Dementia Flashcards by Ryley Cornfield

5 most common types of dementia:

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

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Mixed dementia =

Alzheimer’s disease + Vascular dementia

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ICD-10 defines dementia =

Chronic or progressive
Multiple higher cortical functions
Consciousness not clouded

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Forgetfulness is normal with

Age

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MCI =

Mild cognitive impairment

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Mild-cognitive impairment =

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

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Dementia vs MCI

Dementia = impairs ADLs

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Potential differentials for dementia:

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

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Dementia effecting frontal lobe =

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

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Dementia effecting temporal lobe =

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

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Dementia effecting parietal lobe =

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

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Dementia effecting occipital lobe =

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

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3 basic groups of dementia symptoms:

memory problems
impairments in cognitive abilities
impairments in communication

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Impairments in communication:

Repetitive
Reading and writing
Following and engaging in conversation

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Most common type of dementia =

Alzheimer’s

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3 mechanisms of Alzheimer’s pathology:

Beta-amyloid plaques
Neurofibillary tangles
Reduced Ach

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APP =

Amyloid precursor protein, helps neurone grow and repair

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What recycles APP

alpha-secretase and gamma-secretase

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What recycles APP in AD?

beta-secretase instead of alpha

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Beta-amyloid plaques are where in neurone

Outside neuron

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What is found on microtubules of cytoskeleton?

Tau proteins

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What happens to Tau in AD?

Hyperphosphorylated and forms neurofibrillary tangles

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How do these cause disease in AD?

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

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AD on scan:

Diffuse cerebral atrophy
Ventricular dilation
Widened sulci
Narrowed gyri

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Hippocampus is in what lobe?

Temporal

Insidious onset =

Slow

5 A's of alzheimer's

``` Apraxia Agnosia Aphasia Amnesia Associated symptoms ```

Symptoms of AD:

``` 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 ```

Altered personality in AD:

Apathy | Irritability

Age of AD tends to be:

>65 years

At >80 years what is the chance of developing AD

1/6th

Gender of AD:

More common in females

With genetic AD, the disease tends to be:

Earlier in onset <65 yrs

Risk facotrs of AD:

- >65 - Women - Genetics - Poor physical health: heart disease, diabetes - Lifestyle: smoking, lack of exercise, alcohol

2 drugs used in AD:

1. Acetylcholine esterase inhibitors | 2. NMDA antagonists

Ex of AchEi

Doneprezil

Ex of NMDA antagonist

Memantine

Memantine an help with which symptoms

Behavioural

NMDA antagonists moa:

Blocks effects of excess glutamate

Most common form of dementia >65s

Vascular dementia

Vascular dementia can be caused by:

TIAs Arteriosclerosis Haemorrhage

Multiple-infarct dementia follows a

Stroke

Ex of a cause of vascular demntia with ischaemic changes

Small vessel disease (SVD)

Features of small vessel disease:

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

In SVD there is a relative preservation of

Higher cortical functions

Risk factors of vascular dementia:

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

Management of vascular dementia:

- Adequate management of BP, cholesterol, heart disease, diabetes, weight - Lifestyle changes: smoking, alcohol, exercise, diet

3rd most common form of dementia =

Lewy body dementia

What gets misfolded into lewy-bodies?

Alpha-synuclein

Where do lewy bodies effect?

Cortex and substantia nigra

3 features of LBD:

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

Distinguishing LBD with AD:

- Movement symptoms more early - Hallucination, delusions, identification of familiar people in early - REM sleep disorders

Distinguishing LBD with PD:

- Earlier cognitive symptoms

Sex and LBD:

Effects men and women equally

Dementia not common in >65s

Frontotemporal dementia

2nd most common dementia in people <65

Frontotemporal dementia

Prominent pathologies with FTD:

Tau gene mutation | TDP43 protein

Types of frontotemporal dementia:

1. Behavioural variant frontotemporal dementia (pick's) | 2. Primary progressive aphasia

Pick's disease =

Behavioural varient frontotemporal dementia

Types of primary progressive aphasia =

Semantic dementia | Progressive non-fluent aphasia

Behavioural variant frontotemporal dementia:

Prominent changes in personality, interpersonal relationships and conduct

Behavioural variant FTD occurs at what age

50s-60s (early 20s)

Initial symptoms of behaviours FTD:

``` 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 ```

Semantic dementia:

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

Progressive non-fluent aphasia:

Progressive difficulty in language. Hesitant, laboured and ungrammatical speech

Sex with frontotemporal dementia:

Men and women equally

genetics and FTD:

up to 1/3 of cases familial

Management of dementia can be broken down into:

Psychosocial | Medial management

Psychosocial management:

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

Medical management includes:

Drugs: for dementia, symptomatic | Risk factor modification