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BB CC > Dementia > Flashcards

Dementia Flashcards

1
Q

Dementia

A

Syndrome that may be caused by a number of illnesses in which there is progressive decline in multiple areas of function, including:

  • -> decline in memory, reasoning + communication skills
  • -> inability to carry out daily activities
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2
Q

Dementia definition

A

Clinical syndrome characterised by a cluster of symptoms manifested by difficulties in memory, language, behavioural, psychological changes and impairments in daily living

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3
Q

Mini Mental State Exam

A

Time orientation- what is date
Information- something that happened in news recently
Recall test- give name + address, want u to repeat it, will ask again in few minutes
Clock drawing task
5-8= mild impairment
<4= cognitive impairment

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4
Q

Degenerative or inherited

A 
Alzheimer's 62%
Lewy body dementia
Huntington's 
Pick's
MS
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5
Q

Vascular

A

Vascular dementia 17%

Cerebral vasculitis

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6
Q

Space-occupying lesions

A

Chronic hydrocephalus

Tumour

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7
Q

Infection

A

HIV-associated dementia
Abscess
Syphilis
Post-meningitis

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8
Q

Traumatic

A

Post head trauma

Boxing

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9
Q

Toxic

A

Cerebral anoxia

Alcohol + drugs

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10
Q

Metabolic or nutritional causes

A

Hypothyroidism
Hypocalcaemia
Vit B12/folic acid/niacin
Thiamine deficiency –> Korsakoff’s and Wernicke’s

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11
Q

Non-modifiable risk factors

A

Age
Genetics
Family history
Down’s

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12
Q

Modifiable RFs

A

Vascular (high cholesterol, hypertension, diabetes)
Cognitive inactivity (low education attainment)
Environment (head injury in boxers)
Depression

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13
Q

Alzheimer’s pathophysiology

A 
Beta amyloid plaques
Tau neurofibrillary tangles
Neurotic dystrophy
Synaptic loss
Selective neuronal loss
Significant loss cholinergic cells
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14
Q

Beta amyloid plaques

A

Extracellular deposits of Beta amyloid peptide in senile plaques
Deposits of Beta amyloid peptide in cerebral vessels

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15
Q

Tau tangles

A

Intraneuronal neurofibrillary tangles (hyper-phosphorylated tau protein) in cell bodies + neurites

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16
Q

Genetic factors - early onset AD

A 
Amyloid precursor protein (APP)- chromosome 21
Presenilin 1 (PSEN1)- chromosome 4
Presenilin 2 (PSEN2)- chromosome 1
17
Q

Genetic factors- late onset AD

A

Apolipoprotein E (APOE)- chromosome 19

18
Q

APP

A

Single transmembrane polypeptide
APP abundantly expressed in neurones
Also expressed in glia and endothelial and smooth muscle cells
APP increase A beta production

19
Q

Alzheimer’s pathology

A

Extreme shrinkage of hippocampus
Extreme shrinkage of cerebral cortex
Severely enlarged ventricles

20
Q

APP processing

A

Cleaved by 3 secretases- alpha, beta and gamma secretase
Cleaved in non-amyloidogenic (alpha and gamma) and amyloidogenic (beta and gamma) pathway
Amyloidogenic pathway –> production of A beta 40-42, which form fibrillar insoluble plaques between neurones

21
Q

PSEN

A

PSEN 1 + 2 are subunits of gamma secretase (responsible for A Beta generation)
PSEN 1- most common cause of early onset Alzheimer’s
PSEN 2- least common cause of early onset Alzheimer’s

22
Q

APOE

A 
Secreted lipoprotein
Involved in cholesterol metabolism
Strong RF for late onset
APOE 2, 3 and 4
ApoE4- shown to decrease clearance of extracellular A beta
23
Q

Tau

A

Microtubule-associated protein
Role in microtubule stabilisation + axonal transport
Phosphorylation of tau regulates its activity to bind to microtubules
Hyperphosphorylation of tau results in formation of neurofibrillary tangles - primarily composed of paired helical filaments

24
Q

Nicotinic receptors

A

Ion-gated receptor channels

Selective for cations- K+, Na+ and Ca2+

25
Q

Muscarinic receptors

A

G protein coupled receptors

26
Q

ACh synthesis

A

Synthesised from choline and acetyl-CoA by choline acetyltransferase

27
Q

ACh transferred into synaptic vesicles by…

A

Vesicular acetylcholine transporter

28
Q

ACh hydrolysis

A

By acetylcholinesterase into choline and acetate

Recycled into pre-synaptic neurone by high affinity choline transporter (CHT1)

29
Q

What neurones are main neurones affected in Alzheimer’s

A

Cholinergic neurones

30
Q

AChE inhibitors

A

Increase ACh levels + reduce anxiety, improve motivation, memory and concentration, and improve ability to continue activities of daily living

31
Q

Donepezil

A

AChE inhibitor

32
Q

Rivastigmine

A

AChE inhibitor

33
Q

Galantamine

A

AChE inhibitor

34
Q

Memantidine

A

Moderate to severe Alzheimer’s
Intolerant to AChE inhibitors
Reduces glutamate excitatory neurotoxicity
NMDA receptor antagonist
Works on ion channel + extracellular surface of receptor

35
Q

Anti-amyloid strategies

A

Inhibition or stimulation of secretases involved in APP metabolism
Selective reduction of ABeta42 synthesis
Prevention of amyloid aggregation
Anti-amyloid immunotherapy

BB CC (29 decks)

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