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Neurology > Dementia > Flashcards

Dementia Flashcards

1
Q

What is the definition of cognition?

A

The mental action of acquiring knowledge and understanding through thought, experience, and the senses.

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2
Q

What processes does cognition encompass?

A 
attention
social functioning 
language 
memory formation
executive function
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3
Q

What is executive function?

A

problem solving / decision making

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4
Q

What is the criteria for dementia?

A

Evidence of significant cognitive decline in at least 1 cognitive domain or social cognition.

PLUS this interferes with independence in everyday activities.

PLUS there is no better explanation / this does not occur exclusively in a delirious context.

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5
Q

What sort of cognitive dysfunction might you see in viral encephalitis?

A

memory, behaviour change and language problems

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6
Q

70 y/o patient received some bad news and for the proceeding 5hrs could only recall the last few minutes before he received the bad news. The patient was still able to talk, tell you basic information about themselves but they could not remember things you said to them.
Diagnosis?

A

transient global amnesia

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7
Q

What are some triggering factors for transient global amnesia?

A

emotion

changes in temperature

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8
Q

Which type of amnesia is associated with temporal lobe seizures? Describe an episode of this amnesia.

A

Transient epileptic amnesia
Short-lived (20-30mins) and repetitive (e.g. questioning).
Can carry out complex activities with no recollection of events.

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9
Q

A patient had a 20 minute episode of asking the same questions over and over and who when the episode ended they had no recollection of the events. How could you confirm this diagnosis?

A

should respond to anti-epileptic medication

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10
Q

Patient presents complaining they can’t remember anything. This has been happening on and off for the past 6 months and they have also noticed reduced concentration levels. They work in an office and are worried since they say they used to have a really good memory/.
Diagnosis?

A

Functional (subjective) cognitive impairment

mismatch between symptoms + reported function, e.g. still maintains their job despite forgotten “everything”

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11
Q

Give an example of prion disease.

A

Creutzfeldt-Jakob disease

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12
Q

What diagnostic pathological change would you see in CJD?

A

spongiform change

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13
Q

Disruption of cholinergic pathways in the brain seen in Alzheimer’s results in formation of what?

A

Extracellular amyloid plaques

intracellular neurofibrillary tangles

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14
Q

In which area of the brain does Alzheimer’s disease start?

A

hippocampus

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15
Q

What is the age differences between early onset and sporadic Alzheimer’s?

A 
<65 = early onset
>65 = sporadic
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16
Q

what are 2 atypical presentations of Alzheimer’s?

A

posterior cortical atrophy

progressive primary aphasia

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17
Q

60 y/o patient is referred from ophthalmology. Their PC was difficulty reading, depth perception, visuospatial awareness and some apraxia.
Diagnosis?

A

Posterior cortical atrophy

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18
Q

What is semantic aphasia?

A

difficulty naming things

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19
Q

What is logopenic aphasia?

A

unable to repeat long sentences back to you

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20
Q

What is non-fluent aphasia?

A

effortful speech - staccato speech which is eventually lost completely

21
Q

Which type of atypical dementia is semantic, logopenic and non-fluent aphasia part of?

A

progressive primary aphasia

22
Q

What ratio are you looking for in CsF analysis for dementia?

A

low amyloid : high tau

23
Q

Type of investigation that identifies defects in perfusion & metabolism in temporal/parietal lobes?

A

SPECT

24
Q

What treatment can you provide in dementia?

A

address vascular risk factors

acetylcholine boosting therapy - cholinesterase inhibitors / NMDA receptor blocker

25
Q

Which protein aggregate is seen in Front-temporal dementia?

A

ubiquitin (comes from TAU)

26
Q

List the 3 presentations of FTD.

A

behavioural variant
early frontal features
early loss of insight

27
Q

60 y/o patient presents with reduced cognitive function but appears happy/slightly exaggerated and out of character whilst family is highly concerned.
Diagnosis?

A

FTD with early loss of insight

28
Q

Fronto-temporal dementia is late onset.

T/F?

A

false

early onset <65

29
Q

Daughter has brought her mother (63) to practice after she has recently become disinhibited, and has become very unsympathetic and empathetic with family members. She has a recent history of forgetting things.

A

FTD with early frontal features.

30
Q

What would you expect to see on CSF analysis in FTD?

A

increased TAU : normal amyloid

31
Q

What treatment would you try in a dementia patient with behavioural features?

A

trazadone / antipsychotics

32
Q

Vascular dementia is an early onset dementia.

T/F?

A

false

late >65

33
Q

What are the core criteria for vascular dementia?

A

presence of cerebrovascular disease + clear temporal relationship between the onset of dementia and cerebrovascular disease.

34
Q

What is the typical presentation of subcortical (small vessel disease) VaD?

A

decreased attention, executive dysfunction and slowed processing

35
Q

within how many months of a stroke does post-stroke dementia occur?

A

<3 months

36
Q

Give examples of acetylcholine boosting therapy drugs.

A

rivastigmine / galantamine = cholinesterase inhibitors

memantine = NMDA receptor blocker

37
Q

Which protein aggregates in Lewy body dementia and which pathways does it disrupt?

A

alpha-synuclein

disrupts cholinergic and dopaminergic pathways

38
Q

What is the core criteria for dementia with Lewy bodies?

A

fluctuating cognition +
recurrent wellformed visual hallucinations ±
presence of extrapyramidal features (seen in 75%)

39
Q

Dementia patient comes into hospital agitated and is given haloperidol which makes them much worse.
which type of dementia do they have and what is this feature?

A

lewy body dementia

neuroleptic sensitivity

40
Q

What investigation would you do if you suspected your patient had Lewy body dementia?

A

DaT scan (dopamine transporter imaging)

41
Q

What is the treatment for Lewy body dementia?

A

small dose levodopa / reduce acetylcholine by trial of cholinesterase inhibitors

42
Q

What is the difference between Parkinson’s disease Dementia and Dementia with Lewy bodies?

A

PDD = >1yr motor symptoms before dementia.

DLB = dementia <1yr presentation

43
Q

What dementia is seen in Huntington’s disease?

A

dysexecutive syndrome + slowed speed of processing

44
Q

If you were to MRI a patient with Huntington’s, what would you see?

A

loss of caudate heads

45
Q

What is the treatment for Huntington’s disease?

A

mood stabilisers

chorea therapy

46
Q

Which dementia(s) are due to amyloid proteinopathy?

A

vascular dementia

alzheimer’s

47
Q

Which dementia(s) are due to alpha-synuclein proteinopathy?

A

Parkinson’s disease dementia

Dementia with Lewy bodies

48
Q

Which neurodegenerative proteinopathy causes CJD?

A

prion

49
Q

Tau & ubiquitin are involved in which dementia?

A

FTD

Neurology (11 decks)

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