

- retrograde: the inability to recall old memories

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6
Q

In which condition may both these amnesia present together?

A

Transient Global Amnesia

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7
Q

What may trigger transient global amnesia and who is it often seen in?

A
  • seen in >50 y.o

- triggers: emotions and changes in temperatures

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8
Q

Which anatomical site in the brain is said to be closely linked to TGA?

A
  • the hippocampus
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9
Q

How often may TGA occur and how long does an episode take?

A
  • this is a transient condition lasting 4-6hrs (always <24hrs)
  • only 6% recurs
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10
Q

How is TGA different from Transient Epileptic Amnesia?

A
  • more short lived (lasts 20-30 mins)
  • a/w temporal lobe seizures (30% not witnessed)
  • response to ANTI-EPILEPTIC medication
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11
Q

What metabolic factors cause sub-acute cognitive d.o?

A
  • B12, calcium levels

- thyroid factors

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12
Q

Inflammatory cause of sub-acute cognitive d.o?

A

-limbic encephalitis

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13
Q

What is Subjective Cognitive Impairment?

How does subjective cognitive impairment present as?

A

Pt complains of worsening of thinking abilities, but standard test can’t proove decline….

  • everyday forgetfulness
  • reduced concentration/ attention/ reaction time and memory d.o
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14
Q

What causes Creuztfeldt-Jakob Disease? (CJD)

A

-causes by highly infective prion protein, which ACCUMULATES at high levels in the brain
>irreversible nerve damage —RARE CONDITION

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15
Q

What is the most common type of CJD and how does it come about?

A
  • the SPORADIC type
  • occurs in the 60s
  • said to be caused by the “misfolding” of a normal brain protein forming a prion
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16
Q

Which CJD arises from eating beef?

A
  • variant CJD d.t contamination by BSE
  • seen in 20s
  • —<1% of cases
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17
Q

How may Iatrogenic CJD occur?

A
  • by poor sterility of surgical instruments used between brain surgeries
  • (Past); CJD arose from the use of human pituitary GH from deceased individuals. infected with GJD
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18
Q

Which CJD presents with cerebellar dysfxn or visual onset of symptoms?

What is this CJD type’s age of onset?

A
  • iatrogenic

- 30s

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19
Q

Which CJD causes painful SENSORY disturbance?

How long does this CJD last?

A

Variant

14months

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20
Q

Which CJD type causes RAPID onset of dementia, myoclonus, neuro deficits?

How long does this CJD type last?

A

Sporadic

4 months

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21
Q

What are the other symptoms of Prion disease?

A
  • difficulty in gait
  • hallucinations
  • muscle stiffness
  • confusion and Fatigue
  • hard to speak
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22
Q

Major cause of dementia in the UK

A

AD

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23
Q

What are the initial symptoms of AD and why?

A

FORGETFULNESS

-d/t the degeneration of the MEDIAL hippocampus and lateral parietal lobes ->APRAXIA and visuospatial difficulties

24
Q

What causes the neurodegeneration in AD?

A

d/t to the accumulation of the A-Beta amyloid proteins in the form of extracellular amyloid plaques -> APOPTOSIS

