Dementia - Aziz Flashcards
older patients will exhibit which symptoms first?
memory loss
younger pts in the late 40s to 50s will exhibit which symptoms first?
changes in behavior and personality
What part of the brain atrophies in dementia?
frontal atrophy
What does HMPAO SPECT scans show of a brain with dementia?
hypoperfusion in the areas of atrophy
Are the acts of finding and recognizing words the same act?
no, two different acts
Dementia is a decline of…
cognition
What are some of the aspects of cognition beyond memory?
executive function
Most actions happen in which half of the brain while perceptions happen in which half?
actions in front
perceptions in back
Association is (uni/multi)modal
unimodal
T/F: all types of dementia affect the frontal lobe
false
Temporal lobe dementia indicates…..
deeper and usually alzheimers
Hippocampal dementia affects…
short term memory
Frontal-temporal dementia on the (right/left) can lead to broca’s and wernicke’s
left
Broca’s, wernicke’s, Auditory association cortex, somatosensory association, and visual association are all (uni/multi)modal areas
unimodal
What parts of the brain are used in cognition, emotion, and behavior?
thalamus
basal ganglia
pons
cerebellum
T/F: dementia is a purely cortical problem
false
what is the function of the caudate nucleus? what is it a part of?
controls movement
part of basal ganglia
What is the function of the nucleus accumbens?
processes motivation, pleasure, and reward.
part of the basal ganglia
what are the descending pathways from the cortex involved in cognition?
- cortex to pons to cerebellum
2. cortex to basal ganglia
What are the ascending pathways involved in cognition?
- cerebellum to thalamus to cortex
2. basal ganglia to thalamus to cortex
what are the cognitive domains tested in dementia?
Memory (Episodic, Attention Executive function (working memory, mental flexibility, inhibition, fluency, abstract reasoning). Language Visuospatial abilities Behavior assessment Functional status
What are the two most commonly used neuropsych screening tests?
MMSE
MOCA
What is MILD cog impairment?
doesn’t interfere with ADLs; not severe enough to meet dementia criteria
mild cog impairment is in one or multiple domains?
single OR multiple
80% of pts with MCI convert to dementia in what time period?
6 years
What are the risk factor for progression from MCI to dementia?
Apolipoprotein E e4 allelle
poor performance on semantic cueing memory test
reduced hippocampal volumes
Mild cogntive impairment shows the impairment how during assessment?
can drive, handle money, etc, but when you stress them out you see that they are not normal for their age
What is dementia?
PROGRESSIVE deterioration of cognitive function; IMPAIRMENT of social and occupational skills
What is the pathophys of dementia?
relentless brain tissue loss due to multiple degnerative processes
If the loss of function happens in days to weeks, then you don’t have dementia but….
delirum
Dysfunction in dementia occurs at what level?
the neuronal level
Describe the histological changes to the neurons in dementia?
accumulation of protein inside of the cells
neuronal loss
affected glial cells
neurons become swollen and redundant
Neuronal loss in dementia is often secondary to…
protein dysfunction
What are the neurodegenerative types of dementia?
Alzheimer dementia Dementia with Lewy Bodies Frontotemporal dementia Vascular dementia Parkinson Disease Dementtia Corticobasalar degeneration Normal Pressure Hydrocephalus
Alzheimer’s typically have what types of problems?
memory
What are the risk factors for Alzheimer’s?
Age female low level of education Down syndrome head trauam ApoE e4 Genetic: APP, PS1, PS2 CV factors: HTN, hypercholesterolemia, sendentary lifestyle
t/F; Alzheimer’s has modifiable and non-modifiable risk factors
true
what areas of the brain are heteromodal association areas?
prefrontal cortex
part of the temporal lobe
heteromodal means that they take somatosensory, visual, audio, and combine it all together to analyze it, while a unimodal just looks at one sense and what to do with it
the language area of the right temporal lobe is responsible for what?
emotion of language and prosody
the anterior nuclei of the thalamus have what function?
involved in emotion
VA and mediodorsal groups are the main ones for behavior and cognition
which neurotransmitter in which brain structure is essential for LTP?
glutamate in the hippocampus
which neurotransmitter is used in the basal forebrain?
ACh
Accumulation of plaques in Alzheimers is (intercellular/interstitial)
interstitial
What is the protein that makes up the plaques?
Myeloid beta protein
what type of meyloid beta protein the abnormal protein?
AB42
neurofirbrillary tangles are (intraneruonal/interstitial) pathology
intraneuronal!
Alzheimer’s Dx needs impairment in two domains, one of which must be…
memory
What are the “cognitive” disturbances that must be present along with memory issues for Alzheimer’s dx?
aphasia
apraxia
agnosia
distrubed executive function
What are the components of an initial demential eval?
