Dementia

Question 1

Most common type of dementia

Answer 1

Alzheimers dementia

Question 2

History of Alzheimers

Answer 2

Preclinical (30yrs) -> Mild cognitive impairment(5yrs) ->

Dementia (9-10yrs)

Question 3

Pathological features of AD

Answer 3

Medial temporal atrophy
60-90% of AD have vascular lesions
Plaques, NFT, synaptic and neuronal loss (Hirano bodies)
Congophilic angiopathy(90%)-superficial siderosis

Question 4

Inclusions in AD

Answer 4

APP(amyloid precursor protein) Chr 21

Beta-amyloid oligomers, fibrillar beta amyloid forms plaques. Tau pathology secondary to beta amyloid accumulation

Question 5

Important genes in AD

Answer 5

PSEN1, PSEN2, APP, APOE4(Chr 19), ADAM 10

Question 6

Genetic factor in early onset familial AD

Answer 6

APP mutation on Chr 21
Presenilin 1 on Chr 14
Presenilin 2 on Chr 1

Question 7

Mutation causing decreased risk of AD

Answer 7

Icelandic A673T mutation

Question 8

ApoE4 in AD

Answer 8

Decreases age of onset by 10% per E4 allele

Question 9

Enviornmental risk factors for AD

Answer 9

Age, family history, female sex/ single,cardiovascular risk factors
Low education,socialisation, physical inactivity, mid life depression

Question 10

Protective factors

Answer 10

Physical exercise , ?education

Question 11

Neurodegenerative markers in AD

Answer 11

CSF -High t-tau, p-tau
SPECT -Parieto temporal hypoperfusion
FDG PET- Precuneus, parieto temporal hypometabolism
MRI - Hippocampal atrophy (specific sign)

Question 12

Primary age related taupathy (PART)

Answer 12

Relatively benign
Predominantly NFT
Asymptomatic to mild amnesia
MRI -temporal lobe atrophy

Question 13

Features of AGD (Argyrophilic grain disease)

Answer 13

Tauopathy - 4-R Tau predominant spindle shaped grains in hippocampus and amygdala
Relatively well preserved cognition
Personality changes characterised by emotional disorder involving aggression

Question 14

HS -Aging

Answer 14

Sclerosing of one or both hippocampus
Rapid forgetting pattern of episodic memory
PET Scan resembles AD
Prevalence exponentially increases with aging

Question 15

Prevention of AD

Answer 15

In MCI home based exercise regime -> improvement in cognition, aerobic exercise
Mediterranean diet -possibly effective

NSAIDS, Estrogen, fish oil,Vitamin E, statin,ginko biloba - not effective

Question 16

Souvenaid -medical food supplement in AD

Answer 16

Decreases hippocampal Atrophy

Decreased functional decline

Question 17

Treatment for AD

Answer 17

Acetylcholinesterase inhibitors-donepezil, rivastigmine, galantamine
CI -asthma, peptic ulcer, conduction defects
S/E : GIT, insomnia, cholinergic

Memantine- Non competitive NMDA antagonist
Moderate to severe AD
S/E: Drowsiness

Question 18

Aducanumab in AD

Answer 18

Human monoclonal ab for aggregated forms of Abeta amyloid

Question 19

Fronto temporal dementia

Answer 19

Second commonest young onset dementia
Can have spectrum of continuity with MND
Behavioural variant more common
Non fluent variant linked to CBD,PSP

Question 20

FTD pathology

Answer 20

50% - TDP 43

50% - Tau

Question 21

Genetics in FTD

Answer 21

Upto 30% positive family history
Chr 17 -microtubule-associated protein
progranulin gene(associated with wound healing)
Chr 9- C9ORF 72 -single most imp mutation
Psychosis common

Question 22

Clinical features of behavioural variant of FTD

Answer 22

Disinhibition, apathy, loss of empathy
Hyprorality
Perseverative, stereotypic, ritualistic behaviour