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Psychiatry > Memory Problems > Flashcards

Memory Problems Flashcards

1
Q

What is the first line screening test for people with suspected memory problems?

A

MMSE

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2
Q

What routine blood tests should be done on someone presenting with symptoms of dementia?

A

FBC
BIochemistry
Thyroid function
Serum B12 and folate

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3
Q

What is a normal MMSE score?

A

Over 27/30

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4
Q

What 5 areas should be assessed in someone with memory loss?

A 
Memory
Attention and Concentration
Executive functioning
Visuo spatial functioning
Language
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5
Q

What is anterograde amnesia?

A

Difficulty in acquiring new material and remembering events since the onset of the illness/injury

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6
Q

What is retrograde amnesia?

A

Difficulty in remembering information prior to the onset of the illness or injury

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7
Q

Why is imaging used in the diagnosis of dementia?

A

To exclude other cerebral pathologies and help establish the subtype of dementia

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8
Q

What kind of scan is used to differentiate Alzheimer’s, FT dementia and vascular dementia?

A

SPECT (Single photnon emission CT)

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9
Q

Alongisde the MMSE what other clinical test gives a better picture of memory loss?

A

Addenbrookes Cognitive Examination

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10
Q

What domains are important to explore in patients presenting with symptoms of dementia?

A 
Pre – Morbid Functioning
Orientation & Attention 
Memory & New Learning 
Visuo – Spatial & Constructional Functioning 
Language 
Executive Functioning
Emotional Status
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11
Q

What are the first line drugs in dementia?

A

Cholinesterase inhibitors - Donepezil, Galantamine, Rivastigmine

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12
Q

Which learning disability increase the risk of alzheimers?

A

Downs syndrone

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13
Q

What lobes are affected in alzheimers disease?

A

Frontal
Temporal
Parietal

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14
Q

What are the two pathological hallmarks seen in alzheimer’s disease?

A

Intracytoplasmicc neurofibrillary tangles

beta amyloid plaques

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15
Q

What protein makes up the neurofibrillary tangles seen in alzheimers disease?

A

Tau proteins

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16
Q

What is the problem with the tau proteins in AD?

A

They are abnmormally phosphorylated which causes them to gather in the cytoplasm and encircle the nuclei

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17
Q

What areas of the brain are most affected by intracytoplasmic neurofibrillary tangles?

A

Hippocampus

Temporal lobe

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18
Q

What area of the brain are most affected by beta amyloid plaques?

A

Hippocampus
Cerebral cortex
Deep grey matter

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19
Q

How do beta amyloid plaques lead to symptoms of AD?

A

Reduces the ability of the synapses to transmit acetylcholine signals (and seratonin and noradrenaline to a lesser degree)

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20
Q

What cells are most affected by neurofibrillary tangles?

A

Pyramidal cells of the cortex

21
Q

Give 4 microscopic changes seen in AD?

A

Intracytoplasmic neurofibrillary tangles
Beta Amyloid plaques
Amyloid Angiopathy
Extensive neuronal loss with astrocytosis

22
Q

In what three areas of the brain do you see the most neuronal loss in AD?

A

Hippocampus
Frontal lobe
Temporal lobe

23
Q

A man presents with memory loss, visual hallucinations and agitation worsening over 6 months. His wife says some days are much worse than others.

A

Dementia with lewy bodies

24
Q

What area of the brain degenerates most in DLB?

A

Substantia Nigra

25
Q

How do you detect lewy bodies in a patient?

A

Immunochemical staining for ubiquitin proteins

26
Q

What is a lewy body?

A

Eosinophillic cytoplasmic inclusion

27
Q

What chromosome is the huntingtons gene carried on?

A

Chromosome 4p

28
Q

What is the genetic problem in huntingtons?

A

Too many CAG repeats

29
Q

Where are neurones lost in huntingtons disease?

A

Caudate nucleus

Also cerbral cortex

30
Q

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.

A

F`rontotemporal dementia

31
Q

What are the two histological hallmarks of frontotemporal dementia?

A

Picks cells = swollen neurones

Pick’s bodies = intracytoplasmic filamentous inclusions

32
Q

What is the management of vascular dementia?

A

Maintain adequate BP control

Aspirin

33
Q

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

A

vascular dementia

34
Q

How do acetylcholinesterase inhibitors work?

A

They inhibit acetylcholinesterase from breaking down acetylcholine and so increase its duration of action

35
Q

In what two types of dementia are acetylcholinesterase inhibitors used?

A

Alzheimers

dementia with lewy bodies

36
Q

What are the major side effects of acetylcholinesterase inhibitors ?

A

Act on the PS nervous system so cause

  • Bradycardia
  • Hypotension
  • Hypersecretion
  • Bronchoconstriction
  • GI hypermobility
37
Q
  1. 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
A

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

38
Q

Below what score of the MMSE would be considered dementia?

A

24

39
Q

What is the first area of the brain to be affected by the neuropathological processes of alzheimers disease?

A

Nucleus basalis of Maynert in the basal forebrain. This is becausse this is the main source of acetylcholine for the cortex

40
Q

What part of the brain is the main source of actelycholine for the cortex?

A

Nucleus basalis of maynert

41
Q

What are the two drug classes used in alzheimers?

A

Cholinesterase inhibitors

Memantine ( NMDA receptor antagonist)

42
Q

What cholinesterase inhibitors is used in dementia with lewy bodies?

A

Rivastigmine

43
Q

What scoring system is a useful test in differentiating between alzheimer’s disease and vascular dementia?

A

Hachinski Iscaemic score

44
Q

What does a Hachinski Iscaemic score of less than 4 mean?

A

Alzheimers disease

45
Q

What does a Hachinski Iscaemic score of more than 7 mean?

A

Vascular dementia

46
Q

What drugs should be considered if a patients is being extremely aggressive and becoming more agitate?

A

IM lorazepam, haloperidol or olanzapine

47
Q

When is SPECT imaging not useful?

A

Downs syndrome

48
Q

When would LP be useful in the diagnosis of dementia?

A

If creutzfedlt Jakob disease was suspected

49
Q

In which dementia do you get REM disturbance?

A

Lewy body

Psychiatry (24 decks)

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