PBL5- Dementia Flashcards
Delirium
Acute and reversible disturbance of higher mental function
E.g. Metabolic disturbances, alcohol toxicity
Presenile dementia is before the age of
65
Commonest cause of dementia -
Alzheimer’s disease
Alzheimer’s - slowly progresses
Cognitive - (2)
Mood - (3)
Behavioural - (2)
Cognitive - difficulty in abstract thought, confusion of time and place
Mood - depression, anxiety, anger
Behavioural - loss of inhibitions, act out of character
Test intellectual function
Score - indicated dementia
Mini-mental state exam
Score more than
Alzheimer’s Pathophysiology
6
Neuritic plaques Neurofibrillary tangles Neuronal loss Granulovascular degeneration Cerebral Atrophy Loss of sub cortical projections
Neuritic plaques
Extra cellular aggregates of beta -amyloid peptide, particularly in parietal lobe and hippocampus
Neurofibrillary tangles
Intracellular deposits of hyperphosphorylated tau protein filaments
Mutation in what gene is associated with early onset Alzheimer’s?
APP - amyloid precursor protein
Markers of Alzheimer’s:
CSF levels of (2)
Beta APP - decreased
Tau - increased
Late-onset Alzheimer’s gene associated? + chromosome
E3 Allele of the APOE gene - encodes apolipoprotein E
Chromosome 19
Dementia types (8)
Multi-infarct dementia
Pick’s disease- frontal lobe dysjunction, no treatment
Primary progressive - dominant hemisphere focal atrophy
AIDS Dementia complex - CNS infection from AIDS
Metabolic dementia - vitamin B12 deficiency
Normal pressure hydrocephalus
Trauma
Other neurological conditions - Parkinson’s, Huntington’s
Wernickes Korsakoff syndrome (2)
Short term memory affected
Due to thiamine deficiency
Dementia associated with
Cortical thinning, increased ventricles, enlarged sulci
Investigate cognitive decline encase
There is a treatable cause e.g. Tumour, hydrocephalus
Learning and memory - neuroplastic changes in
Corticolimbic circuits
Changes in corticolimbic circuits due to … (2)
Long term potentiatin (LTP) and long term depression (LTD)
Corticolimbic circuits and neurotransmitters (3)
Glutaminergic transmission
- ionotrophic glutamate receptors = NMDA and AMPA
- Metabotrophic glutamate receptors
Alzheimer’s treatment drug (not anti-gluamatergic)
- Why
- Examples (3)
- How the work
Acetylcholinesterase
- Some symptoms due to loss of cholinergic Neurons in forebrain
- Donepezil, rivastigmine, galantamine
- Inhibit the breakdown of Ach by AChE (acetylcholinesterase)
Alzheimer’s treatment drug (not anti-cholinesterase )
- Why
- Examples (1)
- How the work
- Alzheimer’s associated with atypical exitoxicity caused by increased release of glutamate
- Memantine
- Uncompetitive blocker of NMDA glutamate receptors
Can you give anti - cholinesterase and anti-glutamatergic agents together?
YES!
Alzheimer’s vaccine
Anti-amyloid vaccine
- limit toxicity of amyloid peptides - form the amyloid plaques
Dementia -
Progressive deterioration of intellect, behaviour and personality, as a consequence of diffuse disease of the …., maximally affecting the … and …..
Progressive deterioration of intellect, behaviour and personality, as a consequence of diffuse disease of the cerebral hemispheres, maximally affecting the cerebral cortex and hippocampus
