Dementia - Lewy Body Flashcards

1
Q

What is the incidence of lewy-body dementia?

1 - 2 cases per 100,000
2 - 20 cases per 100,000
3 - 200 cases per 100,000
4 - 2000 cases per 100,000

A

2 - 20 cases per 100,000

Effects men and women equally

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2
Q

What age does the incidence of lewy body dementia typically peak?

1 - >70
2 - >60
3 - >50
4 - >40

A

1 - >70

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3
Q

In lewy body dementia is their more short term memory loss or a progressive cognitive impairment?

A

1 - progressive cognitive impairment

Memory impairment is more Alzheimer’s

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4
Q

In lewy body dementia does cognitive impairment continue to decline or can it fluctuate?

A
  • fluctuate

Only form of dementia where cognition fluctuates

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5
Q

Lewy body dementia and Parkinsons disease can occur together. Which one typically occurs 1st?

A
  • Lewy body dementia
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6
Q

Are visual hallucinations (other features such as delusions and non-visual hallucinations) common in patients with Lewy body dementia?

A
  • yes

Lewy body = new hallucinations

Old depressed = old pets or spouses

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7
Q

Which of the following are clinical features that patients with with Lewy body dementia present with?

1 - cognitive ability fluctuates
2 - some sparing of memory
3 - Parkinsonism
4 - visual hallucinations
5 - falls
6 - depression
7 - all of the above

A

7 - all of the above

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8
Q

How can a-synuclein, a normal protein in the brain that is involved in synaptic vesicles trafficking and regulation of neurotransmitter release cause lewy bodies?

1 - clump together forming plaques that build up around synapses causing neuronal cell death
2 - mis-folded form of a-synuclein aggregate around synapse causing neuronal cell death
3 - excessive levels inhibit neurotransmitter release despite action potential
4 - binds to vesicles and inhibits vesicle binding to pre-synapse membrane

A

2 - mis-folded form of a-synuclein aggregate around synapse causing neuronal cell death

  • the aggregates of misfolded protein are called Lewy bodies
  • lewy bodies can cause neurons to die
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9
Q

There are 2 types of dementia (that we need to know about) that are associated with lewy bodies (misfolded a-synuclien), what are these?

1 - Parkinsons disease dementia and dementia with lewy bodies
2 - Lewy body dementia and Alzheimers disease
3 - Alzheimers disease and Parkinsons disease
4 - Vascular dementia and Lewy body dementia

A

1 - Parkinsons disease dementia and dementia with lewy bodies

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10
Q

Dementia with Lewy bodies and Parkinson’s disease dementia are both linked with abnormal folding of a-synuclein, which then aggregate and forms Lewy bodies. Where in the brain do these lewy bodies generally begin forming?

1 - motor cortex
2 - basal ganglia
3 - thalamus
4 - occipital lobe

A

2 - basal ganglia

  • can also then move to the cortex, which then affects cognition
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11
Q

When we investigate patients with dementia with Lewy bodies, it is very difficult to be able to determine where the build up of lewy bodies (aggregates of a-synuclein misfolded proteins) is in the brain and therefore make a diagnosis until post mortem. What else can be used to help diagnose?

A
  • MRI/CT scans = may show atrophy or be normal
  • Single-photon emission computed tomography may be able to identify where the lewy bodies are or the atrophy of the involved receptors are
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12
Q

Single-photon emission computed tomography (SPECT) imaging using a ligand for dopamine transporter proteins can be used to detect atrophy of dopamine receptors. This can help identify if a patients symptoms are due to dementia with lewy bodies (cortical) or parkinsons dementia disease (sub-cortical), due to where is affected in the brain. In the image below, which is Alzheimers?

A
  • 1
  • can see atrophy in hippocampus
  • large dark spaces in cortical area and ventricles
  • uptake of ligand in caudate putamen (involved in motor control, cognition, and emotion)
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13
Q

Single-photon emission computed tomography (SPECT) imaging using a ligand for dopamine transporter proteins can be used to detect atrophy of dopamine receptors. This can help identify if a patients symptoms are due to dementia with lewy bodies (cortical) or parkinsons dementia disease (sub-cortical), due to where is affected in the brain. In the image below, which is dementia with Lewy bodies?

A
  • 2
  • some atrophy of cortical area
  • no significant hippocampus atrophy
  • poor uptake by the caudate putamen (motor control, cognition, and emotion)
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14
Q

What is the life expectancy of a patient with Lewy body dementia?

1 - 4-10 years
2 - 5-15 years
3 - 10-20 years
4 - >20 years

A

1 - 4-10 years

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15
Q

Which class of drugs is the 1st line treatment for patients with Lewy body dementia?

1 - acetylcholinesterases
2 - dopamine agonists
3 - Catechol-O-methyltransferase inhibitor (COMT) inhibitors
4 - NMDA receptor antagonist

A

1 - acetylcholinesterases
- donepezil and rivastigmine

4 - NMDA receptor antagonist
- Memantine

These are used in same way as they are for Alzheimers

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16
Q

Patients with dementia with Lewy bodies are highly sensitive to which group of drugs?

1 - ACE inhibitors
2 - antipsychotics
3 - benzodiazepines
4 - neuroleptics

A

2 - antipsychotics
4 - neuroleptics

  • can be hypersensitive to these medications
  • AVOID AT ALL COSTS