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Spring 2 > Dementia > Flashcards

Dementia Flashcards

1
Q

Define Dementia

A

Umbrella term.
Chronic progressive mental disorder that adversely affects higher cortical functions including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement.

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2
Q

Define Alzheimer’s disease

A

Most common form of dementia.
Degenerative cerebral disease with characteristic neuropathological and neurochemical features
Onset and development is slowly but steadily over several years
Progressive deterioration in cognition, function and
behaviour

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3
Q

Approximately how many people suffer with dementia in the UK?

A

820,000

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4
Q

What are the cognitive symptoms?

A 
Memory loss
Failing intellect  (inability to learn new skills)
Poor concentration
Language impairment 
Disorientation/confusion
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5
Q

What are the non-cognitive symptoms?

A 
Depression
Delusion
Anxiety
Aggression
Sleep disturbances
Disinhibition
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6
Q

What are disability symptoms?

A

Difficulties with activities of daily living
Self-neglect
Incontinence and other physical disabilities

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7
Q

What could the symptoms of AD be mistaken for?

A
  • Vitamin deficiency
  • Thyroid problems
  • Infection
  • Anxiety
  • Brain Tumour
  • Depression
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8
Q

Describe plaques and tangles

A

Amyloid plaques and Neurofibrillary tangles each have different proteins underlying each. They are characteristic of dementia when they undergo a conformational change and become toxic

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9
Q

What techniques are used for the diagnosis of dementia

A
  1. symptoms and memory assessment

2. MRI and PET scans for biomarkers

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10
Q

What are the outcomes of using Memory tests and MRI and PET scans?

A

Memory tests can show problems in particular areas

CT and MRI scans may show brain shrinkage (atrophy)

SPECT and PET scans may show areas of:
Loss of function (fluoro­ deoxyglucose [FDG]­PET)
Presence of AD biomarkers (PET with amyloid-binding radiotracer or chemical marker of cerebrospinal fluid [CSF] amyloid and tau proteins)

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11
Q

Describe the scoring system of the mini mental state exam?

A 
Scored out of 30
≥27 = Normal 
19-24 = Mild cognitive impairment
10–18 = Moderate impairment
≤9 = Severe impairment
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12
Q

What does an MRI scan highlight in pathology?

A 
Highlights atrophy in hippocampus 
and mesiotemporal lobe (MT)
Can detect pre-symptomatic changes
Non-invasive
Reproducible and quantitative read
out.
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13
Q

What does an FDG scan highlight?

A 
Highlights deficits in parietal lobe
(P) and posterior cingulate gyrus (PCG).
Links metabolic state to synaptic
activity.
Open to errors from other
metabolic changes.
Useful tool in differentiating 
dementia’s (e.g. AD vs FTD).
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14
Q

What are the risk factors for dementia? In order of highest effect

A 
Age >65
ApoE genotype - if have one copy of the APOE 4 makes them 3 times as likely and if have two copies makes them more than 8 times more likely.
TREM2 status
History of stroke (hypoxic episodes)
Parkinson’s disease
Head injury
Vascular diseases
Diabetes
Smoking
Drinking
Education
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15
Q

What is dementia pugilistica?

A

Dementia Pugilistica is a form of dementia that poses a serious long-term threat to individuals involved in contact-heavy sports, or who have sustained multiple concussions throughout their lives.

otherwise known as “punch-drunk syndrome” or “boxer’s dementia,” is a form of dementia that originates with repeated concussions or other traumatic blows to the head.

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16
Q

What is the Amyloid cascade hypothesis? Describe the cascade

A

The amyloid cascade hypothesis, which posits that the deposition of the amyloid-β peptide in the brain is a central event in Alzheimer’s disease pathology.

1. Increased amyloid-β production OR decreased amyloid-β degradation
Leads to: 
2. Increase in amyloid-β accumulation 
3. amyloid-β oligomenisation and deposition  
4. Inflammatory response 
5. Synapse loss
6. Oxidative stress
7. Ca2+ overload ad neuronal death
17
Q

What are the current treatment strategies for Dementia?

A

No disease modifying therapy exists for dementia.
Current treatment strategies centre around neurotransmitter modulation as a symptomatic approach.
In particular, cholinergic and glutamatergic signalling.

18
Q

Modulating neurotransmission: What do Acetylcholinesterase inhibitors do? and give examples

A

Enhance cholinergic transmission and improve cognitive functions
Therapeutic effectiveness decreases with increasing neuronal damage
Does not prevent progression of disease!

Examples:
Donepezil
Galantamine
Rivastigmine

19
Q

How do we know if Acetylcholinesterase inhibitors are working?

A

Benefit assessed by repeating the cognitive assessment after 3 months treatment.
Discontinue treatment if patient does not respond to therapy!

20
Q

What are the effects of N-methyl D-aspartate antagonism? give an example

A

Improves cognitive functions
Effects evident at late stages of disease
Role in early stage of AD unclear…
Not certain if it prevents progression of disease…

e.g. Memantine- Non-competitive antagonist at NMDA receptors

21
Q

What are the possible drug interactions when using N-methyl D-aspartate antagonists?

A

Possible drug interactions e.g., antipsychotic (see non-cognitive changes and treatments!), anticoagulant (warfarin), analgesic and muscle relaxant

22
Q

Which drugs does NICE recommend to use for mild or moderate Alzheimer disease?

A

Donepezil, Galantamine and Rivastigmine

23
Q

What is Memantine now recommneded as an option for by NICE?

A

moderate Alzheimer’s disease for people who cannot take AChE inhibitors
severe Alzheimer’s disease
In combination? Not currently recommended

24
Q

What are some novel strategies for treating dementia?

A 
Modulating neurotransmission
Amyloid based strategies
Tau based therapies
Modulating intracellular signalling cascades
Oxidative stress reduction
Mitochondrial targeted therapy
Modulation of cellular calcium homeostasis
Anti-inflammatory therapy
25
Q

Give an example of a drug used in stage 3 clinical trials for Alzheimer’s disease? Did it work?

A

Solanezumab = Anti-amyloid antibody

Failed to significantly slow cognitive decline in people with mild AD

26
Q

What are the pharmacological interventions concerning Behaviour that challenges?

A

Antipsychotics
Patients with mild-to moderate non-cognitive symptoms should not be prescribed antipsychotic drugs

Patients with psychosis and/or agitated behaviour causing significant distress may be offered treatment with an antipsychotic

Sedatives
For challenging behaviour: violence, aggression, severe agitation: i.m. Lorazepam, Haloperidol or Olanzapine

27
Q

What are the pharmacological interventions concerning emotional disorders?

A

Antidepressants
People with dementia who also have major depressive disorder should be offered antidepressant medication

Avoid certain TCA and MAOI as they have anticholinergic properties

Spring 2 (23 decks)

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