dementia Flashcards
what are the main risk factors
age and family history
what cognitive tests can you do
MMSE, ACE (Addenbrookes Cognitive Examination)
what does clock drawing test
parietal lobe
what reflexes should you check
primitive reflexes- grasp, pout
how can you test praxis
copying hand gestures, miming
investigations
FBC, ESR, B12, TFT, LFT, U&E, glucose. CT
what further investigations should be done in a younger patient
EEG, genetic testing HIV serology, metabolic tests, brain biopsy
what is the main cause of dementia
alzheimers
features of alzheimers
memory impairment, language impaired, apraxia- cant carry out skilled motor activities, agnosia, frontal executive function (organising, planning), anosognosia, visuospatial
what lobe is associated with visuospatial
parietal
what is anosognosia
lack of insight
what is agnosia
cant recognise objects, people
what are late non cognitive features AD
myoclonus, seizures, sleep wake cycle reversal, incontinence
what happens to personality in AD
stays relatively intact until late
what is the pathology in AD
B amyloid deposition in plaques, formation of tau containing intracellular neurofibrillary tangles
what does having a first degree relative do to your chance of having AD
doubles the lifetime risk
what are the genes involved in AD
amyloid precursor protein, presenilin 1 and 2
what other environmental risk factors AD
head trauma, vascular risk factors
what are the degenerative causes dementia
AD, dementia with lewy bodies, frontotemporal dementia, huntingtons, parkinsons, prion
what other causes for dementia
vascular, metabolic (uraemia, liver failure), toxic (alcohol, solvent abuse), vitamin (B12, thiamine), intracranial (tumour, haematoma, hydrocephalus), infections, psych
what are the features of dementia with Lewy bodies
visual hallucinations (animals, people, sense of a presence- extracampine); fluctuating cognition, sleep disorders, Parkinsonism. memory loss may not occur at early stages. delusions, transient LOC
what are there aggregations of in DLB
alpha-synuclein protein
what happens in Parkinsons disease dementia
cognitive problems are a late feature- at least 1 year after onset and above 75.
what may DLB and PDD respond to
cholinesterase inhibitors
what is vascular dementia course
can be progressive and similar to AD, can be a hx of TIAs or lots of cerebrovascular events. stepwise manner
additional signs in vascular dementia
apraxic gait disorders, pyramidal signs, urinary incontinence
what do you see on MRI in vascular dementia
widespread small vessel disease
what happens in frontotemporal dementia
frontal and temporal lob atrophy on MRI
when is the onset typically in frontotemp
what is the presentation frontotemporal dementia
frontal presentation- personality change, emotional blunting, apathy, disinhibition, carelessness, behavioural change. MEMORY IS PRESERVED. temporal presentation- progressive impairment language function
what is the incubation of prion disease
long- can be several years. but death happens soon after start getting symptoms
pathology prion disease
accumulation misfolded native prion protein PrPc
what is the commonest form of Creutzfeldt Jakob disease and what is the course
sporadic. spontaneous mutations. rapidly progressive dementia leads to death within 6months. myoclonus
what is iatrogenic CJD
from neurosurgical instruments as prion resistant to sterilisation; transplant material; cadaveric pituitary derived GH from pt with CJD
what is variant CJD
affects younger people. neuropsychiatric symptoms. ataxia and dementia with myoclonus/chorea. longer course- a few years
what drugs can be used in dementia
cholinesterase inhibitors (donezepil, rivastigmine), memantine (NMDA receptor antagonist)
