Dementia

Question 1

Define dementia [4]

Answer 1

• A neurodegenerative syndrome with progressive cognitive decline in several domains which:
  
  • interferes with the ability to function at work or at usual activities and
  • represent a decline from previous levels of functioning and performing and
  • is not explained by delirium or major psychiatric disorder

Question 2

The cognitive or behavioral impairment in dementia involves a minimum of two of what domains? [5]

Answer 2

1. Memory
2. Executive function
3. Language
4. Apraxia (difficulty with motor effect even though understanding is intact)
5. Visuospatial dysfunction

Question 3

What are the causes of dementia? [8]

Answer 3

VITAMINS

1. Vascular
2. Infections (syphilis/HIV/lyme disease)
3. Toxic (Wernicke’s/B12)
4. Autoimmune encephalitis
5. Metastatic/neoplastic
6. Iatrogenic
7. Neurodegenerative (2 examples AD)
8. Systemic/seizure

Question 4

Where does Alzheimer’s normally start? and where does it spread to? [2]

Answer 4

1. starts in temporal
2. spreads to parietal/frontal

Question 5

What are the following basal ganglia loops responsible for?

1. motor loop? [1]
2. prefrontal loop? [1]
3. limbic loop? [1]

Answer 5

1. motor loop → motor
2. prefrontal loop → mood
3. limbic loop → memory

Question 6

Describe the symptoms associated with memory dysfunction [5]

Answer 6

• Impaired ability to acquire and remember new information → symptoms include:
  
  • repetitive questions or conversations,
  • misplacing personal belongings,
  • forgetting events or appointments,
  • getting lost on a familiar route

Question 7

Describe the symptoms associated with impairment in executive function [5]

Answer 7

• Impaired reasoning and handling of complex tasks, poor judgment → symptoms include:
  
  • poor understanding of safety risks,
  • inability to manage finances,
  • poor decision making ability,
  • inability to plan complex or sequential activities

Question 8

Describe the symptoms associated with visuospatial dysfunction [4]

Answer 8

• Impaired visuospatial abilities → symptoms include:
  
  • inability to recognize faces or common objects or to find objects in direct view despite good acuity,
  • inability to operate simple implements
  • inability to orient clothing to the body

Question 9

Describe the symptoms associated with language dysfunction [3]

Answer 9

• Impaired language functions (speaking, reading, writing) → symptoms include:
  
  • difficulty thinking of common words while speaking,
  • hesitations with speech and spelling
  • writing errors

Question 10

What does the Addenbrookes cognitive assessment examine/assess? [6]

Answer 10

1. Memory
2. Attention/Concentration
3. Language
4. Visuospatial
5. Executive function
6. Purpose: to assess…
   
   • Severity
   • Pattern of impairment

Question 11

Describe the functions of the following parts of the frontal cortex of the brain:

1. Orbitofrontal cortex? [2]
2. Dorsolateral prefrontal cortex? [3]
3. Anterior cingulate? [1]

Answer 11

1. Orbitofrontal cortex
   
   • responsible for behaviour, social awareness
2. Dorsolateral prefrontal cortex
   
   • responsible for working memory, cognitive estimates, planning
3. Anterior cingulate
   
   • responsible for motivation

Question 12

Name the condition that is associated with defects in each of the following brain functions:

1. Episodic memory [1]
2. Semantic memory [2]
3. Attention/conc. [1]
4. Naming [1]
5. Fluency [1]
6. Visuospatial [2]

Answer 12

1. Episodic memory
   
   • Alzheimer’s
2. Semantic memory
   
   • Semantic Dementia
   • Variants: Frontotemporal dementia
3. Attention/conc.
   
   • Delirium
4. Naming
   
   • Progressive non-fluent aphasia
5. Fluency
   
   • Progressive non-fluent aphasia
6. Visuospatial
   
   • PD plus syndrome or variants AD