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Neurology > Dementia > Flashcards

Dementia Flashcards

1
Q

What is the DSM-4 dementia criteria?

A

The development of multiple cognitive deficits including
- memory impairment
- one of executive dysfunction, language disorder, apraxia and visuospatial dysfunction
Deficits need to impact on social or occupational function
Gradual onset and progression
This is not caused by delirium, medication or another illness

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2
Q

How are patients assessed for dementia?

A 
Patients history
Informant history
Daily activities (functional abilities)
Cognitive assessment 
Physical examination
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3
Q

Why do you need to take a history from both the patient and a collateral?

A

Patient
- assessing the ability to give an account of the problem
- memory, language and organisation
Collateral history
- personality or behaviour changes
- has information the patient might have forgotten

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4
Q

What cognitive assessments can you perform on someone with suspected dementia?

A 
Abbreviated mental test
Mini-Mental Test Evaluation
Montreal cognitive assessment 
ACE-R
Neuropsychology input
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5
Q

What are you looking for on physical examination of someone with dementia?

A 
Involuntary movements (chorea)
Eye movements
Frontal release signs
- e.g. grasp reflex reappears 
Extrapyramidal signs
Ataxia
Praxis
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6
Q

What are the most common causes of rapidly progressive cognitive impairment?

A

V - vascular
I - infectious (HIV, syphilis)
T - toxic/metabolic (Wernicke’s, B12 deficiency)
A - autoimmune encephalitis
M - metastatic/neoplastic
I - iatrogenic/inborn error of metabolism (drugs)
N - neurodegenerative
S - systemic/seizure (hypertensive encephalopathy)

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7
Q

What is the most common type of dementia?

A

Alzheimer’s (63% of dementia cases)

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8
Q

List the different types of dementia.

A 
Alzheimer's
Mixed (vascular and alzheimer's)
Vascular dementia
Lewy body dementia
Fronto-temporal dementia
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9
Q

Describe the different groupings of memory?

A

Explicit (declarative, memory that can be tested)
- episodic (life events, time and place)
- semantic (knowledge memory, factual things)
- working (information is kept in your brain for around 10 seconds)
Implicit
- procedural memory
- priming

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10
Q

Where in the brain is episodic memory processed?

A

Localised

Hippocampus and medial temporal lobe are good at tying when and where something happened

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11
Q

Where in the brain is semantic memory processed?

A

Widely distributed, but key linking area (node) in the left temporal lobe
- linked to multiple cortical areas (visual, auditory association areas)

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12
Q

Where in the brain is working memory processed?

A

Distributed throughout the brain

  • frontal lobes (attention)
  • temporal lobes
  • parietal lobe
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13
Q

Name some amnestic syndromes of episodic memory (have trouble creating new memories).

A 
Hippocampal (mesial temporal lobes)
- Alzheimer's, limbic encephalitis, herpes simplex encephalitis and post-hypoxic syndromes
Mammilary bodies and Thalamus
- Korsakoff's pychosis
Thalamus, subcortical areas
- infarction, vascular dementia
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14
Q

Describe the clinical progression in Alzheimer’s disease.

A 
Mild/Early
- problems with topographic memory
- progressive amnesia 
Moderate (altered functional abilities)
- visuospatial difficulties 
- personality/behaviour change
- executive dysfunction
Advanced (increasing dependency)
- global cognitive deficits
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15
Q

How does Alzheimer’s spread through the brain?

A

Starts in the hippocampus area
Spreads to spatial areas and the frontal lobe
Moves backwards and affects the whole brain

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16
Q

What are the language problems that are associated with Alzheimer’s?

A 
Nominal dysphasia
- difficulty naming object
Lopopenic dysphasia 
- nominal dysphasia
- difficulty with sentence repetition (starts before memory impairment)
17
Q

Describe semantic dementia.

A

Caused by atrophy of the anterior-temporal lobe area

  • Gradual loss of semantic knowledge
  • Initial loss of low frequency words
  • Surface dyslexia
    • > don’t know how to pronounce non-phonetic words
  • Will have difficulty naming pictures and sounds
18
Q

What is Brocca’s area involved with?

A

Expressive speech

- forming speech

19
Q

What is Wernicke’s area involved with

A

Understanding what people are saying

Use of the correct words

20
Q

What are the three main areas affected by dementia within the frontal lobes?

A

Orbitofrontal cortex
Anterior cingulate cortex
Dorsolateral prefrontal cortex

21
Q

What happens to a person if there are orbitofrontal deficits?

A

Behavioural disturbance

  • disinhibition
  • euphoric
  • loss of social awareness
22
Q

What happens to a person if there is anterior cingulate damage?

A

Abulia

  • apathy
  • akinetic mutism
  • loss of self-awareness
23
Q

What happens to a person if there is dorsolateral prefrontal cortex damage?

A

Deficits in

  • working memory
  • planning
  • cognitive estimates
  • understanding proverbs
24
Q

Name some common pathologies that can cause frontal lobe defects.

A

Traumatic injury
- orbitofrontal syndrome
Anterior cerebral artery ischaemia
- anterior cingulate syndrome
Fronto-temporal dementia
- pattern of onset depends on type of dementia
- motor neurone disease has associated familial aspects

25
Q

Name and describe the two main pathways involved in visuo-spatial functioning.

A 
Both begin in the occipital lobe
Dorsal stream (where)
- position of object (dyspraxia)
- picking an object from a scene
Ventral stream (what)
- object recognition (visual agnosia)
- facial recognition (prosopagnosia)
26
Q

Damage to which lobes can cause problems with visual processing?

A 
Fronto-temporal dementia
- can affect the ventral stream
- recognition 
Damage to the parietal lobe
- can affect the dorsal stream
- where the object is
27
Q

Give some symptoms you would expect to see with damage to the parietal lobe.

A

Visual perception
Spatial awareness
Praxis
- limb kinetic dyspraxia (can’t copy hand movements)

28
Q

Name some clinical pathologies that can cause damage to the parietal lobe.

A 
Watershed ischaemia 
Posterior cortical atrophy
- biparietal onset Alzheimer's
Cortico-basal degeneration
- parkinsonism
- alien limb
- unilateral onset dyspraxia
Dementia with Lewy bodies
- visual hallucinations, fluctuation, autonomic symptoms
29
Q

What are subcortical dementias?

A

Dementia that affects the deep structures of the brain first

30
Q

Name some types of sub-cortical dementias.

A

Parkinson’s dementia

Huntington’s disease dementia

31
Q

What are the three Ms of sub-cortical dementia?

- associated with basal ganglia loops

A 
Motor (motor loop)
- parkinsonism
- chorea
Mood (prefrontal loop)
- anxiety and depression
Memory (limbic loop)
- bradyphrenia 
- degenerates over time

Neurology (13 decks)

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