Dementia Flashcards
What is dementia
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
causes of primary dementia (organic diseases)
Alzheimer’s disease
Lewy body dementia
Huntington’s disease
Pick’s disease
causes of secondary dementia
vascular dementia
metabolic
infection
trauma
what is the commonest cause of dementia
Alzheimer’s disease
macroscopic pathological features of Alzheimer’s
cortical atrophy (decreased size and weight of brain)
widening of sulci and narrowing of gyri
compensatory widening of ventricles
microscopic features of Alzheimer’s
neurofibrillary tangles (intracellular)
senile plaques (extracellular)
protein deposits containing amyloid B protein
neuronal loss and astrocytosis
clinical features of Alzheimer’s
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
what clinical test is used to detect dementia
MMSE - score of less than 24/30 suggests dementia
what other investigations should be cone to rule out reversible causes of dementia
bloods - rule out hypothyroid (FBC, U+E, LFTs, Ca, glucose, TFTs, B12 and folate)
what are hallmarks of lewy body dementia
hallucinations
fluctuating levels of attention
fluctuating severity of the condition on a day-to-day basis
features of parkinsons
pathology of lewy body dementia
degeneration of substantia nigra
lewy bodies
degeneration of cortical areas of brain
how do you detect lewy bodies
immunochemical staining for ubiquitin
genetic abnormality found in huntington’s
huntingtin gene on chromosome 4p
pathology of hungington’s
progressive neuronal loss in caudate nucleus and cerebral cortex
reactive fibrillary gliosis
other name for pick’s disease
frontotemporal dementia
pathology of pick’s disease
extreme atrophy of cerebral cortex in frontal and temporal lobes
pick’s bodies - intracytoplasmic filamentous inclusions
pick’s cells - swollen neurons
clinical features of pick’s disease
related to frontal and temporal lobes: personality and behavioural changes speech and communication problems changing in eating habits reduced attention span
most common cause of secondary dementia
vascular
risk factors for vascular dementia
> 60 years
hypertension
men
pathology of vascular dementia
damage to brain tissue due to hypoxia/anoxia - causes multiple clots within blood vessels causing many infarcts
how to distinguish vascular dementia from Alzheimer’s
abrupt onset
stepwise progression
history of hypertension/stroke
evidence of stroke on CT/MRI
what does huntington’s look like on CT
butterfly in caudate nucleus
