Dementia

Question 1

What is dementia?

Answer 1

A collection of symptoms affecting thinking and social abilities resulting from damage to the brain. Interfering with daily functioning

Question 2

What conditions can mimic dementia?(6)

Answer 2

Delirium
Depression/schizophrenia
Drugs/alcohol
mental retardation
normal age memory decline
mild cognitive impairment

Question 3

What is needed for a diagnosis of dementia?

Answer 3

1. deatailed history + collateral history
2. Cognitive and mental exam
3. MMSE, CDT, MoCA, STMS

Question 4

What can be the causes of dementia? (8)

Answer 4

Neurodegenerative - AD, LBD, FTD, HD
Vascular - infarcts, amyloid, vasculitides
Neurological - MS, NPH
Nutritional - B12, Thiamine, Niacin
Infectious - HIV, Prion, Syphilis, Cryptococcus
Metabolic - Hepatic, renal, Wilsons
Traumatic - hematoma, dementia pugilistica
Toxic - alcohol, heavy metals, anticholinergic, CO

Question 5

What is the most common type of dementia?

Answer 5

Azlheimer’s disease

Question 6

What are the features of Alzheimer’s disease?(4)

Answer 6

• Gradual cognitive decline
• fresh memory impairement - remote memory intact
• changes in language, reasoning, executive funct.
• seldom before age of 65

Question 7

What are the three stages of alzheimer’s in terms of daily activities?

Answer 7

1. Need some assistance with daily activities
2. Trouble taking care of themselves, but still involved
3. Need help to eat, walk, go to the toilet

Question 8

What are the three stages of alzheimer’s in terms of behavior and cognition?

Answer 8

1. Sad/ avoid social - misplacing items, forgets appointements/names/recent events
2. changes is sleep, wandering, easily upset - trouble recognizing family members, difficulty expressing self
3. Touching things over and over, sleeping
   - less speaking, less response to care partners

Question 9

What is the pathophysiology behind Alzheimer’s?

Answer 9

Hippocampus most impacted

Amyloids plaques, Neurofibrillary tangles

Question 10

What are the risk factors for Alzheimer’s?(5)

Answer 10

genetic - apoE4, 
femal gender
head injury
lower education
smoking

Question 11

What drugs can be used to treat Alzheimer’s? (2)

Answer 11

Cholinesterase inhibitors:

• DOnezepil
• Rivastigmine, galantamine

NMDA channel modulator:
- mementine

Question 12

What are the three clinical variants of frontotemporal degeneration?

Answer 12

• Frontal variant/Pick disease
• Semantic dementia (temporal variant)
• progressive nonfluent aphasia

Question 13

What is the pathological findings in PIck disease?

Answer 13

atrophy of frontotemporal region
Pick’s cells
50% are familial

Question 14

What are the symptoms of frontotemporal dementia?(4)

Answer 14

Personality changes: rude, inappropriate, obsessive, aggressive

Speech problems: Reduced quantity/quality/loss - reduced understanding

Eating habits: overeating, alcohol, sweets, objects

Attention: cant maintain line of thought, easily distracted

Question 15

What is Primary progressive Aphasia?

Answer 15

Progressive language disorder with preservation of other mental functions for 2 years

Divided into: - Progressive non-fluent aphasia
- Semantic dementia

Question 16

What is Semantic dementia?

Answer 16

Circumscribed multimodal disorder of conceptual knowledge (word meaning and comprehension)

• bilateral assymmetric degeneration of ant. temp lobe

Question 17

What is progressive non-fluent aphasia?

Answer 17

impaired production of speech /word retrival

preserved ria and non-verbal comm.

Question 18

What is needed to diagnose Lewy body dementia?

Answer 18

Dementia and 2 of the following three:

• motor feature of Parkinsonism
• visual hallucinations
• Fluctuating cogniton

Suggestive:

• early falls and
• oversensitivity to neuroleptics

Question 19

What is vascular dementia?

Answer 19

Multiple cognitive deficits manifested by both:

• memory impairement
• aphasia/apraxia/agnosia/executive disturb.

+impaired socal/occupation
focal signs
not delirium

Question 20

What are the risk factors for vascular dementia?(4)

Answer 20

Age
cardiovascular risk factors
elevated homocysteine
genetic (CADASIL)

Question 21

What is normal pressure hydrocephalus(NPH)?

Answer 21

ventricles enlarge at expense of brain
normal CSF pressure

due to a gradual blockage of CSF drainage

Question 22

What can be the cause of normal pressure hydrocephalus (NPH) ?(2)

Answer 22

complication of cerebral infection or hemorrrhage

Idiopathic

Question 23

What are the characteristic symptoms of NPH? (4)

Answer 23

Urinary incontinence - wet
Dementia - wacky
Wide gait - wobbly

also a general slowing of activity

Question 24

What is the treatment for NPH?

Answer 24

shunting of CSF from ventricles to peritoneum

Question 25

What is the pathophysiology of Huntington disease?

Answer 25

AD - Trinucleotide repeat, chromosome 4

- degeneration of caudate and putamen (striatum)

Question 26

When does the symptoms of Huntington disease usually develop?

Answer 26

30-50 years of age (can vary greatly)

Question 27

What are some early symptoms of Huntington disease?

Answer 27

slight uncontrollable movements
stumbling/clumsiness
lack of concentration
short term memory lapses
depression irritability
mood changes - sometimes aggressive

Question 28

How is Huntington disease diagnosed?

Answer 28

genetic testing + history and exam