Dementia Flashcards
What encompasses cognition?
Attention
Social functioning (judgement, evaluation, reasoning)
Language (comprehension and production of language)
Executive function (problem solving, decision making)
Formation and knowledge of memory
What is the clinical definition of dementia?
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
What are acute cognitive disorders?
Viral encephalitis
Head injury
Stroke
What are the symptoms of viral encephalitis?
Memory
Behaviour change
Language
What are the symptoms of acute cognitive disorder in the context of head injury?
Attention
Memory
Executive function
What are the clinical features of transient global amnesia?
Abrupt onset antegrade more than retrograde amnesia
Preserved knowledge of self
Always less than 24 hours
Generally a once off
What are triggering factors for transient global amnesia?
Emotion/ changes in temp
What are the clinical features of transient epileptic amnesia?
Forgetful/ repetitive questioning
Can carry out complex activities with no recollection of events
Short lived (20-30 mins)
What is transient epileptic amnesia associated with?
Temporal lobe seizures
What is the differential for sub-acute cognitive disorders?
Toxins; alcohol, carbon monoxide Neurodegeneration: CJD Metabolic: B12, calcium, thyroid Infection: HIV, syphilis Functional Mood disorders Inflammatory: limbic encephalitis
What are the clinical features of functional cognitive impairment?
Everyday forgetfullness impacting on functioning
Fluctuation of symptoms
Mismatch between: symptoms + reported function/ symptoms _ symptoms of known neurodegenerative disorders
What is the treatment for functional cognitive impairment?
Exclude a mood disorder
Refer to neuropsychology
What is the most common prion disease?
CJD
What are the 4 subtypes to CJD?
Sporadic
Variant
Iatrogenic
Genetic
What causes variant CJD?
Exposure to BSE
What can be seen in histology of CJD?
Spongiform change
What can be seen in the CSF of CJD?
14-3-3
S100b
RT-QuIC
What is the commonest dementia syndrome?
Alzhemiers
What is the pathology behind alzheimer’s disease?
Neurodegenerative amyloid proteinopathy
Disruption of cholinergic pathways in the brain + synaptic loss results in extracellular amyloid plaques and intracellular neurofibrialty tangles
Which proteinopathy is assoc with alzheimer’s disease?
Amyloid
What are the initial symptoms of alzheimer’s disease?
General forgetfulness
Which areas of the brain are most commonly affected by alzheimer’s disease?
Medical hippocampus and lateral parietal lobes (apraxia and visuospatial difficulties)
What will posterior cortical atrophy result in?
Visuospatial disturbance
Commonly referred from ophto
What are the different types of progressive primary aphasia?
Semantic
Logopenic aphasia
Non-fluent aphasia
What investigations should be ordered in alzheimer’s disease?
MRI; atrophy of temporal/ parietal lobes
SPECT; temporoparietal decreased metabolism
CSF: decreased amyloid: increased TAU
What is the treatment for alzheimer’s disease?
Address vascular risk factors
ACh boosting: cholinesterase inhibitors (rivastigmine)
NMDA receptor blockers; memantine
What ages will be affected by frontotemporal dementia?
Early onset; before age 65
What will be seen on pathology in FTD?
Pick body
Which protein is involved in the progression of FTD?
Tau and ubiquitin
What are the presentations of FTD?
Frontal features; disinhibition, apathy, loss of empathy, stereotyped or compulsive behaviours, hyperorality
Early loss of innsight
What are the genetic causes of FTD?
C9orf
What investigations should be done in FTD?
MRI; atrophy of frontotemporal lobes
SPECT; frontotemporal decreased metabolism
CSF; Increased TAU/ normal amyloid
What is the treatment for FTD?
Trial of trazadone/ antipsychotics Not really anything Safety management; controlled access to food/ money/ internet Power of attorney Support
What is the core criteria for vascular dementia?
Presence of CVD
A clear temporal relationship between the onset of dementia and CVD
What are the presentations of vascular dementia?
Subcortical (small vessel disease): decreased attention, executive dysfunction and slowed processing
Post-stroke dementia
Co-existing amyloid with a prognosis similar to AD
What is the management of vascular dementia?
Vascular risk factors +/- cholinesterase inhibitor
CPN (community psychiatric nurse)
What protein is involved in the progression of lewy body dementia?
Alpha-synuclein
What is the pathogenesis of lewy body dementia?
Alpha synuclein aggregates which build up in the cell resulting in dysfunction and a lack of cholinergic and dopaminergic pathways
What is the core criteria for DLB?
Fluctuating cognition
Recurrent well-formed visual hallucinations
Presence of extrapyramidal features (parkinsonism)
Neuroleptic sensitivity; gets MUCH worse with haloperidol
What investigations should be performed in DLB?
DaT (dopamine transporter imaging)
What is the treatment for DLB?
Small dosages of levodopa if motor features
Trial cholinesterase inhibitors
PD nurse specialist
What is the difference between parkinson’s disease dementia and dementia with lewy bodies?
DLB; dementia within 1 year of presentation
PDD; dementia presents after 1 year
Cardinal symptoms of PD?
Bradykinesia
Ridigidy
Tremor
Dementia (decreased attention, slowness of processing, impaired visuospatial functions and memory) +/- hallucinations
What is the pathogenesis of huntington’s disease?
CAG repeats on huntingtin gene
What is the protein involved in the progression of huntington’s disease?
Huntingtin
What dementia is assoc with huntington’s disease?
Dyexecutive syndrome + slowed speed of processing Eventual involvement of memory Changes in mood/ personality Chorea Psychosis
What is the treatment for huntington’s disease?
Mood stabilisers
Treatment for chorea
HD nurse specialist
What will the MRI for huntington’s disease show?
Atrophy of caudate lobes
Who should you refer to neurology with symptoms of dementia?
Under 65 or any unusual features with additional neurology
What bloods are involved in the “dementia screen”?
B12 TFTs Syphilis HIV Ca2+ \+/- genetic panel
What cognitive assessment should be performed in a memory clinic?
Addenbrooke’s cognitive assessment
Describe the main neurodegenerative proteinopathies
AS = amyloid PDD/DLB = alpha-synuclein CJD = prion FTD = Tau HD = huntingtin
