Dementia Flashcards
What are clinical features of dementia?
Mood and psychotic symptoms Communication problems Functional impairments Memory disorder Manage vascular risk factors “Agitation” and aggression “Wandering” Depression Psychosis Sleep disturbance Incontinence Physical co-morbidities - delirium
What are the main causes of dementia and what changes do they cause?
Alzheimer’s disease Vascular dementia Frontotemporal dementias Lewy body dementia Progressive supranuclear palsy Huntington’s disease Prion disease
What are the differences between sporadic CJD and new variant CJD?
sporadic CJD: Non specific changes basal ganglia
variant CJD: Characteristic abnormality seen in the posterior thalamic region
What is the definition of dementia?
COGNITIVE DISEASE
a syndrome due to disease of the brain usually of a chronic or progressive nature, in which there is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement
How can neurodegenerative disorders be classified?
Functional:
Cognitive disorders, e.g. Alzheimer’s Disease (AD)
Movement disorders, e.g. Parkinson disease (PD)
Anatomical, e.g. Frontotemporal dementia (FTD), Corticobasal degeneration (CBD)
Etiological, e.g. vascular dementia (VaD), Prion disease
Proteinopathy, e.g. Taupathy (AD), α-Synucleinopathy (DLB)
What are examples of cognitive disorders?
Temporal, parietal and frontal degeneration: Alzheimer disease (AD)
Frontal temporal degeneration (FTD)
Multifocal degeneration: Corticobasal degeneration (CBD)
Cognitive and movement: Dementia with Lewy body (DLB)
What proteins can be involved in dementia?
Β-amyloid - insoluble misfolded structures. Plaques accumulates EXTRAcellularly
Tau - group of proteins that stabilize microtubules in neurons. Accumulates INTRAcellularly
α-synclein - Lewy Bodies accumulates INTRAcellularly
Ubiquitin - Pick’s bodies accumulates INTRAcellularly
Why do dementia changes happen in the brain?
Oxidative stress: free radicals can cause aging and damage to amino acids
Excitotoxicity: over stilmulation via glutamine
Induction of programmed cell death (apoptosis)
Cytokines: inflammatory response?
Genetic factors: single gene mutations, multiple genes
Aging: age-related decline in the efficiency of some metabolic pathways (e.g RNA synthesis)
Unknown aetiology
What MACROscopical changes occur in dementia?
Brain weight 900-1100 grams (normal 1200-1400)
Atrophy in cerebral gyri
Atrophy in white matter: thin corpus callosum
Atrophy in deep white matter
Ventricular dilatation
Atrophy in brain stem and cerebellum
Pale substantia nigra and locus ceruleus
What MICROscopical changes occur in dementia?
Neuron loss from hippocampus, cerebral cortex, SN and LC
Microvacuolation in cerebral neocortex
Attenuation in white matter
Wide perivascular spaces in white matter Accumulation of abnoramal proteins
What MACROscopical changes occur in
Alzheimer’s disease?
Brain weight: 900 –1200 (Normal: 1200 – 1400)
Atrophy of gyri and widening of sulci: frontal, temporal, parietal, and hippocampus
Ventricular dilatation
What MICROscopical changes occur in
Alzheimer’s disease?
Neuronal loss
Neural plaque
Neurofibrillary tangles and neuropil threads
What MACROscopical changes occur in
dementia with Lewy Bodies?
Pale substantia nigra and locus coeruleus (nucleus in the pons involved with physiological responses to stress and panic)
Atrophy in amygdala, cingulate gyrus, temporal, parietal and frontal lobes
What MICROscopical changes occur in
dementia with Lewy Bodies?
Neuronal loss from the substantia nigra and locus coeruleus
Accumulation of α – Synuclein bodies in the neurons of the substantia nigra, amygdala and later in the cerebral cortex
What causes vascular dementia?
Multi-infarct dementia
Binswanger’s disease - caused by damage to the white brain matter
Arteriolosclerosis
