TBL 2- Dementia (Pre-reading)

Question 1

What is the ICD-10 criteria for Dementia?

Answer 1

Syndrome due to brain disease
-chronic or progressive 
-disturbance of higher cortical functions: 
1. Memory
2. Thinking 
3. Orientation 
4. Comprehension 
5. Calculation 
6. Learning capacity 
7. Language 
8. Judgement 
-Consciousness is not clouded 
Cognitive function often preceded by deterioration in emotional control, social behaviour or motivation

Question 2

What are the common neuropathological findings in the brain of someone wit Alzheimer’s dementia?

Answer 2

Amyloid plaques- outside cell, where the fragments are left after secretases snip APP, and disintegrated dendrites exist
Neurofibrillary tangles- inside cell

Question 3

Where is the main source of ACh for the cortex in the brain?

Answer 3

The Nucleus Basalis of Meynert in the basal forebrain.

It is one of the first areas of the brain affected in AD.

Question 4

What three cholinesterase inhibitors are in use for alzheimers?

Answer 4

1. Donepezil
2. Rivastigmine- AD + Dementia with Lewy Bodies
3. Galantamine

Slow cognitive decline by increasing cholinergic transmission.
Licenced for mild-moderate alzheimers.

Question 5

What are common side effects of cholinesterase inhibitors?

Answer 5

GI upset 
Tiredness
Headache
Sleep disturbance
Bradycardia - increased ACh stimulates the vagus systeme

Question 6

What is the license and mechanism of action of Memantine?

Answer 6

Moderate-severe Alzheimers
MoA: blocks NMDA-type glutamate receptors

Theory: neurons are damaged by glutmate over-activation
(Glutamate is main excitatory NT in the brain)

Question 7

What are the common side effects of memantine?

Answer 7

Dizziness
Confusion
Agitation 
Sedation 
Headache
Insomnia 
Hallucinations

Question 8

What is the Hachinski Ischaemic Score?

Answer 8

It is a quick and easy test for vascular dementia ddx AD
Score =4 indicates Alzheimer’s
Score >/=7 indicates Vascular Dementia

        Abrupt onset				2
	Stepwise deterioration			1
	Fluctuating course				2
	Nocturnal confusion			1
	Preservation of personality		1
	Depression					1
	Somatic complaints			1
	Emotional incontinence			1
	History of hypertension			1
	History of stroke				2
	Associated atherosclerosis		1
	Focal neurological symptoms		2
	Focal neurological signs			2

Question 9

What clinical criteria differentiate Lewy Body Dementia and Dementia in Parkinson’s Disease?

Answer 9

DLB- Cognitive impairment precedes or coincides with movement disorder
DPD- Movement disorder is present FIRST for at least a YEAR prior to onset of cognitive impairment.

Question 10

What are the features of probable dementia with Lewy Bodies?

Answer 10

2 of 3:

1. Flux. cognition with variation in attention and alertness
2. Recurrent visual hallucinations- well formed and detailed often
3. Spontaneous features of parkinsonism

OR 1 of the above + 1 of:

1. PEM sleep behaviour disorder
2. Severe neuroleptic sensitivity
3. Low dopamine transporter uptake in basal ganglia dem. by SPECT or PET imaging.