Dementia: Non-Alzheimer's Disease

Question 1

this type of dementia is the second most common cause of dementia (besides alzheimers), and it correlated with strokes. Can be seen in patients with silent strokes, and patterns of deficits can vary based on where storkes occured

Answer 1

VASCULAR DEMENTIA

• BINSWANGERS disease: insidious onset of a subcortical ischemic syndrome

Question 2

Key and supportine features of dementia with Lewe bodies

Management?

Answer 2

Key Features of DLB: DEMENTIA (critical feature), parkinsonism, cognitive fluctuations, visual hallucinations, REM sleep disturbance (acting out dreams)

Supportive Features of DLB: Neuroleptic sensitivity***, postural instability/falls, syncope/transient LOC, autonomic dysfunction.

Dementia associated with parkinson’s disease has a similar pathology (deposition of Lewy bodies)

Management: cholinesterase inhibitor (neuropsychiatric sx and cognition), levodopa (parkinsonism), SSRI/SNRI (depression), melatonin of clonazepam (REM-sleep behaviour) Frontotemporal Degeneration/Dementia (FTD)

Question 3

Outline Pick’s Disease

Answer 3

aka frontotemporal dementia; Behavioural changes including disinhibition and perseveration. MEMROY IS OFTEN PRESERVED.

no pharmacotherapies

investigations: variable focal/frontal atrophy on MRI, hypometabolism may predate structural changes.

Question 4

Outline the summary of this table: outline key clinical features, investigations of each disease causing dementia/MCI

Answer 4

Question 5

Outline which proteins are involved in which dementing diseases

Answer 5

Question 6

Creutzfeldt-Jakob Disease (CJD)

Definition: a prion disease responsible for __ __ __

Investigation:

• EEG: generalized bi or triphasic periodic sharp wave complexes with a frequency of around 1-2/s
• CSF: protein elevation
• MRI: grey matter hyperintensities in __, __ or >__ __ gyrus OR >3 gyri

Answer 6

Creutzfeldt-Jakob Disease (CJD)

Definition: a prion disease responsible for transmissible spongiform encephalopathies

Investigation:

• EEG: generalized bi or triphasic periodic sharp wave complexes with a frequency of around 1-2/s
• CSF: protein elevation
• MRI: grey matter hyperintensities in cingulate, striatum or >1 neocortical gyrus OR >3 gyri

Question 7

. Contrast VaD, DLB and FTD presentations from a typical AD presentation.

Answer 7

VaD does not have parkinson-like features, as opposed to DLB which often has parkinsonism as a key feature.

FTD has relatively preserved memory compared to VaD and DLB and AD, but much less social discretion.

Question 8

Definition: neurodegenerative disease caused by __ __ __

Mechanism: stress and strain forces when exposed to rapid acceleration/deceleration forces

Symptoms: hx of multiple head impacts, behavioural/mood/cognitive difficulties +/- motor features

Answer 8

Chronic Traumatic Encephalopathy (CTE)

Definition: neurodegenerative disease caused by repeated head injuries

Mechanism: stress and strain forces when exposed to rapid acceleration/deceleration forces

Symptoms: hx of multiple head impacts, behavioural/mood/cognitive difficulties +/- motor features

Question 9

Differentiate delirium from dementia or depression in terms of onset, duratiion, attention, psychomotor activity, affect and psychotic features

Answer 9