Neurobiology of cognition and dementia Flashcards
What is Broca’s aphasia also known as
expressive aphasia
Broca’s aphasia has good/poor comprehension and good/poor speech
good comprehension
poor speech
What is Wernicke’s aphasia also known as
receptive aphasia
Wernicke’s aphasia has good/poor comprehension and good/poor speech
poor comprehension
good speech
define dementia
progressive, irreversible, global cognitive decline
disruption to higher cortical function in clear consciousness
can you get dementia after a large stroke
no, because onset of dementia is progressive/chronic
which Brodmann area is the primary motor cortex
4
which brain structure is important for incorporating short into long term memory
hippocampus
what is damaged in Alzheimer’s disease
nucleus basalis of Meynert in medial temporal lobe
which pathways are disrupted in Alzheimers
ACh
molecular features of Alzheimers
extracellular amyloid plaques
intracellular neurofibrillary tangles (tau)
symptoms of Alzheimers
short term memory loss dysphasia dyspraxia agnosia poor adaptability psychosis dysphagia - late stage
management of Alzheimer’s disease
acetylcholinesterase inhbitors eg
donepezil, rivastigmine, galantamine
what is memantine
low affinity, voltage dependent, non-competitive NMDA antagonists
what is vascular dementia
stepwise progression after accumulative small infarcts
overlaps with Alzheimers
features of vascular dementia
affects white matter
dysphasia, dyscalculia
mood symptoms
focal neurological signs
what is the damage in Lewy Body Dementia DLB
a-synuclein and ubiquitin at higher quantities in the brain
loss of dopaminergic neurons in substantia nigra
presence of lewy bodies
loss of ACh in nucleus basalis of meynert
features of lewy body dementia
fluctuating visual hallucinations parkinsonism autonomic instability visuospatial problems REM behavioural disorder
which drugs should be avoided in lewy body dementia
dopamine agonists eg sinemet
management of lewy body dementia
acetylcholinesterase inhibitors
timing of dementia in Parkinson’s disease
dementia within 1 year of symptoms = DLB
dementia after 1 year of symptoms = parkinson’s disease dementia
damage in frontotemporal lobe dementia
atrophy of frontal and temporal lobes with corresponding reduction in activity
gliosis
abnormal proteins
symptoms of FTD
social disinhibition
early onset
personality changes
apathy
what are the types of FTD
behavioural
progressive non-fluent
semantic
cause of Wernicke’s encephalopathy
thiamine/vit B1 deficiency
wernicke’s encephalopathy triad of symptoms
confusion
ataxia
ophthalmoplegia
symptoms of wernicke’s encephalopathy
confusion ataxia ophthalmoplegia visual and hearing impairments reduced consciousness hypothermia lactic acidosis circulatory changes
what should be given in wernicke’s encephalopathy to prevent progression to Korsakoff’s
IV pabrinex (vitamins)
what is the damage in Korsakoff’s syndrome
damage to mamillary bodies
symptoms of Korsakoff’s
confabulation
anterograde amnesia
telescoping of events
is alcohol induced brain damage a type of dementia
no
consequences of alcohol induced brain damage
Wernicke-Korsakoff
myelin sheath degradation
neuroinflammation
falls
differentials of dementia
delirium depression --> pseudodementia deafness dysphasia late onset Schizophrenia subdural haematoma tumours infection
duration of sensory memory
<1 sec
duration of short term memory
<1 min
duration of long term memory
lifetime
explicit memory is conscious/unconscious
conscious
implicit memory is conscious/unconscious
unconscious
difference between episodic memory and semantic memory
episodic = personal events and experiences semantic = facts, concepts, knowledge
anterograde amnesia
difficulty in acquiring new information since onset of illness
retrograde amnesia
difficulty in acquiring new information prior to onset of illness
defining factors of dementia
progressive ie >6 months
global cognitive decline
disturbance of higher cortical functions
clear consciousness
what are useful questions to ask in a dementia history
day to day life affected problems in kitchen difficulty with technology news/newspaper driving hobbies
what does cognitive screening assses
memory attention + concentration executive functioning visuo-spatial functioning language
what is the 4AT and what are its elements
rapid assessment for delirium Alertness AMT4 Attention Acute
which screening test should be used initially in the case of dementia
MMSE
advantages and disadvantages of MMSE
Adv: quick, different languages, pen and paper only
Disadv: poor examination of executive functioning, copyrighted
MMSE of what score supports and excludes dementia
> 27/30 - excludes
<24/30 - supports
when is the 6-CIT used
in non-specialist settings
bedside test
what is the GPCOG
6 questions asked in the GP/community setting
scoring of GPCOG
9 = normal
5-8
0-4 = poor
what is the clock drawing test
assesses executive function, visuospatial ability
what is the MoCA
Montreal Cognitive Assessment
rapid screening instrument for mild cognitive dysfunction
freely available
what is ACE
addenbrooke’s cognitive assessment
scored out of 100 and assesses 5 domains
what is a normal score in ACE
> 84/100
what is neuropsychological assessment
determines abnormal intellectual/behavioural decline and whether it is relating to CNS disease
what is CMHT
community mental health team
what is post diagnostic support for dementia
for patient + family/friends after diagnosis including counselling, financial advice/legalities power of attorney …
what cognitive testing is available
ACEIII
MoCA
frontal assessment battery FAB
detailed neuropsychological testing
what is the shortIQCODE used for
taking a collateral history
who carries out a cognitive performance test
OT
what are reversible causes of cognitive impairment
VINDICATE delirium alcohol drugs endocrine depression brain lesion infections
define mild cognitive impairment
noticeable cognitive impairment with little deterioration in functioning
ACEIII and MoCA scores for mild cognitive impairment
ACEIII 75-90/100
MoCA 24-26/30
what is subjective cognitive impairment
patient feels cognitively impaired but the tests are all normal
criteria for DLB
visual hallucinations fluctuating parkinsonism REM behavioural disorder positive DAT scan
can you diagnose dementia from a scan
NO
role of CT scan
excludes lesions, bleeds, stroke, vascular changes, structural changes
indication for MRI
young
fast progression
atypical features
what is a SPECT scan most useful for
FTD
sometimes to clarify Alzheimer’s
when is a DAT scan used
suspected DLB/DPD when there arent enough supporting features
what do acetylcholinesterase inhibitors do
increase ACh at synaptic cleft
pharmacological management of Alzheimer’s
donepezil
rivastigmine
glanatamine
pharmacological management of DLB/DPD
rivastigmine
side effects of AChE inhibitors
nausea, diarrhoea headaches muscle cramps bradycardia worsen asthma/COPD
contraindications to AChE inhibitors
active PUD
asthma/COPD
what is memantine
NMDA antagonist to slow cognitive decline in Alzheimer’s
started in moderate dementia
what does memantine prevent
BPSD
behavioural and psychological symptoms of dementia
side effects of memantine
hypertension sedation dizziness headache constipation
somebody with a dementia diagnosis must report to the DVLA, true or false
true
what form is filled in with regards to driving
CG1 form
what is the Rockwood Driving Battery Test
assesses different aspects of driving
what are features of BPSD
hallucinations delusions insomnia anxiety depression aggression disinhibition agitation
