Memory Problems Flashcards
What is the first line screening test for people with suspected memory problems?
MMSE
What routine blood tests should be done on someone presenting with symptoms of dementia?
FBC
BIochemistry
Thyroid function
Serum B12 and folate
What is a normal MMSE score?
Over 27/30
What 5 areas should be assessed in someone with memory loss?
Memory Attention and Concentration Executive functioning Visuo spatial functioning Language
What is anterograde amnesia?
Difficulty in acquiring new material and remembering events since the onset of the illness/injury
What is retrograde amnesia?
Difficulty in remembering information prior to the onset of the illness or injury
Why is imaging used in the diagnosis of dementia?
To exclude other cerebral pathologies and help establish the subtype of dementia
What kind of scan is used to differentiate Alzheimer’s, FT dementia and vascular dementia?
SPECT (Single photnon emission CT)
Alongisde the MMSE what other clinical test gives a better picture of memory loss?
Addenbrookes Cognitive Examination
What domains are important to explore in patients presenting with symptoms of dementia?
Pre – Morbid Functioning Orientation & Attention Memory & New Learning Visuo – Spatial & Constructional Functioning Language Executive Functioning Emotional Status
What are the first line drugs in dementia?
Cholinesterase inhibitors - Donepezil, Galantamine, Rivastigmine
Which learning disability increase the risk of alzheimers?
Downs syndrone
What lobes are affected in alzheimers disease?
Frontal
Temporal
Parietal
What are the two pathological hallmarks seen in alzheimer’s disease?
Intracytoplasmicc neurofibrillary tangles
beta amyloid plaques
What protein makes up the neurofibrillary tangles seen in alzheimers disease?
Tau proteins
What is the problem with the tau proteins in AD?
They are abnmormally phosphorylated which causes them to gather in the cytoplasm and encircle the nuclei
What areas of the brain are most affected by intracytoplasmic neurofibrillary tangles?
Hippocampus
Temporal lobe
What area of the brain are most affected by beta amyloid plaques?
Hippocampus
Cerebral cortex
Deep grey matter
How do beta amyloid plaques lead to symptoms of AD?
Reduces the ability of the synapses to transmit acetylcholine signals (and seratonin and noradrenaline to a lesser degree)
What cells are most affected by neurofibrillary tangles?
Pyramidal cells of the cortex
Give 4 microscopic changes seen in AD?
Intracytoplasmic neurofibrillary tangles
Beta Amyloid plaques
Amyloid Angiopathy
Extensive neuronal loss with astrocytosis
In what three areas of the brain do you see the most neuronal loss in AD?
Hippocampus
Frontal lobe
Temporal lobe
A man presents with memory loss, visual hallucinations and agitation worsening over 6 months. His wife says some days are much worse than others.
Dementia with lewy bodies
What area of the brain degenerates most in DLB?
Substantia Nigra
How do you detect lewy bodies in a patient?
Immunochemical staining for ubiquitin proteins
What is a lewy body?
Eosinophillic cytoplasmic inclusion
What chromosome is the huntingtons gene carried on?
Chromosome 4p
What is the genetic problem in huntingtons?
Too many CAG repeats
Where are neurones lost in huntingtons disease?
Caudate nucleus
Also cerbral cortex
A lady presents with her husband. He says she has changed in the last 6 months - she has become very ride and inappropriately flirtatious. She reports memory loss.
F`rontotemporal dementia
What are the two histological hallmarks of frontotemporal dementia?
Picks cells = swollen neurones
Pick’s bodies = intracytoplasmic filamentous inclusions
What is the management of vascular dementia?
Maintain adequate BP control
Aspirin
A man with a history of hypertension presents with memory loss. He says it is worse at night and seems to have got a lot worse recently
vascular dementia
How do acetylcholinesterase inhibitors work?
They inhibit acetylcholinesterase from breaking down acetylcholine and so increase its duration of action
In what two types of dementia are acetylcholinesterase inhibitors used?
Alzheimers
dementia with lewy bodies
What are the major side effects of acetylcholinesterase inhibitors ?
Act on the PS nervous system so cause
- Bradycardia
- Hypotension
- Hypersecretion
- Bronchoconstriction
- GI hypermobility
- Mr Anderson has a one year history of short term memory loss, which is gradually getting worse. He has been diagnosed with Alzheimers disease and you suggest a cholinesterase inhibitor. Which feature would concern you most when considering a cholinesterase inhibitor?
a) Age 95
b) Pulse rate 50
c) GI bleed ten years ago
d) General frailty
e) COPD
b) Acetylcholinesterase inhibitors can cause bradycardia due to their effect on the PS nervous system so a heart rate of lower than 50 would be concerning
NB COPD would also be a concern due to bronchoconstrictive effect
There is a slight increased risk of GI bleeding
Below what score of the MMSE would be considered dementia?
24
What is the first area of the brain to be affected by the neuropathological processes of alzheimers disease?
Nucleus basalis of Maynert in the basal forebrain. This is becausse this is the main source of acetylcholine for the cortex
What part of the brain is the main source of actelycholine for the cortex?
Nucleus basalis of maynert
What are the two drug classes used in alzheimers?
Cholinesterase inhibitors
Memantine ( NMDA receptor antagonist)
What cholinesterase inhibitors is used in dementia with lewy bodies?
Rivastigmine
What scoring system is a useful test in differentiating between alzheimer’s disease and vascular dementia?
Hachinski Iscaemic score
What does a Hachinski Iscaemic score of less than 4 mean?
Alzheimers disease
What does a Hachinski Iscaemic score of more than 7 mean?
Vascular dementia
What drugs should be considered if a patients is being extremely aggressive and becoming more agitate?
IM lorazepam, haloperidol or olanzapine
When is SPECT imaging not useful?
Downs syndrome
When would LP be useful in the diagnosis of dementia?
If creutzfedlt Jakob disease was suspected
In which dementia do you get REM disturbance?
Lewy body