CBC Glucose, electrolytes, BUN/creatinine, LFTs Serum B12 Thyroid function Noncontrast CT or MRI Depression Screening
T/F: dementia is often related to vascular issues
true
what are the screening tests not recommended?
Syphilis EEG LP linear or volumetric MR or CT SPECT APOE-e4 genotyping
What are the exceptions for an indicated LP in dementia screening?
mets
CNS infx
Hydrocephalus
<55 yo onset/unusual dementia
What tests have insufficient evidence to support or refute them?
PET
genetic markers for AD
CSF or other biomarkers for AD
ApoE gene is found on which csome?
19
T/F: ApoE-e4 allele add substantially to Dx confidence
false; not recommended for routine screening
what are the three phases of AD?
presymptomatic
Symptomatic (MCI)
Dementia
What are the changes that you see in the presymptomatic phase of AD?
changes in biomarkers
what changes do you see in the symptomatic phase of AD?
MCI
What changes do you see in the dementia phase of AD?
insidious onset over months to years
cognitive decline
What are the markers of Amyloid-B accumulation?
CSF AB1-42
PET amyloid imaging
What are the markers of neuronal injury or degeneration?
- CSF phosphorylated tau and total tau
- imaging markers of synaptic dysfunction
- imaging markers of neuronal loss and atrophy
Where should tau protein be located normally?
inside the cell; leaks outside of the cell during neuronal damage
what is the first biomarker to show large change in AD?
Amyloid-B accumulation
is amyloid protein high or low in the CSF?
LOW
What are the cholinesterase inhibitors for AD?
Donepizil
Glantamine
Rivastigamine
What are the SE of the cholinesterase inhibitors?
N/V
diarrhea
vivid dreams
What is the non-cholinesterase inhibitor for AD?
Memantine
What are the SE for Memantine?
confusion
HA
dizziness
AD is associated with decreased (blank) activity
cholinergic
glutamate is released in a (tonic/phasic) manner
phasic
Increased (tonic/phasic) glutamate triggers NMDA receptor activation
TONIC
tonic glutamate activating NMDA receptors leads to….
toxiciity
what is the MOA of memantine?
NMDA inhibitor
In what severities of dementia can you use memantine?
moderate to severe
T/F: memantine OD can cause glutamate excitotoxicity
false; prevents it!
what are the side effects of memantine?
dizziness confusion HA constipation but similar to placebo
What is primary prevention of dementia?
no dementia present and doing things to keep it from ever happening
what is the most important factor in primary dementia prevention?
middle aged BP needs to be tightly controlled
what is secondary prevention of dementia?
limit progression of already present dementia
What are the preventative measures against dementia/
1ry prevention 2ry prevention diet exercise intellectual activities management of CVD risk factors
What is the best prevention against dementia?
taking vascular protection
what are the vascular protective factors against dementia?
exercise (walk >2 miles per day) high fish/DHA, low sat. fat green tea red wine and modest alcohol Mediterranean diet
what is the average survival from AD onset to death?
4 years
As you get older, what happens to your survival time after AD onset?
goes down
what is this? lack of insight hyperorality apathy irritability disinhibition lack of empathy rudeness
Behavioral Variant Frontal Temporal Dementia
What is this?
speech is fluent, effortless, and grammatically correct, but word finding difficulty = empty speech, naming deficits, and loss of word knowledge
Semantic Variant f Frontotemporal dementia
What is this?
agrammatism, speech apraxia, word finding difficulties, speech slow, effortful, and sometimes telegraphic
progressive nonfluent aphasia frontotemporal dementia
The genetics for frontotemporal dementia are on which two chromosomes?
17 and 9
What proteins are involved in frontotemporal dementia?
taupathy
TDP-43 proteinopathy
T/F: vascular dementia may arise from single or multiple ischemic infarcts
true
Where must the single ischemic infarcts happen to cause vascular dementia?
Caudate nucleus
Hippocampi
Paramedian thalamus
Rt. parietal lobe
T/f: cerebral hemorrhage can cause vascular dementia
true
Lacunar states and Binswanger’s disease are states of extensive (blank) damage
microvascular
What are the three types of hereditary vascular disease?
CADASIL
MELAS
Fabry’s disease
Vascular dementia can result from (hyper/hypo)perfusion injuries, vasculitis, and other angiopathies
hypoperfusion injury
what are the three types of fibers in the white matter?
association: short
projection: body to brain
commisural: side to side
What type of dementia is this?
fluctuating cognition/alertness
recurrent visual hallucinations
spontaneous motor symptoms of parkinsonims
Dementia with lewy bodies
What is the MRI like in dementia with lewy bodies?
normal OR whole brain atrophy
