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Neurology > Dementia > Flashcards

Dementia Flashcards

1
Q

What encompasses cognition?

A

Attention
Social functioning (judgement, evaluation, reasoning)
Language (comprehension and production of language)
Executive function (problem solving, decision making)
Formation and knowledge of memory

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2
Q

What is the clinical definition of dementia?

A

Evidence of significant cognitive decline in at least 1 cognitive domain (attention, executive, learning and memory, perceptuo-motor or social cognition)
PLUS: cognitive deficits interfering with independence of everyday activities
PLUS: not better explained by another process/ do not occur exclusively in the context of delirium

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3
Q

What are acute cognitive disorders?

A

Viral encephalitis
Head injury
Stroke

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4
Q

What are the symptoms of viral encephalitis?

A

Memory
Behaviour change
Language

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5
Q

What are the symptoms of acute cognitive disorder in the context of head injury?

A

Attention
Memory
Executive function

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6
Q

What are the clinical features of transient global amnesia?

A

Abrupt onset antegrade more than retrograde amnesia
Preserved knowledge of self
Always less than 24 hours
Generally a once off

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7
Q

What are triggering factors for transient global amnesia?

A

Emotion/ changes in temp

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8
Q

What are the clinical features of transient epileptic amnesia?

A

Forgetful/ repetitive questioning
Can carry out complex activities with no recollection of events
Short lived (20-30 mins)

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9
Q

What is transient epileptic amnesia associated with?

A

Temporal lobe seizures

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10
Q

What is the differential for sub-acute cognitive disorders?

A 
Toxins; alcohol, carbon monoxide 
Neurodegeneration: CJD
Metabolic: B12, calcium, thyroid 
Infection: HIV, syphilis 
Functional
Mood disorders
Inflammatory: limbic encephalitis
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11
Q

What are the clinical features of functional cognitive impairment?

A

Everyday forgetfullness impacting on functioning
Fluctuation of symptoms
Mismatch between: symptoms + reported function/ symptoms _ symptoms of known neurodegenerative disorders

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12
Q

What is the treatment for functional cognitive impairment?

A

Exclude a mood disorder

Refer to neuropsychology

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13
Q

What is the most common prion disease?

A

CJD

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14
Q

What are the 4 subtypes to CJD?

A

Sporadic
Variant
Iatrogenic
Genetic

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15
Q

What causes variant CJD?

A

Exposure to BSE

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16
Q

What can be seen in histology of CJD?

A

Spongiform change

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17
Q

What can be seen in the CSF of CJD?

A

14-3-3
S100b
RT-QuIC

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18
Q

What is the commonest dementia syndrome?

A

Alzhemiers

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19
Q

What is the pathology behind alzheimer’s disease?

A

Neurodegenerative amyloid proteinopathy
Disruption of cholinergic pathways in the brain + synaptic loss results in extracellular amyloid plaques and intracellular neurofibrialty tangles

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20
Q

Which proteinopathy is assoc with alzheimer’s disease?

A

Amyloid

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21
Q

What are the initial symptoms of alzheimer’s disease?

A

General forgetfulness

22
Q

Which areas of the brain are most commonly affected by alzheimer’s disease?

A

Medical hippocampus and lateral parietal lobes (apraxia and visuospatial difficulties)

23
Q

What will posterior cortical atrophy result in?

A

Visuospatial disturbance

Commonly referred from ophto

24
Q

What are the different types of progressive primary aphasia?

A

Semantic
Logopenic aphasia
Non-fluent aphasia

25
Q

What investigations should be ordered in alzheimer’s disease?

A

MRI; atrophy of temporal/ parietal lobes
SPECT; temporoparietal decreased metabolism
CSF: decreased amyloid: increased TAU

26
Q

What is the treatment for alzheimer’s disease?

A

Address vascular risk factors
ACh boosting: cholinesterase inhibitors (rivastigmine)
NMDA receptor blockers; memantine

27
Q

What ages will be affected by frontotemporal dementia?

A

Early onset; before age 65

28
Q

What will be seen on pathology in FTD?

A

Pick body

29
Q

Which protein is involved in the progression of FTD?

A

Tau and ubiquitin

30
Q

What are the presentations of FTD?

A

Frontal features; disinhibition, apathy, loss of empathy, stereotyped or compulsive behaviours, hyperorality
Early loss of innsight

31
Q

What are the genetic causes of FTD?

A

C9orf

32
Q

What investigations should be done in FTD?

A

MRI; atrophy of frontotemporal lobes
SPECT; frontotemporal decreased metabolism
CSF; Increased TAU/ normal amyloid

33
Q

What is the treatment for FTD?

A 
Trial of trazadone/ antipsychotics
Not really anything 
Safety management; controlled access to food/ money/ internet 
Power of attorney
Support
34
Q

What is the core criteria for vascular dementia?

A

Presence of CVD

A clear temporal relationship between the onset of dementia and CVD

35
Q

What are the presentations of vascular dementia?

A

Subcortical (small vessel disease): decreased attention, executive dysfunction and slowed processing
Post-stroke dementia
Co-existing amyloid with a prognosis similar to AD

36
Q

What is the management of vascular dementia?

A

Vascular risk factors +/- cholinesterase inhibitor

CPN (community psychiatric nurse)

37
Q

What protein is involved in the progression of lewy body dementia?

A

Alpha-synuclein

38
Q

What is the pathogenesis of lewy body dementia?

A

Alpha synuclein aggregates which build up in the cell resulting in dysfunction and a lack of cholinergic and dopaminergic pathways

39
Q

What is the core criteria for DLB?

A

Fluctuating cognition
Recurrent well-formed visual hallucinations
Presence of extrapyramidal features (parkinsonism)
Neuroleptic sensitivity; gets MUCH worse with haloperidol

40
Q

What investigations should be performed in DLB?

A

DaT (dopamine transporter imaging)

41
Q

What is the treatment for DLB?

A

Small dosages of levodopa if motor features
Trial cholinesterase inhibitors
PD nurse specialist

42
Q

What is the difference between parkinson’s disease dementia and dementia with lewy bodies?

A

DLB; dementia within 1 year of presentation

PDD; dementia presents after 1 year

43
Q

Cardinal symptoms of PD?

A

Bradykinesia
Ridigidy
Tremor
Dementia (decreased attention, slowness of processing, impaired visuospatial functions and memory) +/- hallucinations

44
Q

What is the pathogenesis of huntington’s disease?

A

CAG repeats on huntingtin gene

45
Q

What is the protein involved in the progression of huntington’s disease?

A

Huntingtin

46
Q

What dementia is assoc with huntington’s disease?

A 
Dyexecutive syndrome + slowed speed of processing 
Eventual involvement of memory 
Changes in mood/ personality 
Chorea
Psychosis
47
Q

What is the treatment for huntington’s disease?

A

Mood stabilisers
Treatment for chorea
HD nurse specialist

48
Q

What will the MRI for huntington’s disease show?

A

Atrophy of caudate lobes

49
Q

Who should you refer to neurology with symptoms of dementia?

A

Under 65 or any unusual features with additional neurology

50
Q

What bloods are involved in the “dementia screen”?

A 
B12
TFTs
Syphilis
HIV
Ca2+ 
\+/- genetic panel
51
Q

What cognitive assessment should be performed in a memory clinic?

A

Addenbrooke’s cognitive assessment

52
Q

Describe the main neurodegenerative proteinopathies

A 
AS = amyloid
PDD/DLB = alpha-synuclein 
CJD = prion 
FTD = Tau
HD = huntingtin

Neurology (48 decks)

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