L24: Dementia Flashcards
main cause of dementia
alzheimer’s disease
second commonest dementia
mixed
what is mixed dementia
Alzheimer’s and vascular
3rd commonest dementia
vascular dementia
differential diagnosis (3)
- ageing and mild cognitive impairment
- depression
- Delirium (including infection)
five As of alzheimer’s
- amnesia
- aphasia
- apraxia
- agnosia
- associated features
amnesia=
memory
aphasia=
speech
apraxia=
motor
agnosia=
recognition
what part of the brain is most affected by alzheimer’s disease
medial temporal and parieto-temporal lobes
what is often spared in alzheimers
primary sensory / motor/ visual cortex
what is widened and narrowed in the brain
widened sulci
narrowed gyri
2 general terms for the pathophysiology of alzheimers
plaques and tangles
what are plaques
abnormal processing og amyloid precursor protein leading to excessive beta amyloid
what does abnormal amyloid protein mean (3)
- calcium influx and cell death via glutamate excitotoxicity
- interference with nerve signalling
- associated inflammatory response
what are tangles
hyper-phosphorylated tau protein
what does tau protein disrupt
cerebral architecture and functioning
2 treatments for alzheimers
- acetylcholinesterase inhibitors
- N-methyl D-aspartate (NMDA) antagonists
name 3 acetylcholineesterase inhibitors
- donepezil
- galantamine
- rivastigmine
name 1 NMDA receptor antagonists
memantine
which drug is used in mild-moderate AD
acetylcholinesterase inhibitors
what neurotransmitter does NMDA reduce
glutamate
which drug is used in moderate- severe AD
NMDA antagonist -memantine
reason for vascular dementia
problems with blood supply to brain
4 risk factors for vascular dementia
- hypertension
- raised cholesterol
- diabetes
- smoking
treatments for vascular dementia
- lifestyle change
- control of Bp ect
- Aspirin/ clopidogrel
what is MID
multiple infarct dementia following a stroke
what is MID often associated with
physical problems especially posterior circulation
what is often preserved in small vessel disease
higher cortical functions
what would be diagnosis if ; early cognitive symptoms, rapidly progressing dementia, hallucinations and mild parkinsonian features
dementia with lewy bodies
what would be diagnosis if; motor symptoms >1 year, apathy, slowing of thought and executive functioning, forgetfulness
parkinsons disease with dementia
what is the difference between DLB and parkinsons disease with dementia
which way round the diagnosis is
for DLB you need 2 out of 3 of these:
- fluctuations in cognition
- persistent hallucinations
- spontaneous parkinsonism
what is syncope
temporary loss of consciousness
what is the pathophysiology of DLB
degeneration of brainstem substantia nigra
what is the substantia nigra involved in
dopamine production
what do the remaining nerve cells in DLB contain
Lewy bodies
where is atropy of the brain common in DLB
4
- midbrain
- temporal lobe
- parietal lobe
- cingulate gyrus
when is the onset for frontotemporal dementia
early onset mainly
what mutation is in the 10% of familial frontotemporal dementia
tau gene
3 common syndromes of frontotemporal dementia
- frontal lobe atrophy
- progressive non fluent aphasia
- semantic dementia
what does frontal lobe atrophy effect
emotions and behaviour
what is progressive non fluent aphasia
progressive difficulty in language
what is semantic dementia
loss of knowledge of meaning of words
what does frontotemporal dementia usually present with
emotional or behavioural changes (rather than STM loss)
what is relatively preserved in frontotemporal dementia
memory
