Dementia: subtypes, Mx and prognosis

Question 1

the frontal lobe does

Answer 1

personality, behaviour, executive function, impulse control, language fluency, memory, selective attention, smell

Question 2

the temporal lobe does

Answer 2

memory, understanding and producing speech, naming, language, recognising and processing sound

Question 3

the parietal lobe does

Answer 3

sensory (touch, temperature, pain), construction, spatial skills and attention, ideomotor praxis

Question 4

the occipital lobe does

Answer 4

visual information, shapes and colours

Question 5

which lobe does personality

Answer 5

frontal

Question 6

which lobe produces speech

Answer 6

temporal

Question 7

which lobe does spacial skills

Answer 7

parietal

Question 8

anterograde memory

Answer 8

new learning

Question 9

retrograde memory

Answer 9

memory of past events

Question 10

which type of memory is affected first

Answer 10

anterograde - new learning

Question 11

bilingual individuals in dementia

Answer 11

will revert back to a primary language

Question 12

language in different types of dementia

Answer 12

alzheimers - occurs later
fronto temporal - occurs early
vascular - may occur at any stage

Question 13

dyspraxia is

Answer 13

parietal motor coordination system deficit
difficulty using day to day items e.g toothbrush or fork
individuals need help with ADLs

Question 14

dyspraxia occurs when

Answer 14

late in Alzheimer’s dementia
occur when memory problems and intellectual challenges are more severe

Question 15

pathophysiology of alzeimers

Answer 15

beta-amyloid plaques outside cells
neurofibrillary tangles made of tau inside cells
brain cells eventually die and brain volume shrinks

Question 16

in alzheimers disease, neurofibrillary tangles are made of

Answer 16

tau

Question 17

factors increasing risk of alzheimers disease

Answer 17

sedentary lifestyle
less mentally active
vascular risk factors (HTN, smoking, obesity, cholesterol)
mood disorders
role of inflammation

Question 18

main signs of vascular dementia

Answer 18

early gait disturbance with falls
memory impairment not the first or most dominant feature
evidence of vascular change on CT/MRI
pt will have vascular risk factors

Question 19

vascular dementia with cortical vascular damage

Answer 19

cortical deficits such as aphasia, apraxia, agnosia

Question 20

vascular dementia with subcortical vascular damage

Answer 20

subcortical frontal areas linking frontal cortex to related areas in the basal ganglia and thalamus
problems with attention, processing speed
usually accompanied by motor signs: suffering walk, brradykinesia, tremor and incontinence

Question 21

symptoms of dementia with levy bodies

Answer 21

fluctuating cognition
Parkinsonism
prominent visual hallucinations
visuospatial difficulties
REM sleep disorder

Question 22

what are levy bodies

Answer 22

intracellular spherical inclusion bodies (alphasynuclean) found diffusely through cerebral cortex

Question 23

dementia with levy bodies responds to

Answer 23

cholinesterase inhibitor

Question 24

symptoms of frontal temporal dementia

Answer 24

spectrum of presentations
predominantly frontal: mainly behaviour and personality
predominantly temporal: speech and language disturbance

little insight, disinhibition
primitive reflexes, early urinary incontinence

Question 25

age of onset of front temporal dementia

Answer 25

younger age than alzheimers

Question 26

things that foreshadow development of fronto-temporal dementia

Answer 26

mood and emotional disorders
depression/anxiety prominent

Question 27

parkinsons dementia presentation

Answer 27

similar features to levy body dementia but cognitive decline occurs >12 months after clinical features of PD have developed

Question 28

what can be used to medicate in alzheimers dementia

Answer 28

cholinesterase inhibitors

Question 29

how do cholinesterase inhibitors help in Alzheimer’s dementia

Answer 29

target deficiency in cerebral cholinergic transmission in alzheimers disease
reduces breakdown of acetyl choline by acetyl cholinesterase
increasing amount of acetyl choline in synapse

Question 30

how effective is cholinesterase inhibitors in alzheimers dementia

Answer 30

not disease modifying
temporary improvements in cognition
can improve ADLs in mild-moderate disease
not all patients respond

Question 31

side effects of cholinesterase inhibitors

Answer 31

nausea, vomiting, diarrhoea, fatigue.
may cause bradycardia

Question 32

Memantine

Answer 32

(Ebixa)
NMDA-receptor antagonist
may be disease modifying in alzheimers dementia by protecting neurons
can be used in combination with cholinesterase inhibitor
side effects uncommon and mild

Question 33

BPSD

Answer 33

behavioural and psychological symptoms of dementia
non-cognitive symptoms of dementia
tends to occur late in course of disease
common, distressing

Question 34

typical behaviours of BPSD

Answer 34

agitation, aggression, delusions, shouting, wandering, insomnia, pacing etc.

Question 35

mainstay of treatment of BPSD

Answer 35

non-pharmacological
optimise environment

Question 36

when non-pharmacological treatment of BPSD fails

Answer 36

drugs are second line
antipsychotic drugs should not be used as first line as they have significant side effects including increased risk of cardiovascular events and stroke.
antipsychotics have only moderate benefit

Question 37

types of symptoms that respond to antipsychotics

Answer 37

aggression, agitation, psychotic

Question 38

types of symptoms that do not respond to antipsychotics

Answer 38

wandering, withdrawal, touching, shouting, insomnia, pacing

Question 39

preferred antipsychotic for Parkinson’s dementia and dementia with lewy body

Answer 39

quetiapine