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Z YEAR 2 BRS NEURO > Dementia > Flashcards

Dementia Flashcards

1
Q

What is the commonest cause of dementia?

A

Alzheimers

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2
Q

What type of drug has modest symptomatic benefit in early stages?

A

acetylcholinesterase inihibitors

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3
Q

What is young onset dementia?

A

Less than 65

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4
Q

Why is it hard to accurately diagnose dementia in clinic?

A
  1. Follow heterogenous. course
  2. In old age disease presentation is of multiple comorbities
  3. Lots of mixed and uncertain. pictures (with pathology)
  4. Important clinical history and function. and how it has changed
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5
Q

What are some pathologies in brain? Most mixed

A
  1. Neuronal tau
  2. A beta
  3. TDP-43
  4. Alpha synuclein
  5. Parenchymal ischaemic changes
  6. Vessel wall pathology. e.g. cerebral amyloid angiopathy
    - Amyloid and tau major for Alzhiemers
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6
Q

What is dementia?

A

Severe loss of memory and other cognitive abilities which leads to impaired daily function (regardless of underlying cause)

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7
Q

What investigations would you do?

A
  • Neuropsychology
  • Bloods
  • MRI
  • PET
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8
Q

What is MMSE?

A

Cognitive test

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9
Q

What bloods do you order?

A
  1. FBC
  2. Inflammatory markers
  3. Thyroid function
  4. Biochemistry and renal function
  5. Glucose
  6. B12 anf folate
  7. Clotting.
  8. Syphillus serology
  9. HIV
  10. Caeruloplasmin
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10
Q

What happens to the brain as the disease progresses?

A
  1. Narrow gyri
  2. Widend sulci
  3. Ventricles dilated at arch
  4. Medial temporal volume loss bilaterally
  5. hippocampus volume loss
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11
Q

Why are amyloid PET scans good?

A
  • Diagnosis made not post mortem

- Lights up amyloid

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12
Q

What are some differential diagnosis?

A
  1. Alzheimer’s
  2. Vascular dementia
  3. Lewy body dementia
  4. FTD
  5. Depression
  6. Delirium
  7. Mixture or none, or functional neurological disorder that improves over time
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13
Q

What are management options?

A
  1. Actylcholinesterase inibitors (A)
  2. Watch and what as unsure
  3. Treat behavioural psychological symptoms
  4. Occupational therapist / social services
  5. Specialist therapy
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14
Q

What are major symptoms of Alzheimers?

A
  • Subtle

- Insidious amnestic/non amnestic presentation

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15
Q

What are symptoms of vascular dementia?

A
  • Related to cerberovascular disease with a. classical step wise deterioration
  • Usually Multiple infarcts
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16
Q

What are symptoms of dementia with Lewy bodies?

A
  1. Cognitive impairment before/within 1 year of Parkinsonian symptoms
  2. Visual hallucinations
  3. Fluctuating cognition
  4. REM sleep disorder
  5. High risk of falls
    - Preserved hippocampal and medial temporal volume
    - Decreased availability of dopamine transporters in Lewy body compared to Alzheimers
17
Q

What are symptoms of frontotemporal dementia?

A
  • Behavioural variant FTD
  • Semantic dementia
  • Progressive non-fluet aphasia
18
Q

What can happen in Alzheimer’s?

A
  • Patient lack of awareness of
  • History (collateral) v important
  • Increasingly irritable, watch thing both
  • Wrong medication taking
19
Q

What do you find in the examination for Alzheimers?

A
  1. Head turning sign (unsure of answer)
  2. Vague about recent news events and sports result
  3. Not certain about route to hospital
  4. MMSE and ACE
20
Q

What is the neuropsychology in Alzheimers?

A
  • Profound impairment of episodic memory

- Particularly in relation to recently learned material

21
Q

What is episodic memory?

A
  1. Memory for particular episodes in life

2. dependent on the medial temporal lobes including the hippocampus

22
Q

What is the pathology in Alzheimers?

A

amyloid and then tau then neurodegenration

23
Q

What happens if amyloid PET is negative?

A

low likelihood Alzheimer’s

24
Q

How does CSF change Alzheimers?

A

lower in beta-amyloid and higher in tau

25
Q

Which areas of medial temporal lobe are affected in Alzheimer’s?

A

Entorhinal cortex and. hippocampus

26
Q

What is dementia with lewy body?

A
  1. Aware of recent news
  2. No evidence of altered behaviour
  3. No evidence of Parkinsonism
  4. 28/30 in MMSE
  5. Daily visual hallucinations
    - Follow up in 6 months
  6. Developed shuffling hair with reduced facial expression
  7. Hallucinations decreased in response to cholinesterase inhibitor with noted improvement in cognition
27
Q

What can happen in FTD?

A
  • Difficulty understanding speech and difficult speaking
  • Rude, and angry
  • Less personal hygiene
  • Volume loss in temporal lobes and frontal opercula more so on the right

Z YEAR 2 BRS NEURO (21 decks)

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