  • formation of the neurofibrillary tangles
  • also said to cause synaptic loss
25
What occurs with posterior cortical atrophy ?
-visuospatial disturbance
26
What forms of PRIMARY PROGRESSIVE aphasia is seen in AD?
- SEMANTIC - Staccato speech (effortful) - Logopenic Aphasia
27
What ivx may prove the presence of AD?
- MRI: focal atrophy of TEMPORAL and PARIETAL lobes - SPECT: reduced metabolism at the temporoparietal region - CSF: reduced amyloid and increase in TAU
28
What rx for AD?
- MEMANTINE (NMDA-r blocker); gold standard | - ACh boosting rx > Cholinesterase inhibitors (rivastigmine/ galantamine)
29
Who is usually seen to have FTD?
-MOST <65Y.O; Early onset dementia
30
What pathogenic proteins are involved in the pathogenesis of FTD?
tau protein TDP-43 Ubiquitin ----aggregation of these proteins cause cell damage -> NEURODEGEN.
31
What are the 3 variants of FTD?
1. Behavioural Variant (most common) 2. Semantic Dementia 3. Progressive Non-fluent aphasia
32
What are some frontal features seen in FTD?
- DISINHIBITION - apathy - loss of empathy - hyperorality - compulsive behaviours
33
What is found with IVX of FTD?
- MRI- atrophy of FT lobes - SPECT - reduced FT metabolism - csf: NORMAL amyloid; incr. TAU
34
How to treat FT dementia?
- with antipsychotics - safety management of finances, food and internet - Power of attorney
35
Give 2 examples of Late-Onset dementia.
1. Lewy body dementia | 2. Vascular dementia
36
How does Vascular dementia occur and how does it present as?
-d/t subcortical SMALL VESSEL DISEASE...co-existent amyloid pathology >reduced attention, executive dysfxn, slow processing
37
What pathways are disrupted in Lewy Body Dementia?
cholinergic and dopaminergic d/t cell damage by alpha-synuclein aggregates in cells
38
What forms the CORE criteria of Lewy body dementia?
1. fluctuating cognition 2. recurrent well-formed VISUAL hallucinations +/- extrapryamidal fts.
39
What are the physical symptoms of extrapyramidal fts?
- slurred speech, paranoia, anxiety - dystonia, AKATHISIA, BRADYKINESIA, TARDIVE DYSKINESIA - tremor
40
What ivx could be done for LBD?
- DaT imaging | - alpha-synuclein ligand imaging
41
What rx for LBD?
- small dose LEVODOPA to reduce ACh | - trial cholinesterase inhibitors
42
How is Parkinson's D. DEMENTIA different from Lewy Body Dementia?
If Body or Brain came first! - PDD: cogntive decline occurs >1 YEAR of motor symptoms - LBD: cognitive may occur in <1 year of Motor presentation (or they occur TOGETHER/ cognitive decline comes first) ---though both dementias are pathologically and clinically similar
43
What additional symptoms are seen in Huntington's Disease?
- in addition to dementia: - ---chorea with LATER psychosis - changes in mood and personality (APATHY) - SLURRED speech
44
What IVX for Huntington's disease?
- genetic testing (>35 repeats of CAG repeats) | - MRI (loss of caudate heads)
45
What rx could be given?
mood stabilizers chorea rx HD nurse specialist
46
Why check for Vit B12 and Calcium levels for dementia screening?
- Vit B12 def. predisposes one to DEMENTIA | - Hypercalcemia is said to cause memory loss, irritability and depression
47
Name the disorders of cognitions that kicks in with AD.
1. Posterior Cortical Atrophy | 2. Progressive primary aphsia
48
What is in the core criteria to make the dx of Vascular Dementia?
1. Presence of Cerebrovascular disease | 2. Clear temporal relationship between ONSET of dementia and cerebrovascular dementia
49
How does vascular dementia present as >
- reduced attention - reduced executive dysfxn - slowed processing
50
Is post-stroke dementia a thing?
YES | - 25% develop Vascular dementia usually in less than 3 months of the stroke
51
How to manage VaD?
- vascular risk factors +/- Cholinesterase inhibitor | 2. Community Psyciatry Nurse
52
What are the fts of FTD?
- early FRONTAL fts (apathy/ loss of empathy/ disinhibition/ hyperorality) - early loss of insight
53
How is FTD managed?
- Safety management= controlled access of FOOD/ MONEY/ INTERNET - Power of Attorney - MND nurse specialist if co-existent MND
54
How is FTD treated?
- trial of TRAZADONE/ anti-psychotics to help behavioural fts
55
What support could be given to a LB pt?
PD nurse specialist
56
Name 2 early onset dementia.
1. FTD | 2. Huntington's Dementia
57
What is involved in the dementia screen and when is it performed?
- B12 - TFTS - syphilis - HIV - Ca2+ - --screen is done when pt is YOUNG or there is family hx

NEUROLOGY (36 decks)

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