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Neurological, neuromuscular and musculoskeletal disease > Dementia > Flashcards

Dementia Flashcards

1
Q

5 most common types of dementia:

A 
Alzheimer's disease
Vascular dementia
Dementia with lewy bodies
Frontotemporal dementia
Mixed
Other
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2
Q

Mixed dementia =

A

Alzheimer’s disease + Vascular dementia

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3
Q

ICD-10 defines dementia =

A
  • Chronic or progressive
  • Multiple higher cortical functions
  • Consciousness not clouded
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4
Q

Forgetfulness is normal with

A

Age

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5
Q

MCI =

A

Mild cognitive impairment

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6
Q

Mild-cognitive impairment =

A

Syptoms worse than expected for age but not severe enough to impair ADLs

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7
Q

Dementia vs MCI

A

Dementia = impairs ADLs

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8
Q

Potential differentials for dementia:

A 
Dementia
Aging
MCI
Depression
Delirium
Physical: metabolic (hypothyroidism, B12, NPH), trauma (subdural haemorrhage, cerebral tumour)
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9
Q

Dementia effecting frontal lobe =

A 
Emotional expression
Personality
Problem solving
Judgement
Motor function
Expressive language
Motivation
Social behaviour
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10
Q

Dementia effecting temporal lobe =

A 
Memory
Speech
Language comprehension
Auditory and visual perceptions
Emotional responses
Facial recognition
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11
Q

Dementia effecting parietal lobe =

A

Learned skills: reading, writing, calculations
Ability to perform complex skills: driving, constructing
Recognition of objects
Spatial awareness

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12
Q

Dementia effecting occipital lobe =

A 
Spatial processing
Ability to determine between different colours
Spatial awareness
Colour and object recognition
Hand eye coordination
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13
Q

3 basic groups of dementia symptoms:

A

memory problems
impairments in cognitive abilities
impairments in communication

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14
Q

Impairments in communication:

A

Repetitive
Reading and writing
Following and engaging in conversation

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15
Q

Most common type of dementia =

A

Alzheimer’s

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16
Q

3 mechanisms of Alzheimer’s pathology:

A
  1. Beta-amyloid plaques
  2. Neurofibillary tangles
  3. Reduced Ach
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17
Q

APP =

A

Amyloid precursor protein, helps neurone grow and repair

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18
Q

What recycles APP

A

alpha-secretase and gamma-secretase

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19
Q

What recycles APP in AD?

A

beta-secretase instead of alpha

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20
Q

Beta-amyloid plaques are where in neurone

A

Outside neuron

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21
Q

What is found on microtubules of cytoskeleton?

A

Tau proteins

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22
Q

What happens to Tau in AD?

A

Hyperphosphorylated and forms neurofibrillary tangles

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23
Q

How do these cause disease in AD?

A
  • Ca2+ and glutamate influx
  • Inflammatory response - free radicals
  • Neural death
  • Tau broken - loss of structural integrity
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24
Q

AD on scan:

A

Diffuse cerebral atrophy
Ventricular dilation
Widened sulci
Narrowed gyri

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25
Q

Hippocampus is in what lobe?

A

Temporal

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26
Q

Insidious onset =

A

Slow

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27
Q

5 A’s of alzheimer’s

A 
Apraxia
Agnosia
Aphasia
Amnesia
Associated symptoms
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28
Q

Symptoms of AD:

A 
Difficulty remembering recent events
langaue problems
changes in ability to process and interpret visual info
decision making, problem solving, planning, sequencing
disorientation
not recogniting familiar faces
reduces ADLs
altered personality
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29
Q

Altered personality in AD:

A

Apathy

Irritability

30
Q

Age of AD tends to be:

A

> 65 years

31
Q

At >80 years what is the chance of developing AD

32
Q

Gender of AD:

A

More common in females

33
Q

With genetic AD, the disease tends to be:

A

Earlier in onset <65 yrs

34
Q

Risk facotrs of AD:

A
  • > 65
  • Women
  • Genetics
  • Poor physical health: heart disease, diabetes
  • Lifestyle: smoking, lack of exercise, alcohol
35
Q

