the ageing brain and dementia REVISE

Question 1

what is the cost of dementia to the UK economy?

Answer 1

bigger than cancer and heart disease combined

Question 2

in which sort of countries are the vast majority of new dementia cases recorded?

Answer 2

low/middle income countries

Question 3

is dementia a disease?

Answer 3

no
it is an overall term describing a group of symptoms (e.g memory loss) associated with decline in cognitive functioning leading to an increasing inability to cope

a major neurocognitive disorder

Question 4

how many types of demetia are there?

Answer 4

over 100 types

Question 5

what are the 2 main criteria for dementia diagnosis?

Answer 5

decline in cognitive functioning

leading to an increase in inability to cope and independetly function

Question 6

what is the difference in the diagnostic criteria for those with a mild or major neurocognitive disorder?

Answer 6

mild - modest cognitive decline but doesn’t interefere with capability for independence

modest - significant cognitive decline leading to lack of ability to act independently and to cope

Question 7

what is dementia more feared than?

Answer 7

heart disease, stroke, diabetes and cancer

Question 8

what is the prevalence of dementia in england in 2011?

Answer 8

670 000

compared to estimated 884 000

Question 9

what are the percentage probabilities that a randomly seleceted elderly person will have dementia?

Answer 9

6.5% england, 2011
8.3% england, 1991
40% Torbay memory clinic, 2015
65% england care homes, 2011

Question 10

what is the biological process cause of dementia?

Answer 10

misfolded proteins accumulate into amyloid plaque (either producing too much or unable to clear it)
which can occur both inside and outside neurons in the cerebral cortex and certain subcortical regions (occurs in everyone but some bodies better at breaking this down)

when this occurs inside neurons, they will die as do the synapses connected between them

the rate of neuronal loss can cause the onset of dementia after 10-20 years (middle age wen develop)

Question 11

what are tell tale signs that someone has dementia from looking at the brain?

Answer 11

brain shrinkage (atrophy) and gapping due to neuronal loss, especially in memory and language areas and hippocampus

reduction of brain activity due to neuronal loss which has occured (detected predominantly by a CT scan but MRI scans can also be used)

Question 12

what percentage of dementia patients have Alzheimer’s disease?

Answer 12

60-80%

most common form

Question 13

what are some early signs and symptoms of Alzheimer’s disease?

Answer 13

memory loss
problems with language
changes in mood or behaviour 
changes in personality
misplacing things

Question 14

what is the second most common form of dementia?

Answer 14

vascular dementia

Question 15

what is the cause of vascular dementia?

Answer 15

series of strokes (ischemic) causing clot
impairs circulation of blood to the brain
causes cell death

Question 16

what 3 elements is cognition made up of?

Answer 16

thinking, memory and reasoning

Question 17

what are the 2 main continuums for types of dementia

Answer 17

alzheimers - vascular (can be a combination of the 2 known as ‘mixed dementia’)

dementia with Lewy Bodies - Parkinson’s

Question 18

what is the cause of dementia with Lewy Bodies?

Answer 18

results from clumps of alpha-synuclein and ubiquitin protein

Question 19

what are some of the symptoms of dementia with Lewy Bodies?

Answer 19

cognitive:
fluctuating cognition
visual hallucinations

motor:
spontaneous parkinsonism

Question 20

what differentiates dementia with Lewy Bodies from Parkinson’s?

Answer 20

if there are more cogntive components of parkinson’s than motor then diagnosed with dementia with Lewy Bodies

Question 21

why is frontotemporal dementia easy to misdiagnose as a psychiatric disorder?

Answer 21

due to mood and behaviour disturbances
display ‘odd’ social behaviour
euphoria and apathy
repetitive compulsive behaviour

Question 22

which brief cognitive assessments are there for assessing dementia?

Answer 22

the Mini Mental State Examination (MMSE)

the Montreal Cognitive Assessment (MOCA)

Question 23

what are the main cognitive assessments used by GPs and why

Answer 23

have only around 8 mins to see a patient

Memory Impairment Screen (MIS)

GPCOG Screening Test

Question 24

why is it hard to accurately measure cognition in cognitive assessments?

Answer 24

testing effects e.g tired and also no comparison to previous cognition so might normally be lower and therefore no change

Question 25

what is the most telling cognitive test at the beginning of dementia?

Answer 25

delayed recall and also clock drawing

Question 26

what is an issue with cognitive assessments?

Answer 26

in some there are cultural and educational biases within the questions and tasks

Question 27

how often is the GPCOG used by GPs

Answer 27

50% of referrals as takes less than 10 mins

Question 28

drug treatments available

Answer 28

medication which reduces numbers of plaque don’t improve symptoms
medications mainly used to treat psychological symptoms

3 types of medication:
cholinesterase inhibitors
NMDA receptor antagonsists
antipsychotics (only used with severly distressed patients or those at risk of harm to themselves or others)

Question 29

best treatment for dementia as identified by NICE?

Answer 29

psychological

Question 30

intervention for cognitive symtpoms of dementia?

Answer 30

cognitive stimulation

Question 31

interventions for non-cognitive symptoms of dementia and challenging behaviour?

Answer 31

aromatherapy, multisensory stimulation, therapeutic use of music and/or dancing, animal-assisted therapy, massage

Question 32

is dementia more common with men or women?

Answer 32

women

Question 33

risk factors for dementia

Answer 33

stroke
hypertension
diabetes
obesity
smoking
depression
physical inactivity
cognitive inactivity
vitamin D deficiency
mediterranean diet

Question 34

what is hypertension?

Answer 34

when blood pressure increases to over 140/90 mm Hg

this damages target organs (if the brain then can lead to dementia)

Question 35

what is the controversy over the link between hypertension and dementia?

Answer 35

midlife hypertension associated with increased dementia risk
BUT
late-life hypertension inversely associated with dementia risk

Question 36

how many people in the world have vitamin D deficiency or insufficiency?

Answer 36

1 billion

Question 37

what is the threshold risk of vitamin D?

Answer 37

around 50 nmol/L

Question 38

how does the mediterranean diet link with dementia?

Answer 38

greater adherence to the diet associated with slower cognitive degeneration and reduced risk of dementia

could be to do with oily fish containing vitamin D

Question 39

what is the link between alcohol consumption and dementia?

Answer 39

it appears light to moderate drinkers are at the lowest risk and heavy drinkers are at the highest risk (nondrinkers at the highest risk for Alzheimer’s disease)

and history of alcohol use disorders more than double the odds of severe memory impairment

HOWEVER this could be due to the general lifestyle choices that these people take e.g heavy drinkers may not exercise as frequently etc.

Question 40

what does the NHS recommend in terms of drinking and physical activity?

Answer 40

at least 150 minutes of moderate aerobic activity every week and strength exercises on 2+ days working all major muscles

don’t exceed 14 units a week and space over at least 3 days

Question 41

heritability of Alzheimer’s disease?

genes which may incur an increased risk?

Answer 41

79% (79% of variance in onset of disease related to genetics)

may be related to having 1 or 2 E4 alleles