Dementia

Question 1

What are amyloid plaques that are commonly present in dementia?

Answer 1

Insoluble beta amyloid peptide deposits or beta pleated sheets- they are dense and take uo lots of brain space

Question 2

What are neurofibrillary triangles commonly present in dementia?

Answer 2

Phosphorylated tau protein (they are also found in normal ageing)

Question 3

What are the most affected areas in the brain in dementia?

Answer 3

Hippocampus and cerebral cortex

Question 4

How do PET scans of brains of dementia patients differ?

Answer 4

They are more red

Question 5

What chromosomes are involved with increased genetic risk of dementia?

Answer 5

21, 19, 14, 1

Question 6

What medicine is commonly given in dementia that draws upon the cholinergic hypothesis? How does it work?

Answer 6

Donepezil, its an acetylcholine inhibitor

Question 7

What is the cholinergic hypothesis of dementia?

Answer 7

Pathological changes lead to degeneration of cholinergic nuclei in the basal forebrain

Question 8

What might psychiatric symptoms of dementia be?

Answer 8

Delusions, hallucinations (auditory or visual), depression

Question 9

What does diagnosis of Alzheimer’s require?

Answer 9

1) Presence of dementia
2) Insidious onset
3) There is a deterioration from the individual’s baseline
4) Not more likely to be accounted for by another cause (for example, other types of dementia, neurological, medical or psychiatric comorbidities).

Question 10

What is the name of the exam performed when Alzheimer’s is suspected?

Answer 10

Mini mental state exam

Question 11

What is confabulation?

Answer 11

When people make up stories because they don;t remember (often as an anxiety defence mechanism)

Question 12

What is an important differential to consider when someone presents and you suspect dementia? How can they be differentiated?

Answer 12

Delirium
Delirium will have an acute onset, dementia an insidious one, delirium will be fluctuating but dementia will be progressive, consciousness will be altered in delirium but usually clear in dementia,

Question 13

What is the most common cause of dementia?

Answer 13

Alzheimers

Question 14

Define dementia

Answer 14

Severe loss of memory and other cognitive abilities which leads to impaired daily function

Question 15

What are important things to ask about when you suspect dementia and are taking a history?

Answer 15

Memory
Language
Numerical skills
Executive skills
Visuospatial skills
Neglect phenomena
Visual perception
Personality and social conduct
Eating
Mood
Anxiety/agitation
Delusions/hallucinations

Question 16

What examinations are carried out when dementia is suspected?

Answer 16

Neurological exam
Mental state exam
Cranial nerves exam

Question 17

How will the MRI of someone with Alzheimer’s appear different?

Answer 17

Narrow gyri
Widened sulci
Widened ventricles
Volume loss (markedly hippocampal)

Question 18

How is amyloid imaged in the brain? How will it differ in someone with Alzheimer’s

Answer 18

Via amyloid PET

Someone who has Alzheimer’s will have lower levels of amyloid in their brain

Question 19

How is Alzheimer’s treated?

Answer 19

Acetylcholinesterase inhibitor
Treat other symptoms
Social services referral

Question 20

How long must decline be present for there to be a confident diagnosis?

Answer 20

6-12 months

Question 21

Describe the main characteristics of Alzheimer’s

Answer 21

Subtle with insidious amnestic/non amnestic presentation

Question 22

Describe the main characteristics of vascular dementia

Answer 22

Step wise deterioration, multiple infarcts, related to cerebrovascular disease

Question 23

Describe the main characteristics of dementia with lewy bodies

Answer 23

Primary cognitive impairment within 1 year of parkinsonian symptoms
Visual hallucinations
Fluctuating cognition

Question 24

Describe the main characteristics of frontotemporal dementia

Answer 24

Behaviour variance

Progressive non fluent aphasia

Question 25

What biochemical test can be done to help with dementia diagnosis?

Answer 25

CSF sample analysis looking for amyloid and tau

Question 26

How do patients with Alzheimer’s typically present?

Answer 26

Forget their medication
Watch the same film twice with no recollection
Asks similar questions daily
Forgets the directions to places they go often
Turn their head when you ask them a question

Question 27

How do patients with dementia with Lewy bodies typically present?

Answer 27

Able to do less than previously
Behaviour is normal
Fine on some days but disorientated on others
Daily visual hallucinations
Fluctuating cognition
REM sleep disorder (lash out in sleep, talking, shouting)

Question 28

In which type of dementia is hippocampal volume preserved?

Answer 28

Dementia with Lewy bodies

Question 29

How do patients with frontotemporal dementia typically present?

Answer 29

Disturbed speech- they speak as if they are dyslexic
Rude often
Bad hygiene
Stubborn food cravings
Can't identify objects well
Extensive temporal lobe volume loss
Difficulty doing some gestures