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Year 2 C&M symposia > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia?

A

Chronic progressive disorder of mental processes due to brain injury/disease.

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2
Q

Does the area of the brain affected have an effect on the presentation?

A

Yes.

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3
Q

How do frontal lobe (anterior) problems normally present?

A

Behavioural changes.

  • impaired judgement, abstract reasoning, incontinence
  • e.g. hydrocephalus
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4
Q

How do problems with the medial temporal lobe/hippocampus/amygdala/limbic system normally present?

A

Memory disorder and hallucinations.

-e.g. Alzheimer’s

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5
Q

How do temporal neocortex problems normally present?

A

Receptive dyshphasia and automatisms.

-e.g. Alzheimer’s

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6
Q

How do occipital lobe problems normally present?

A

Failure of visual sensory systems.

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7
Q

How do parietal lobe problems normally present?

A
  • Visuospatial impairment

- Decreased integration of sensory inputs (agnosia, apraxia)

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8
Q

Give some examples of neurodegenerative dementias. (4)

A
  • Alzheimer’s
  • Lewy body dementia
  • Frontotemporal
  • Huntington’s
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9
Q

What is Lewy Body dementia?

A

Deposition of proteins (Lewy bodies) in brain cells in the brainstem/cortex.

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10
Q

What is Hungtington’s?

A

Movement disorder in which nerve cells degenerate/waste away.
-More frontal

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11
Q

What is vascular dementia?

A

Dementia cause by a lack of blood supply to the brain.

-e.g. due to small strokes

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12
Q

What effect does treatment have on vascular dementia?

A

Treatment may reduce the progression of vascular dementia, but not cure it.

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13
Q

What is another name for Prion diseases?

A

Transmissible spongiform encephalopathies.

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14
Q

What are Prion diseases?

A

Collection of neurodegenerative diseases where pathogens&raquo_space; abnormal folding of proteins.
-often accompanied by triphasic EEG waves

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15
Q

Give an example of a Prion disease.

A

Creutzfeldt-Jakob Disease (CJD).

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16
Q

Are Prion diseases treatable?

A

No, and they have rapid progression.

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17
Q

What type of neurodegenerative disease is smoking thought to prevent?

A

Parkinson’s.

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18
Q

How do subcortical dementias normally present?

A

Apathetic, forgetful, movement disorders.

-e.g. Parkinson’s

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19
Q

How do cortical dementias normally present?

A

Higher cortical abnormalities.

  • dysphasia, agnosia, aparaxia
  • e.g. Alzheimer’s
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20
Q

How can neurodegenerative diseases functionally clasified? (2)

A
  • Dementias (e.g. Alzheimer’s)

- Movement disorders (e.g. Parkinson’s)

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21
Q

How are neurodegenerative diseases classified based on molecular-genetics? (3)

A
  • Tauopathies
  • Synucleinopathies
  • Ubiquinopathies
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22
Q

What is normal pressure hydrocephalus?

A

Abnormal build up of CSF in the brain’s ventricles/cavities.

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23
Q

What is the triad of problems that accompanies normal pressure hydrocephalus?

A
  • Dementia
  • Gait disturbance
  • Urinary incontinence
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24
Q

What are the 2 types of normal pressure hydrocephalus?

A
  • Idiopathic

- Secondary

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25
Q

What are possible causes of normal pressure hydrocephalus?

A
  • Subarachnoid haemorrhage

- Infection (e.g. meningitis)

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26
Q

What is ‘pulvinar sign’ a sign of?

A

Variant Creutzfeldt-Jakob Disease (vCJD).

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27
Q

What is VGKC Ab LE?

A

Limbic encephalitis due to voltage-gated potassium channel antibody.

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28
Q

What are possible symptoms of VGKC Ab LE ?

A
  • Subacute memory loss
  • Psychiatric disturbance
  • Seizures
  • Hyponatraemia
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29
Q

What may be present in the serum/CSF with GKC Ab LE?

A
  • LGI1 subunit

- CASPR2

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30
Q

Who was Auguste Deter?

A

The first person to be diagnosed with dementia.

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31
Q

Who was Alois Alzheimer?

A

Doctor who diagnosed Auguste Deter with dementia.

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32
Q

What are possible side effects of using anti-psychotics to treat dementia?

A

Increased risk of stroke and death.

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33
Q

How many stages of dementia are there to measure the level of independence?

A

4 stages.

34
Q

What are the symptoms of stage 1 of dementia, and what are the healthcare focuses?

A

Changes in memory/personality/visuo-spatial abilities.

-rehabilitation and self-help

35
Q

What are the symptoms of stage 2 of dementia, and what are the healthcare focuses?

A

Aphasia, apraxia, confusion, insomnia.

-Social care intervention, mental and physical services

36
Q

What are the symptoms of stage 3 of dementia, and what are the healthcare focuses?

A

Resistiveness, incontinence, motor impairment.

-Same as stage 2 (social care intervention) & start advance planning

37
Q

What are the symptoms of stage 4 of dementia, and what are the healthcare focuses?

A

Bedfast, mute, dysphasia.

-Advance planning, 1* and 2* care

38
Q

How frequent is incapacity in acutely ill medical in-patients?

A

40%.

39
Q

What proportion of patients with incapacity are cognitively impaired/unconscious?

A

25%.

40
Q

What is the limbic system?

A

Network of nerves near the cortex.

41
Q

What does the limbic system control?

A

Arousal, emotion, motivation, attention and memory.

