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Neurology finals > Dementia > Flashcards

Dementia Flashcards

1
Q

What is dementia

A

A neurodegenerative syndrome with progressive decline in several cognitive domains

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2
Q

What is the initial presentation of dementia

A

Memory loss over months/years

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3
Q

What is a diagnosis of dementia made by?

A

History - from patient and collateral narrative
Cognitive testing
Examination - identify and physical cause or risk factors also mental state examination
Medication review - important to exclude drug induced cognitive impairment

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4
Q

List some non-cognitive symptoms of dementia which indicate late disease

A

Agitation
Aggression
Apathy

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5
Q

What tool is used for cognitive testing

A

AMTS

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6
Q

What investigations should be carried out when diagnosing dementia

A 
FBC
B12/folate
Thiamine
Ca2+
MSU
ESR
U&E
LFT
glucose
MRI - vascular or structural pathology 
Functional imaging - help delineate subtypes 
Consider EEG in suspected delirium, frontotemporal dementia, CJD or seizure disorder
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7
Q

List the subtypes of dementia

A 
Alzheimer's disease
Lewy body dementia
Vascular dementia  
Fronto-temporal dementia 
Picks disease
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8
Q

Describe vascular dementia

A

Cumulative effect of many small strokes
Sudden onset and stepwise deterioration is characteristic
Look for evidence of arteriopathy (increased BP, focal CNS signs, past strokes)

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9
Q

Which drugs should you not use for treating vascular dementia

A

Acetylcholinesterase inhibitors and memantine

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10
Q

Describe Lewy body dementia

A

Fluctuating cognitive impairment
Detailed visual hallucinations
Later - parkinsonism

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11
Q

Describe histology in Lewy body dementia

A

Lewy bodies - eosinophilic intracytoplasmic inclusion bodies

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12
Q

Where are Lewy bodies found?

A

Brainstem and neocortex

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13
Q

Which drugs should be avoided in Lewy body dementia

A

Antipsychotics

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14
Q

Why should antipsychotics be avoided in Lewy body dementia?

A

Increased risk of side effects

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15
Q

Describe frontotemporal dementia

A

Frontal and temporal atrophy with loss of >70% of spindle neurons
Patients display executive impairment, behavioural/personality change, disinhibition, hyperorality, stereotyped behaviour and emotional unconcern
Episodic memory and spatial orientation are preserved until later stages

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16
Q

Describe picks disease

A

Few fronto-temporal patients who have pick inclusion bodies on histology

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17
Q

What are pick inclusions?

A

Spherical clusters of tau-laden neurons

18
Q

How is dementia managed?

A

Referral to integrated memory services for further assessment and management
Medication - avoid drugs that impair cognition - neuroleptics, tricyclics and sedatives
Non-pharmacological - non cognitive symptoms may respond to aromatherapy, multisensory stimulation, music and animal assisted therapy

19
Q

What other co-morbidities occur with dementia

A

Depression

Capacity

20
Q

Describe the management of depression with dementia

A

Try SSRI or if severe then try mirtazapine

CBT

21
Q

Describe Alzheimer’s disease and its presentation

A

Leading cause of dementia
Adults >40yo with persisting, progressive and global cognitive impairment: visuospatial skill, memory, verbal abilities and executive function (planning) are all affected, unlike other dementias in which specific domains are affected
Anosognosia - lack of insight into the problems endangered by the disease
Later on there may be irritability, mood disturbance and behavioural change, psychosis, agnosia
No standard history
Cognitive impairment is progressive but non-cognitive symptoms may come and go over months
Eventually patients become sedentary and do not take interest in things

22
Q

Which dementia sometimes coexists with Alzheimer’s disease

A

Vascular dementia (95% of cases)

23
Q

Describe the pathophysiology of Alzheimer’s disease

A

Beta amyloid peptide accumulation which results in progressive neuronal damage, neurofibrillary tangles, increased amyloid plaques and the loss of the neurotransmitter acetylcholine.

24
Q

What is beta amyloid

A

Degradation product of amyloid precursor proteins

25
Q

Where is the neuronal loss in Alzheimer’s disease selective for

A

Hippocampus, amygdala, temporal neocortex and subcortical nuclei

26
Q

What are the risk factors for Alzheimer’s disease

A 
1st degree relative with AD
Downs syndrome - AD is inevitable <40yo 
Homozygosity for apolipoprotein E (APoE) E4 allele
PICALM
CL1 and CLU variants 
Vascular risk factors 
Decreased physical/cognitive activity
Depression
Loneliness
Smoking
27
Q

How is Alzheimer’s disease managed

A

Refer to memory service
Acetylcholinesterase inhibitors
BP control

28
Q

What is the mean survival of Alzheimer’s?

A

7 years from USy

29
Q

Which drug may be given in both Alzheimer’s, Lewy body dementia and Parkinson’s disease

A

Rivastigmine

30
Q

Name some acetylcholinesterase inhibitors

A

Donepezil
Rivastigmine
Galantamine

31
Q

What are the side effects of acetylcholinesterase inhibitors

A

Exacerbate peptic ulcer disease and heart block

32
Q

Name some antiglutamatergic drugs

A

Memantine

33
Q

When is memantine suggested for use in patients with Alzheimer’s disease

A

Late stage AD

Recommended for those intolerable of anticholinesterase inhibitors

34
Q

What are the side effects of memantine

A

Hallucinations
Confusion
Hypertonia
Hypersexuality

35
Q

What is the mechanism of action of memantine

A

NMDA antagonist

36
Q

When are antipsychotics used in the treatment of dementia

A

Severe, non-cognitive symptoms only - psychosis and extreme agitation

37
Q

Describe what antipsychotics increase the risk of

A

Stroke/TIA

38
Q

What complication might occur when antipsychotics are given to those with Lewy body dementia

A

Neuroleptic sensitivity reactions

39
Q

Which vitamin supplement is the best for management of dementia

A

Vitamin E

40
Q

On which chromosome is the APOE4 allele found?

A

Chromosome 19

Neurology finals (32 decks)

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