NEURO 236 - Alzheimers

Question 1

What are the types and prevalence of dementia?

Answer 1

Alzheimers - 50+%
Vascular - 20-25
Lewy Body - 15-20
Fronto-temporal - 5-10

Question 2

What are some differential diagnoses for dementia?

Answer 2

underlying physical illness, mild cognitive impairment, depression and an acute confusional state

Question 3

What is the ICD10 diagnostic criteria for dementia?

Answer 3

acquired impairment in memory for at least 6/12

+ impairment in 1+ domains: executive functioning, language, praxis and gnosis with an interference with daily living

Question 4

What is dementia?

Answer 4

global impairment of cognition and intellect with impaired performance of ADL’s

Question 5

What is mild cognitive impairment?

Answer 5

cognitive decline greater than that expected at that age but no ADL interference

Question 6

What is the presentation for alzheimers?

Answer 6

cognitive decline of an insidious onset and a gradual deterioration

Question 7

What are some risk factors for alzheimers?

Answer 7

Age, female, genes, head injury, environmental factors

Question 8

Where is amyloid precursor protein found?

Answer 8

integral membrane glycoprotein widely expressed but concentrated in neurone synapses

Question 9

What is the neuropathology of Alzheimers?

Answer 9

Amyloid plaques - A-beta protein aggregating
Tau protein - neurofibrilliary tangles inside neurones due to tau hyperphosphorylation
glutamate excitotoxicity
= neurone loss and a cholinergic dysfunction

Question 10

What is the presentation of vascular dementia?

Answer 10

sudden onset, step-wise deterioration, mood/behaviour change but preserved insight

Question 11

What is the neuropathology of vascular dementia?

Answer 11

athersclerosis - small vessel disease

Question 12

What is the presentation of lewy body dementia?

Answer 12

fluctuating cognition, vivid visual hallucinations, mild parkinsonian features

Question 13

What is the management of alzheimers and lewy body dementia?

Answer 13

mild-moderate = anticholinesterase
severe = memantine

Question 14

What is the management of vascular dementia?

Answer 14

aspirin, statins and risk factor controls

Question 15

Give some examples of anticholinesterases

Answer 15

donepezil, rivastigimine and galantamine

Question 16

What is memantine?

Answer 16

An NMDA receptor antagonist

Question 17

What other types of drugs can be used for symptom control?

Answer 17

anti-psychotics ( but take care they increase risk of death) e.g. risperidone short term only
try non -pharm first
ADM’s e.g. sertraline
night sedation

Question 18

Where is acetylcholine made?

Answer 18

Basal forebrain

Question 19

What is learning?

Answer 19

acquisition of new information

Question 20

What is memory?

Answer 20

process by which learning is stored

Question 21

What is working memory?

Answer 21

information is held whilst you work out what to do with it - 1st thing to go in AD

Question 22

What is declarative memory?

Answer 22

memory of “stuff” - semantic (concepts) or episodic (autobiographal) - in the medial temporal lobe, hypothalamus and thalamus

Question 23

What is non-declarative memory?

Answer 23

procedural memory, skills and habits (striatum), motor (cerebellum) and emotional condition (amygdala)

Question 24

What is retrograde amnesia?

Answer 24

loss of memories from before the occurence of the trauma/event

Question 25

What is anterograde amnesia?

Answer 25

Inability to form new declarative memories

Question 26

What are Brodmans areas?

Answer 26

Found in the posterior parietal cortices they integrate visual, auditory and somatosensory information

Question 27

What happens when there is damage to brodmans areas?

Answer 27

neglect - sensory from one side, neglect of body/world in contralateral space, denies affected side belongs to them and motor - fewer movements

Question 28

What happens in temporal cortex damage?

Answer 28

agnosia

Question 29

What happens in inferior temp cortex damage?

Answer 29

visual agnosia (see but not identify)

Question 30

What happens in damage to the fusiform gyrus (TC)?

Answer 30

prosopagnosia - cant recognise faces

Question 31

What happens in damage to mid tempo cortex?

Answer 31

cannot recognise stationary vs moving objects

Question 32

What happens in frontal cortex damage?

Answer 32

loss of restraint, initiative and order

Question 33

What is korsakoff syndrome?

Answer 33

irreversible damage to medial thalamus and mammilliary bodies as a result of thiamine deficiency due to chronic alcoholism = both amnesias and confabulation

Question 34

What are parietal lobe lesions associated with?

Answer 34

apraxia - inability to perform a motor task at request

Question 35

What does brocas area do?

Answer 35

making speech - frontal *what should I do

Question 36

What does wernickes area do?

Answer 36

understand speech - what is it (temporal lobe)

Question 37

What is aphasia?

Answer 37

speech disorder difficulty naming object and repetition

Question 38

What do you see in Brocas aphasia?

Answer 38

an ability to understand speech but cannot make their own, halting and repetitive with disordered syntax and grammar

Question 39

What do you see in Wernickes aphasia?

Answer 39

Unable to understand but has fluent speech just doesnt make any sense or have any relevance

Question 40

What is the pathway that sensory information goes through the brain?

Answer 40

–> cortical association areas —> parahippocampal/hippocampas –> along fornix –> mamilliary bodies –> thalamus