42
Q

Where is most new information stored?

A

Hippocampus.

43
Q

What are the main functions of the hippocampus?

A
  • Stores new information.

- Centre of emotion, memory and autonomic NS (» integrate into the environment)

44
Q

What is cognition?

A

The process of acquiring knowledge and understanding from thought and experience.

45
Q

Give the basic process of a brain microcircuit.

A

Neuron&raquo_space; synapse&raquo_space; neurotransmitter&raquo_space; action potential.

46
Q

What are 4 different ways to classify neurodegenerative disorders?

A
  • FUNCTIONAL (cognition/movement)
  • ANATOMICAL (e.g. coritcobasal dementia)
  • ETIOLOGICAL (e.g. vascular)
  • PROTEINOPATHY (e.g. taupathy)
47
Q

Give an example of a dementia caused by temporal, parietal and frontal degeneration.

A

Alzheimer’s.

48
Q

Give an example of a dementia caused by multifocal degeneration.

A

Corticobasal degeneration.

49
Q

Give an example of a dementia that affects cognition and movement.

A

Dementia with Lewy Body.

50
Q

What are the 4 main proteins involved with dementia?

A
  • B-amyloid
  • Tau
  • Alpha-synuclein
  • Ubiquitin
51
Q

How does B-amyloid cause dementia?

A

Mutated protein&raquo_space; inappropriate folding and insoluble fibres.
» accumulation of fibrils
»amyloidosis & neurodegeneration

52
Q

What is the function of Tau normally?

A

Proteins that stabilise microtubules in neurons.

53
Q

How does a defect in Tau lead to dementia?

A

Defect&raquo_space; unstable, dysfunctioning microtubules.

-intracellular

54
Q

How does a-synuclein cause dementia?

A

Can globulise&raquo_space; intereferes with the function of mitochondria & ER.
-intracellular

55
Q

What disorders is a-synuclein present in?

A

Parkinsons and dementia.

56
Q

What is the function of Ubiquitin normally?

A

Protein in eukaryotic cells that directs proteins to compartments in the cell.
-e.g.&raquo_space; proteosomes to be broken down

57
Q

How can Ubiquitin cause dementia?

A

Mutation can damage cell and cause death.

58
Q

What are possible pathogenesis of dementia? (7)

A
  • Oxidative stress
  • Excitotoxicity
  • Apoptosis
  • Cytokines
  • Genetic factors
  • Aging
  • Accumulation of abnormal proteins
59
Q

How can oxidative stress cause dementia?

A

Leads to production of free radicals.

60
Q

How can excitotoxicity cause dementia?

A

Glutamine stimulation.

61
Q

How can cytokines cause dementia?

A

Cause an inflammatory response (?)

62
Q

How can ageing cause dementia?

A

Decline in the efficiency of metabolic pathways.

63
Q

What are the 2 locations that abnormal proteins accumulate?

A
  • Intracellular

- Extracellular

64
Q

Which proteins accumulate intracellularly? (4)

A
  • Tau
  • a-Synuclein
  • Polyglutamine
  • Ubiquitin
65
Q

Which protein accumulates extracellularly?

A

Amyloid (Azheimer’s).

66
Q

What are the macroscopic findings with dementia? (6)

A
  • Decreased brain weight
  • Atrophy in cerebral gyri
  • Atrophy in white matter (corpus callosum)
  • Ventricular dilation
  • Atrophy in brainstem and cerebellum
  • Pale substantia nigra and locus ceruleus
67
Q

What are the microscopical findings with dementia? (5)

A
  • Neuron loss (hippocampus, cerebral cortex)
  • Microvacuolation in cerebral neocortex
  • Attenuation in white matter
  • Wide perivascular spaces
  • Accumulation of abnormal proteins
68
Q

What sort of structures does amyloid form?

A

Plaques.

69
Q

What sort of structures does Tau form?

A

Neurofibrillary tangles.

70
Q

What sort of structures does a-Synuclein form?

A

Lewy bodies.

71
Q

What sort of structures does ubiquitin form?

A

Pick’s bodies.

72
Q

What neurological problems does hippocampal atrophy cause?

A
  • Difficulty learning new skills/facts

- Start to forget old skills

73
Q

What conditions are Braak and Braak stages used for? (2)

A
  • Parkinsons

- Alzheimer’s

74
Q

What are the macroscopic findings in Lewy Body dementia? (2)

A
  • Pale substantia nigra

- Atrophy (amygdala, cingulate gyrus, T/F/P lobes)

75
Q

What are the microscopic findings in Lewy Body dementia? (2)

A
  • Neuronal loss (substantia nigra)

- Accumulation of a-Synuclein in neurons

76
Q

What are the macroscopic findings in Alzheimer’s? (3)

A
  • Decreased brain weight
  • Atrophy of gyri and widening of sulci
  • Ventricular dilation
77
Q

What are the microscopic findings in Alzheimer’s? (3)

A
  • Neuronal loss
  • Neuropil thread
  • Neuritic plaques
78
Q

What is a normal brain weight?

A

1200-1400.

79
Q

What is the brain weight in people with Alzheimer’s?

A

900-1200.

80
Q

Name 3 forms of vascular dementia.

A
  • Multi-infarct dementia
  • Binswanger’s disease
  • Arteriolosclerosis
81
Q

What is Binswanger’s disease?

A

A form of small vessel vascular dementia caused by damage to white brain matter.

Year 2 C&M symposia (11 decks)

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