Dementia Flashcards
What is the commonest cause of dementia?
Alzheimers
What type of drug has modest symptomatic benefit in early stages?
acetylcholinesterase inihibitors
What is young onset dementia?
Less than 65
Why is it hard to accurately diagnose dementia in clinic?
- Follow heterogenous. course
- In old age disease presentation is of multiple comorbities
- Lots of mixed and uncertain. pictures (with pathology)
- Important clinical history and function. and how it has changed
What are some pathologies in brain? Most mixed
- Neuronal tau
- A beta
- TDP-43
- Alpha synuclein
- Parenchymal ischaemic changes
- Vessel wall pathology. e.g. cerebral amyloid angiopathy
- Amyloid and tau major for Alzhiemers
What is dementia?
Severe loss of memory and other cognitive abilities which leads to impaired daily function (regardless of underlying cause)
What investigations would you do?
- Neuropsychology
- Bloods
- MRI
- PET
What is MMSE?
Cognitive test
What bloods do you order?
- FBC
- Inflammatory markers
- Thyroid function
- Biochemistry and renal function
- Glucose
- B12 anf folate
- Clotting.
- Syphillus serology
- HIV
- Caeruloplasmin
What happens to the brain as the disease progresses?
- Narrow gyri
- Widend sulci
- Ventricles dilated at arch
- Medial temporal volume loss bilaterally
- hippocampus volume loss
Why are amyloid PET scans good?
- Diagnosis made not post mortem
- Lights up amyloid
What are some differential diagnosis?
- Alzheimer’s
- Vascular dementia
- Lewy body dementia
- FTD
- Depression
- Delirium
- Mixture or none, or functional neurological disorder that improves over time
What are management options?
- Actylcholinesterase inibitors (A)
- Watch and what as unsure
- Treat behavioural psychological symptoms
- Occupational therapist / social services
- Specialist therapy
What are major symptoms of Alzheimers?
- Subtle
- Insidious amnestic/non amnestic presentation
What are symptoms of vascular dementia?
- Related to cerberovascular disease with a. classical step wise deterioration
- Usually Multiple infarcts
What are symptoms of dementia with Lewy bodies?
- Cognitive impairment before/within 1 year of Parkinsonian symptoms
- Visual hallucinations
- Fluctuating cognition
- REM sleep disorder
- High risk of falls
- Preserved hippocampal and medial temporal volume
- Decreased availability of dopamine transporters in Lewy body compared to Alzheimers
What are symptoms of frontotemporal dementia?
- Behavioural variant FTD
- Semantic dementia
- Progressive non-fluet aphasia
What can happen in Alzheimer’s?
- Patient lack of awareness of
- History (collateral) v important
- Increasingly irritable, watch thing both
- Wrong medication taking
What do you find in the examination for Alzheimers?
- Head turning sign (unsure of answer)
- Vague about recent news events and sports result
- Not certain about route to hospital
- MMSE and ACE
What is the neuropsychology in Alzheimers?
- Profound impairment of episodic memory
- Particularly in relation to recently learned material
What is episodic memory?
- Memory for particular episodes in life
2. dependent on the medial temporal lobes including the hippocampus
What is the pathology in Alzheimers?
amyloid and then tau then neurodegenration
What happens if amyloid PET is negative?
low likelihood Alzheimer’s
How does CSF change Alzheimers?
lower in beta-amyloid and higher in tau
