Dementia

Question 1

What is dementia?

Answer 1

A set of symptoms including declining cognitive function. memory loss, difficulty thinking, personality change.

Dementia is an umbrella term referring to disorders like Alzheimer’s and others

Question 2

What does the frontal lobe do?

Answer 2

Voluntary + planned motor behaviours

Motor speech area, Broca’s

Personality

Planning

Question 3

What does the temporal lobe do?

Answer 3

Hearing

Language comprehension

Semantic knowledge

Memory

Emotional / affective behaviour

Question 4

List some types of dementias?

Answer 4

Alzheimer’s

Fronto-temporal dementia

Dementia with Lewy bodies

Vascular dementia

Many more

Question 5

What would frontal-temporal dementia present like?

Answer 5

Personality and behaviour change

Followed by breakdown in attention and cognitive function

Question 6

What would dementia with Lewy bodies present like?

Answer 6

Visual recurrent hallucinations

Fluctuating cognition

Pronounced variation in alertness

Depression + sleep disorders

Parkinsonism

Question 7

What is dementia with Lewy bodies?

Answer 7

Dementia caused by tiny deposits of protein in nerve cells

The deposits are called Lewy bodies

Their presence results in a loss of connections between nerve cells and nerve cell death

Question 8

What is vascular dementia?

Answer 8

Dementia caused by a reduced blood supply to the brain

This often occurs as a result of multiple mini strokes

Question 9

What would vascular dementia present like?

Answer 9

Stepwise deterioration with declines, followed by short periods of stability

Question 10

What is fronto-temporal dementia?

Answer 10

Signs of degeneration of fronto-temporal lobes, but no Alzheimer’s histology

Question 11

What is the pathogenesis of Alzheimer’s?

Answer 11

Deposition of amyloid plaques and neurofibrillary tangles.

Plaques are made of protein fragment beta-amyloid

Tangles consist of an abnormal version of tau, a protein normally involved in maintaining the internal structure of the nerve cell.

These things all lead to atrophy of the brain and thus declining cognitive function

Question 12

What does a brain affected by Alzheimer’s look like on a CT scan?

Answer 12

Atrophied

Shrunken

Question 13

What are the risk factors for Alzheimer’s disease?

Answer 13

Family history

Down’s syndrome

Vascular risk factors: diabetes,
high BP

Depression / loneliness

Smoking + alcohol

Question 14

What is semantic dementia?

Answer 14

Loss of semantic memory

General knowledge, facts, names of objects, words

They may not know what a sheep or a chair is for example

Question 15

Investigation of dementia?

Answer 15

Full history from patient and someone who knows them well

Assess cognitive function using tests like mini mental state exam

Blood tests to exclude other causes:

• vitamin deficiencies
• liver function
• thyroid

Brain CT: only if young or unsure of cause

Assess what level of support the patient needs: full time care?

Question 16

Management of dementia?

Answer 16

Acetylcholinesterase inhibitors
Memantine (anti-glutamate)

Control of vascular factors: BP, diabetes

Treat mood and anxiety

Encourage them to be socially and cognitively active

Provide support for family, and for patient

Question 17

Which types of memory are affected in Alzheimer’s and which are not?

Answer 17

Short term memory readily affected, resulting in confusion

Long term, autobiographical memory is usually less affected

Question 18

How would you differentiate between vascular dementia and Alzheimer’s disease?

Answer 18

Similar symptoms

Vascular may have high BP, a history of strokes, more stepwise progression of symptoms

Question 19

Alzheimer’s involves deposition of plaques in the brain, what are they made of?

Answer 19

Amyloid

Question 20

Alzheimer’s involves the deposition of neurofibrillary tangles in the brain, what are they made of?

Answer 20

An abnormal version of the protein Tau

Question 21

What is Tau and what does it do?

Answer 21

A protein usually involved in maintaining the structure of nerve cells

Question 22

What is the effect of amyloid plaques and neurofibrillary tangles on the brain?

Answer 22

Affects conduction of impulses in the brain, slows them down

Causes atrophy

Question 23

Where are the amyloid plaques deposited?

Answer 23

Outside the neuron cells

Question 24

Where are the neurofibrillary tangles deposited?

Answer 24

Inside the neuron cells