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Neurology > Dementia > Flashcards

Dementia Flashcards

1
Q

Describe the pathophysiology of Alzheimer’s disease (AD)?

A

Neurodegenerative proteinopathy (amyloid)
Disruption of cholinergic pathways in the brain + synaptic loss
- extracellular amyloid plaques
- intracellular neurofibrillary tangles

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2
Q

In which genetic condition is early onset AD inevitable?

A

Down’s syndrome

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3
Q

Which gene may be implicated in AD?

A

ApoE gene

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4
Q

Which investigations can be done for suspected AD and what will they show?

A

MRI: atrophy of temporal/parietal lobes
SPECT: temporoparietal reduced metabolism
CSF: reduced amyloid:tau ratio

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5
Q

Which treatments are available for AD and how do they work?

A

Acetylcholine boosting treatment:

  • cholinesterase inhibitors
  • NMDA receptor blockers
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6
Q

Give two examples of cholinesterase inhibitors?

A

Rivastigmine

Galantamine

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7
Q

Give an example of a NMDA receptor blocker?

A

Memantine

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8
Q

What is another name for fronto-temporal dementia?

A

Pick’s disease

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9
Q

What are the histopathological findings in fronto-temporal dementia?

A

Tau proteins

Pick bodies

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10
Q

Which other neurodegenerative condition is linked with fronto-temporal dementia and what is the causative gene?

A

MND

C9orf72

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11
Q

What are the clinical features of fronto-temporal dementia?

A 
Disinhibition
Apathy (loss of interest)
Lack of empathy
Stereotyped or compulsive behaviours
Hyperorality (putting things in mouth)
Changes in food preferences 
Early loss of insight
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12
Q

What would be seen on MRI in fronto-temporal dementia?

A

Frontotemporal atrophy

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13
Q

What would be seen in the CSF of someone with fronto-temporal dementia?

A

Increased Tau

Normal amyloid

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14
Q

Which drugs can be helpful for the behavioural features of fronto-temporal dementia?

A

Trazadone (antidepressant)

Antipsychotics

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15
Q

What is the genetic mutation in Huntington’s disease and what does it cause?

A

Expansion of CAG trinucleotide repeat on huntingtin gene

–> produces neurodegenerative protein (hungingtin)

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16
Q

What are the clinical features of Huntington’s disease?

A

Early onset dementia (30-50)
Changes in mood/personality
Chorea
Psychosis

17
Q

What is the pattern of inheritance in Huntington’s disease?

A

Autosomal dominant

18
Q

What would be seen on MRI in Huntington’s?

A

Loss of caudate heads

19
Q

What are the core criteria for vascular dementia?

A
  1. Presence of cerebrovascular disease

2. Clear relationship between onset of dementia and CVD

20
Q

How do symptoms classically present and progress in vascular dementia?

A

Sudden onset

Stepwise progression

21
Q

How is vascular dementia managed?

A

Modify vascular risk factors

+/- cholinesterase inhibitor

22
Q

What is the causative protein in Lewy body dementia?

A

alpha-synuclein

23
Q

Which pathways are disrupted in Lewy body dementia?

A

Cholinergic + dopaminergic

24
Q

What are the 3 core criteria for Lewy body dementia?

A
  1. Fluctuating cognition
  2. Recurrent visual hallucinations
  3. Extrapyramidal features (parkinsonism)
25
Q

What are the treatment options for Lewy body dementia?

A

Small dose levodopa

Trial cholinesterase inhibitor

26
Q

Who would you refer a patient to if they are over 65 with gradual onset dementia symptoms and no additional neurology?

A

Old age psychiatry

27
Q

What would warrant a referral to neurology for a patient with dementia symptoms?

A
  • age < 65
  • unusual features including speed of onset
  • additional neurology
28
Q

What are the different components of assessment in a memory clinic?

A
  • history from patient
  • collateral history from relative
  • Addenbrook’s Cognitive Assessment
  • MRI (patterns of atrophy)/ SPECT
  • dementia screen bloods
  • neuropsychology
  • possibly CSF
29
Q

What are the dementia screen bloods?

A 
B12
TFTs
syphilis
HIV
calcium etc
\+/- genetic test
30
Q

Which screening tests does NICE recommend for dementia?

A

MMSE - if suspected cognitive assessment

Addenbrookes - improves on initial cognitive assessment

31
Q

How is the MMSE score interpreted?

A 
>27/30 = no cognitive impairment
<24/30 = supports dementia
32
Q

What are the components of the Addenbrookes?

A 
Orientation and attention
Memory
Fluency
Language
Visuospatial functioning
33
Q

How are the Addenbrookes scores interpreted?

A

> 88/100 = likely no cognitive impairment

< 82/100 = supports dementia

Neurology (16 decks)

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