Dementia

Question 1

what is cognition?

Answer 1

mental action of acquiring and understanding information

Question 2

what is dementia?

Answer 2

un-doing of the mind

Question 3

what is the biggest risk factor for dementia?

Answer 3

age

Question 4

causes of acute cognitive decline

Answer 4

focal injuries such as viral encephalitis, head injury and stroke

Question 5

acute cognitive disorder examples

Answer 5

1. transient global amnesia

2. transient epileptic amnesia

Question 6

what is transient global amnesia?

Answer 6

abrupt onset of antegrade amnesia with preserved knowledge of self

Question 7

presentation of transient global amnesia

Answer 7

4-6 hours
antegrade amnesia
>50
triggered by change in temperature or emotion

Question 8

what is transient epileptic amnesia?

Answer 8

associated with temporal lobe seizures causing forgetfulness

Question 9

management of transient epileptic amnesia

Answer 9

AED response

Question 10

causes of sub-acute cognitive disorders

Answer 10

toxins
metabolic changes
inflammation
mood disorders
infection (HIV, syphilis)

Question 11

examples of sub-acute cognitive impairments

Answer 11

1. functional/ subjective cognitive impairment
2. Prion disease
3. Limbic encephalitis

Question 12

what is functional/ subjective cognitive impairment?

Answer 12

everyday forgetfulness impacting on function
fluctuation in symptoms
exclude mood disorder

Question 13

what is prion disease?

Answer 13

CJD is a neurodegenerative proteinopathy with prion building up in the brain

Question 14

examples of gradual onset disorders of cognition

Answer 14

Alzheimer's
FTD
vascular dementia
dementia with LB
PD dementia
Huntington's disease

Question 15

what is the most common form of dementia?

Answer 15

Alzheimer’s disease

Question 16

what is Alzheimer’s disease?

Answer 16

neurodegenerative proteinopathy of amyloid which disrupts cholinergic pathways with synaptic loss due to extracellular amyloid plaques

Question 17

what do intracellular neurofibrillary tangles in Alzheimer’s cause?

Answer 17

disruption to the cytoskeleton and cell death

Question 18

presentation of Alzheimer’s

Answer 18

forgetfulness

apraxia primary progressive aphasia

Question 19

diagnosis of Alzheimer’s

Answer 19

screening tests e.g. MOCA
MRI (atrophy in temporal and parietal lobes)
SPECT (reduced metabolism in temporal and parietal lobes)
CSF= low amyloid with high TAU
amyloid ligand imaging

Question 20

management of Alzheimer’s

Answer 20

ACh boosting= cholinesterase inhibitors e.g. rivastigmine or NMDA blocker e.g. memantine
vascular RF

Question 21

adverse of cholinesterase inhibitors such as rivastigmine

Answer 21

D&V
HA
cramps
bradycardia
worsen COPD/ asthma

Question 22

what should be checked before prescribing cholinesterase inhibitors e.g. rivastigmine?

Answer 22

pulse and before any dose change

Question 23

when should you not use cholinesterase inhibitors?

Answer 23

active peptic ulcer

severe asthma/ COPD

Question 24

adverse of NMDA blocker e.g. memantine

Answer 24

hypertension
sedation
dizziness
HA
constipation

Question 25

what should be checked before starting NMDA blockers e.g. memantine?

Answer 25

BP

Question 26

what is FTD?

Answer 26

early onset dementia caused by neurodegenerative proteinopathy involving the TAU protein which aggregates and causes cell damage

Question 27

presentation of FTD

Answer 27

personality/ behaviour change first, then dementia primary progressive aphasia frontal lobe symptoms MND-FTD spectrum

Question 28

what are some examples of frontal lobe symptoms?

Answer 28

disinhibition apathy empathy lost compulsive behaviour

Question 29

3 syndromes of FTD

Answer 29

1. behavioural variant (frontal) 2. primary progressive aphasia (temporal) 3. semantic dementia (temporal)

Question 30

behavioural variant of FTD

Answer 30

``` behaviour change executive dysfunction disinhibition impulsivity loss of social skills apathy obsessions change in diet ```

Question 31

presentation of primary progressive aphasia

Answer 31

effortful non-fluent speech speech errors lack of grammar and words

Question 32

presentation of semantic dementia in FTD

Answer 32

impaired understanding of meaning of words fluent but empty speech difficulty retrieving names

Question 33

diagnosis of FTD

Answer 33

MRI shows atrophy of FT lobes SPECT has reduced metabolism in FT lobes CSF= high TAU and normal amyloid check FH for MND spectrum

Question 34

management of FTD

Answer 34

trial of trazadone/ antipsychotics to help behavioural features safety management with controlled access to food, money, etc.

Question 35

what is vascular dementia

Answer 35

late onset dementia >65 with the presence of cerebrovascular disease

Question 36

presentation of vascular dementia

Answer 36

memory and personality change in someone with a history of cardiovascular disease step-wise deterioration small vessel disease= reduced attention, slowed processing post-stroke dementia <3 months dysphasia dyscalculi

Question 37

management of vascular dementia

Answer 37

vascular RF +/- cholinesterase inhibitors

Question 38

what is dementia with lewy bodies?

Answer 38

late onset dementia due to neurodegenerative proteinopathy with alpha-synuclein protein

Question 39

what does the alpha-synculein protein in DLB cause?

Answer 39

it is an insoluble protein that disrupts cholinergic and dopaminergic pathways leading to Parkinsonian features

Question 40

presentation of DLB

Answer 40

``` fluctuating cognition vivid visual hallucinations normally of children and not threatening REM disturbance dementia <1 year TRAP features for <1 year ```

Question 41

diagnosis of DLB

Answer 41

clinical DaT protein in CSF or ligand imaging

Question 42

management of DLB

Answer 42

levodopa/ reduced ACh (cholinesterase inhibitors)

Question 43

what is PD dementia?

Answer 43

late onset and have had PD for a number of years before cognitive decline

Question 44

presentation of PD dementia

Answer 44

TRAP features REM disturbance dementia >1 year

Question 45

management of PD dementia

Answer 45

levodopa/ reduced ACh (cholinesterase inhibitors)

Question 46

what is Huntington's disease dementia?

Answer 46

early onset 30-50 years due to expansion of CAG trinucleotide producing neurodegenerative protein (Huntingtin protein)

Question 47

presentation of HD

Answer 47

dementia | associated changes in mood/ personality and chorea +/- psychosis

Question 48

diagnosis of HD

Answer 48

genetics | MRI shows loss of caudate heads

Question 49

management of HD

Answer 49

mood stabilisers | Rx for chorea