Lecture 3: Cortical dementia Flashcards
What are some characteristics of a delirium?
- Disturbance in attention and awareness with a sudden onset.
- It tends to fluctuate in severity during the day.
- The disturbance should be a direct physiologic consequence of another medical condition.
What is ‘closing in’?
When copying an image, they draw within the figure. You’ll see this in demented people (AD) but not in depressed people.
What do you see on an EEG of patients with AD?
In AD you see more of the slower brain waves.
- Increased thetha activity and later also delta activity.
- Decreased alpha and bèta activity.
What kind of atrophy do you see in patients with AD?
Medical temporal lobe atrophy (MTA)
- Entorhinal cortex
- Hippocampus
What is another name for FTD? And in which subtypes can you divide this condition?
Pick’s disease
- FTDbv
- PPA
Which cognitive domains are mosly impaired in FTD?
- EF
- Language
Visuoconstruction is spared (drawing)
What kind of atrophy do you see in patients with FTDbv?
Frontal, insular and/or temporal atrophy (the brain almost looks like a walnut) > symmetric
Usually sparing of the posterior parietal lobe.
Which 4 histological changes can you name that are present in FTDbv?
- Microvacuolation in the upper layers: white looking compartments filled with water-containing molecules.
- Ubiquitin inclusions.
- Pick’s bodies: acumulation of tau proteins (hallmark of FTD).
- Neurofibrillary tangles: also from the tau protein.
Name the 3 subtypes of PPA and describe their symptoms.
PPA-non fluent
- Agrammatism
- Effortful, halting speech
- Impaired comprehension of complex sentences
Semantic dementia
- Difficulties with confrontation naming
- Difficulties with single-word comprehension
- Impaired object knowledge
- Surface dyslexia/dysgraphia
Logopenic PA
- Impaired single-word retrieval in spontaneous speech (and naming)
- Impaired repetition of sentences and names
- Phonologic speech errors
What is the overlap and what is the difference between DLB and PD?
Overlap: (brainstem) Lewy Bodies. Like in PD, there is a change in the neurons that are important for the dopamine production.
Difference: in PD the motor problems start many years before the cognitive problems, in LB within the same year (1 year rule).
Can you name 4 core features of DLB?
- Fluctuating cognition
- Recurrent visual hallucinations
- Spontaneous features of parkinsonism
- REM sleep behavior disorder
Name some supportive features of DLB.
- Severe sensitivity to antipsychotic agents
- Repeated falls, postural instability, and syncope
- Transient, unexplained loss of consciousness
- Severe autonomic dysfunction (constipation, urinary difficulties)
- Hallucinations in other modalities
- Systematized delusions
- Depression, apathy, anxiety
Which 3 cognitive domains are mostly affected in DLB?
- Visuoconstruction problems
- Attention problems
- EF problems
- Memory problems (later stages)
What kind of atrophy do you see in patients with DLB?
Posterior parietal atrophy