2 drugs used in AD:

A
  1. Acetylcholine esterase inhibitors

2. NMDA antagonists

36
Q

Ex of AchEi

A

Doneprezil

37
Q

Ex of NMDA antagonist

38
Q

Memantine an help with which symptoms

A

Behavioural

39
Q

NMDA antagonists moa:

A

Blocks effects of excess glutamate

40
Q

Most common form of dementia >65s

A

Vascular dementia

41
Q

Vascular dementia can be caused by:

A

TIAs
Arteriosclerosis
Haemorrhage

42
Q

Multiple-infarct dementia follows a

43
Q

Ex of a cause of vascular demntia with ischaemic changes

A

Small vessel disease (SVD)

44
Q

Features of small vessel disease:

A

Slow thought, apathy
Problems with executive functioning (planning and performing tasks)
Reduced attention

45
Q

In SVD there is a relative preservation of

A

Higher cortical functions

46
Q

Risk factors of vascular dementia:

A
  • Hypertension, raised cholesterol, diabetes, smoking, ischemic heart disease, AF
  • > 65s
  • Men
  • Family Hx of stroke, heart disease, diabetes
  • Lifestyle and poor physical health
47
Q

Management of vascular dementia:

A
  • Adequate management of BP, cholesterol, heart disease, diabetes, weight
  • Lifestyle changes: smoking, alcohol, exercise, diet
48
Q

3rd most common form of dementia =

A

Lewy body dementia

49
Q

What gets misfolded into lewy-bodies?

A

Alpha-synuclein

50
Q

Where do lewy bodies effect?

A

Cortex and substantia nigra

51
Q

3 features of LBD:

A
  1. Alertness, confusion, concentration : memory, mood
  2. Persistent, well-formed hallucinations. REM sleep problems
  3. Parkinsonian features: TRAP
52
Q

Distinguishing LBD with AD:

A
  • Movement symptoms more early
  • Hallucination, delusions, identification of familiar people in early
  • REM sleep disorders
53
Q

Distinguishing LBD with PD:

A
  • Earlier cognitive symptoms
54
Q

Sex and LBD:

A

Effects men and women equally

55
Q

Dementia not common in >65s

A

Frontotemporal dementia

56
Q

2nd most common dementia in people <65

A

Frontotemporal dementia

57
Q

Prominent pathologies with FTD:

A

Tau gene mutation

TDP43 protein

58
Q

Types of frontotemporal dementia:

A
  1. Behavioural variant frontotemporal dementia (pick’s)

2. Primary progressive aphasia

59
Q

Pick’s disease =

A

Behavioural varient frontotemporal dementia

60
Q

Types of primary progressive aphasia =

A

Semantic dementia

Progressive non-fluent aphasia

61
Q

Behavioural variant frontotemporal dementia:

A

Prominent changes in personality, interpersonal relationships and conduct

62
Q

Behavioural variant FTD occurs at what age

A

50s-60s (early 20s)

63
Q

Initial symptoms of behaviours FTD:

A 
Changes in personality and behaviour
Apathy and withdrawal 
Obsessive and repetivie behaviour
Loss of empathy
Emotional blunting
Changes in appetite and food
Problems with decision making, problem solving and concentration
64
Q

Semantic dementia:

A

Loss of ability to understand or formulate words in a spoken sentence. Loss of knowledge of meaning of words.

65
Q

Progressive non-fluent aphasia:

A

Progressive difficulty in language. Hesitant, laboured and ungrammatical speech

66
Q

Sex with frontotemporal dementia:

A

Men and women equally

67
Q

genetics and FTD:

A

up to 1/3 of cases familial

68
Q

Management of dementia can be broken down into:

A

Psychosocial

Medial management

69
Q

Psychosocial management:

A

Diagnosis and counselling
Identify strengths and weaknesses
Target interventions, social stimulation
Lifestyle changes, modifications of risk factors
Planning for future, practical, financial etc.
Carer support
Social and home care services

70
Q

Medical management includes:

A

Drugs: for dementia, symptomatic

Risk factor modification

Neurological, neuromuscular and musculoskeletal disease (22 decks)

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