Dementia

Question 1

What is dementia?

Answer 1

A chronic progressive mental disorder that adversely affects higher cortical functions (umbrella term for symptoms caused by these diseases)

Functions affected: memory, thinking, orientation, comprehension, calculating, learning capacity

Question 2

What are the common cognitive symptoms in dementia

Answer 2

Memory loss

Poor concentration

Disorientation/confusion

Failing intellect

Language Impairment

Question 3

What are the common non cognitive symptoms in dementia

Answer 3

Depression

Delusion

Anxiety

Aggression

Sleep disturbances

Disinhibition

Question 4

What are the disability symptoms in dementia

Answer 4

Difficulties with activities
Self Neglect
Incontinence and other physical disabilities

Question 5

What is the pathology of dementia

Answer 5

1. Occurs in cerebral cortex, ventricles and hippocampus
2. Loss of tissue
3. 130-140g of brain disappearing

Question 6

How do you diagnose dementia

Answer 6

Clinical cognitive assessment: assess attention and concentration, orientation, short and long term memory, language and executive function (includes mini mental state examination, clock drawing test)

MRI and PET scan can show brain shrinkage and monitor brain volume- atrophy in hippocampus

Can show presence of biomarkers (Alzheimer disease amyloid binding radio tracer)

Question 7

What are high risk factors of dementia

Answer 7

Age >65
ApoE genotype: lipid homeostasis in brain
TREM2 Status: encodes for microglial (monitors inflammation and foreign bodies invade)

Question 8

What are the moderate risk factors of dementia

Answer 8

History of stroke (hypoxic episodes)
Parkinson’s disease
Head injury- dementia pugilistia (many stained amyloid peptides)
Vascular Diseases

Question 9

What are the low risk factors of dementia

Answer 9

Drinking
Diabetes
Smoking
Education

Question 10

What are the familial genes affected in dementia

Answer 10

APOE and TREM2

Question 11

Give features of mild dementia

Answer 11

Memory loss is prominent, core activities like washing is able to be done, but dealing with finances etc cannot

Question 12

Give features of moderate dementia

Answer 12

Cognition worsens, core activities are affected, people not understanding why they are being washed

Question 13

Give features of severe dementia

Answer 13

Needing 24/7 care constantly

Question 14

What is vascular dementia

Answer 14

1. Vascular dementia shows multifocal and diffuse lesions; damage can be small strokes or injury to vessels from high blood pressure
2. Affects neuronal networks involved in cognition, behaviour, execution and memory

Question 15

What is Lewy body dementia

Answer 15

1. Cognitive signs start first and it involves the clumping of lewy bodies that originate from alpha synuclein
2. Early symptoms: confusion, deficits in attention
3. Shows fluctuating cognition, recurrent hallucinations, spontaneous features of Parkinsonism

Question 16

What is the frontotemporal dementia

Answer 16

Affects front part of the brain, usually occurs at earlier age

Symptoms: disinhibitive, apathetic and language effects

Question 17

How do you treat mild dementia, treatment options?

Answer 17

1. Neurotransmitter modulation as a symptomatic approach: cholinergic and glutamatergic signalling
2. Target AChE: acetylcholinesterase
3. Acetylcholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine (improves cognitive function)

Question 18

What is a NMDA antagonist and the effects?

Answer 18

1. Memantine: non competitive antagonist
2. Improves cognitive functions
3. Effects evident at late stages of disease
4. Roles in early stage of alzheimer disease unclear