Dementia Flashcards
Pathology of Alzheimer’s disease
Beta-amyloid plaques
Neurofibrillary tangles of tau protein
Pathology of frontotemporal dementia
Extreme atrophy of frontal and temporal lobes
Pick’s cells, Pick’s bodies
Neurodegenerative proteinopathy (Tau)
Pathology of Lewy Body dementia and Parkinson’s disease dementia
Lewy bodies inside the neurons (contain a-synuclein)
Pathology of vascular dementia
Cerebrovascular disease, reduced blood flow to the brain leading to damage
Pathology of prion disease
Neurodegenerative proteinopathy = change of prion protein within the brain (CJD is most common)
What genes can be associated with autosomal dominant Alzheimer’s disease?
Amyloid precursor protein mutations (chromosome 21)
Presenilin 1
Presenilin 2
APOE gene (e4 allel e predisposes to disease)
What condition is associated with Alzheimer’s disease?
Down’s syndrome
Presentation of Alzheimer’s disease?
Memory loss (short-term) Dysphasia Apraxia (visuospatial difficulties) Agnosia Anosognosia (lack of insight) Insidious impairment of higher intellectual function with alterations in mood and behaviour
What are the different presentations of frontotemporal dementia?
Frontal presentation: behavioural variant
Temporal presentation: primary progressive aphasia (progressive non-fluent aphasia, sematic dementia)
Presentation of the behavioural variant of frontotemporal dementia
Behavioural and personality changes
Presentation of the progressive non-fluent aphasia variant of frontotemporal dementia?
Difficulty pronouncing or speaking words
Presentation of the progressive sematic dementia variant of frontotemporal dementia?
Impaired understanding of words
Fluent speech lacking meaning
What condition can be associated with frontotemporal dementia?
MND
What age group is affected by frontotemporal dementia?
<65yrs
Presentation of Lewy Body dementia
2 of: Visual hallucinations Fluctuating cognition (delirium-like) REM sleep behaviour disorder Parkinsonism (not more than 1yr prior to onset of dementia, TRAP) Positive DAT scan
Presentation of Parkinson’s disease dementia
Same symptoms as Lewy body dementia but have has PD syndrome for >1yr before dementia presentation
Presentation of vascular dementia
Step-wise progression
Similar to Alzheimer’s disease
Dysphasia, dyscalculia, frontal lobe symptoms and affective symptoms more common than in Alzheimer’s
What is the presentation of mild cognitive impairment?
Noticeable cognitive impairment with little deterioration of function
What is the presentation of subjective cognitive impairment?
Patient feels they are cognitively impaired but cognitive testing and day to day function are normal
Normal memory lapses are interpreted as sinister
MRI/CT in Alzheimer’s disease
Atrophy of temporoparietal lobes or medial temporal lobe
MRI/CT in frontotemporal dementia
Atrophy of frontotemporal lobes
DAT scan in Lewy Body dementia and Parkinson’s disease dementia
Reduction of presynaptic dopamine
Comma shape becomes full stop
MRI/CT in vascular dementia
Widespread small vessel disease
Alzheimer’s disease treatment
Anticholinesterase inhibitor: rivastigmine, donepezil, galantamine
NMDA receptor blockers: memantine
Antipsychotics: for agitation
Frontotemporal dementia treatment
Antidepressants (trazadone), antipsychotic can help behavioural features
Frontotemporal dementia prognosis
Rapidly progressive
Life expectancy - 2-10yrs
Lewy Body dementia treatment
Anticholinesterase inhibitor: rivastigmine, donepezil
NMDA receptor blockers: memantine
Levodopa
Antipsychotics make symptoms worse
Vascular dementia treatment
Reduction of vascular risk factors +/- anticholinesterase inhibitors
CSF in Alzheimer’s disease
↓amyloid:↑tau ratio
CSF in frontotemporal dementia
↑tau / normal amyloid
CSF in CJD
↑protein 14-3-3
Cause of normal pressure hydrocephalus
Excess CSF accumulated in the brain’s ventricles
Idiopathic disease of the elderly
Triad of symptoms in normal pressure hydrocephalus
Hakim’s triad:
Abnormal gait
Urinary incontinence
Dementia
In normal pressure hydrocephalus what would be seen after a lumbar drain test?
Mental capacity and physiotherapy assessment should improve