Dementia

Question 1

What is dementia

Answer 1

impairment of previously acquired occupational or social functioning due to development of acquired and persistent memory impairment associated with impairment of intellectual function in the presence of normal consciousness

Question 2

causes of primary dementia (organic diseases)

Answer 2

Alzheimer’s disease
Lewy body dementia
Huntington’s disease
Pick’s disease

Question 3

causes of secondary dementia

Answer 3

vascular dementia
metabolic
infection
trauma

Question 4

what is the commonest cause of dementia

Answer 4

Alzheimer’s disease

Question 5

macroscopic pathological features of Alzheimer’s

Answer 5

cortical atrophy (decreased size and weight of brain)
widening of sulci and narrowing of gyri
compensatory widening of ventricles

Question 6

microscopic features of Alzheimer’s

Answer 6

neurofibrillary tangles (intracellular)
senile plaques (extracellular)
protein deposits containing amyloid B protein
neuronal loss and astrocytosis

Question 7

clinical features of Alzheimer’s

Answer 7

impairment of higher intellectual function with mood and behaviour alterations:
cannot learn, retain or process new information 
difficulty naming/understanding 
apraxia - impaired motor skills
agnosia - can't recognise things
wandering/aggression/delusions
loss of insight 
depression

Question 8

what clinical test is used to detect dementia

Answer 8

MMSE - score of less than 24/30 suggests dementia

Question 9

what other investigations should be cone to rule out reversible causes of dementia

Answer 9

bloods - rule out hypothyroid (FBC, U+E, LFTs, Ca, glucose, TFTs, B12 and folate)

Question 10

what are hallmarks of lewy body dementia

Answer 10

hallucinations
fluctuating levels of attention
fluctuating severity of the condition on a day-to-day basis
features of parkinsons

Question 11

pathology of lewy body dementia

Answer 11

degeneration of substantia nigra
lewy bodies
degeneration of cortical areas of brain

Question 12

how do you detect lewy bodies

Answer 12

immunochemical staining for ubiquitin

Question 13

genetic abnormality found in huntington’s

Answer 13

huntingtin gene on chromosome 4p

Question 14

pathology of hungington’s

Answer 14

progressive neuronal loss in caudate nucleus and cerebral cortex
reactive fibrillary gliosis

Question 15

other name for pick’s disease

Answer 15

frontotemporal dementia

Question 16

pathology of pick’s disease

Answer 16

extreme atrophy of cerebral cortex in frontal and temporal lobes
pick’s bodies - intracytoplasmic filamentous inclusions
pick’s cells - swollen neurons

Question 17

clinical features of pick’s disease

Answer 17

related to frontal and temporal lobes:
personality and behavioural changes 
speech and communication problems 
changing in eating habits 
reduced attention span

Question 18

most common cause of secondary dementia

Answer 18

vascular

Question 19

risk factors for vascular dementia

Answer 19

> 60 years
hypertension
men

Question 20

pathology of vascular dementia

Answer 20

damage to brain tissue due to hypoxia/anoxia - causes multiple clots within blood vessels causing many infarcts

Question 21

how to distinguish vascular dementia from Alzheimer’s

Answer 21

abrupt onset
stepwise progression
history of hypertension/stroke
evidence of stroke on CT/MRI

Question 22

what does huntington’s look like on CT

Answer 22

butterfly in caudate nucleus