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Week 236 - Alzheimers Flashcards

1
Q

Week 236 - Alzheimers: What is the ICD10 diagnostic criteria for dementia?

A

• Acquired impairment in memory for at least 6 months plus impairment in one of the following cognitive domains-

  • Executive functioning
  • Language
  • Praxis (learned motor tasks)
  • Gnosis (ability to recognize objects, faces)

These impairments must be severe enough to interfere with work, social activities and relationships.

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2
Q

Week 236 - Alzheimers: What is mild cognitive impairment?

A

Cognitive decline that is greater than we would expect for age but which does not notably interfere with activities of daily living.

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3
Q

Week 236 - Alzheimers: What are the risk factors for developing alzheimers?

A
  • Age
  • Female
  • Genetics
  • Head injury
  • Environmental (eg. oxidative stress)
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4
Q

Week 236 - Alzheimers: What are the risk factors for developing vascular dementia?

A
  • Smoking
  • Diabetes
  • High cholesterol
  • Hypertension
  • Male
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5
Q

Week 236 - Alzheimers: How are Parkinson’s dementia and Lewy body dementia related and how do they differ?

A

• Parkinsons dementia
- Prominent motor features and motor symptoms predate dementia by at least 6 months.

• Lewy body dementia
- Parkinsonia motor features are mild and onset of memory and motor features are more closely related in time.

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6
Q

Week 236 - Alzheimers: What is the presentation of vascular dementia?

A
  • Sudden onset
  • Stepwise progression
  • Mood/behaviour change
  • Insight preserved
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7
Q

Week 236 - Alzheimers: What is the presentation of Lewy body dementia?

A
  • Fluctuating cognition
  • Vivid visual hallucinations
  • Mild parkinsonian features
  • Repeated falls
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8
Q

Week 236 - Alzheimers: What is Pick’s disease?

A

• A type of fronto-temporal dementia

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9
Q

Week 236 - Alzheimers: How does fronto-temporal dementia present?

A
  • Apathy, reduced motivation, self neglect.
  • Disinhibited, decreased social awareness, lack of judgement.
  • Change in personality
  • Memory loss is variable
  • Language difficulties are prominent
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10
Q

Week 236 - Alzheimers: How can depression be misinterpreted as dementia?

A
  • They may get psychotic features.

* Impaired attention and concentration may lead to subjective complaints of memory loss.

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11
Q

Week 236 - Alzheimers: What are some of the causes of secondary dementia?

A
  • HIV, CJD
  • Inflammatory - SLE,MS
  • Renal failure - Vit def.
  • Hypothyroidism
  • Alcohol
  • Traumatic eg SDH
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12
Q

Week 236 - Alzheimers: What is Korsakoff’s dementia?

A

• A secondary cause of dementia that is related to a history of alcohol dependence.
• Caused by Vitamin B1 deficiency (thiamine)
• Follows acute Wernicke’s encephalopathy.
- Ataxia, opthalmoplegia, nystagmus, confusion.

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13
Q

Week 236 - Alzheimers: What are the genetics underlying the early onset of Alzheimers (

A
  • Presenilin gene 2 (chromosome 1)
  • Presenilin gene 1 (chromosome 14)
  • Beta amyloid precursor protein gene (chromosome 21)
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14
Q

Week 236 - Alzheimers: What are the genetics underlying late onset alzheimers? (>65yrs)

A

• Apolopoprotein E gene (chromosome 19)

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15
Q

Week 236 - Alzheimers: What is the medical treatment in alzheimers and Lewy body dementia?

A
  • Mild-moderate dementia consider anti-cholinesterase.

* Moderate-advance dementia consider memantine.

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16
Q

Week 236 - Alzheimers: What is the medical management for vascular dementia?

A

Treatment of cardiovascular risks.

  • Low dose aspirin, statin, management of BP, blood glucose.
  • Lifestyle advice re smoking, low fat diet.
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17
Q

Week 236 - Alzheimers: What drugs are anti-cholinesterase’s? What are they used to treat?

A
  • Mild-moderate dementia. (Due to alzheimers or Lewy body)
  • Aricept - Donepezil
  • Exelon - Rivastigmine
  • Reminyl - Galantamine
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18
Q

Week 236 - Alzheimers: Memantine is used in the treatment of moderate-severe dementia caused by alzheimers or Lewy bodies. What is it and what is its mechanism of action?

A
  • NMDA antagonist.
  • Blocks NMDA receptors and so blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction.
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19
Q

Week 236 - Alzheimers: What are some of the behavioural and psychiatric features of dementia?

A
  • Agitation and agression.
  • Restlessness and wandering.
  • Depression, anxiety, sleep disturbance.
  • Delusions/hallucinations.
  • Disinhibition.
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20
Q

Week 236 - Alzheimers: What are the key for points for understanding whether someone has capacity?

A

Can the person-
• Understand information relevant to the decision.
• Retain that information.
• Use/weigh that info when making a decision.
• Communicate decision.

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21
Q

Week 236 - Alzheimers: What are the driving rules with dementia?

A
  • Patient must notify DVLA
  • Doctor may advise against driving
  • DVLA 12 month license may renew
  • On road test
  • Patient must inform insurance company
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22
Q

Week 236 - Alzheimers: What are the macroscopic pathology findings of alzheimers?

A
  • Cerebral atrophy

* Ventricular dilatation

23
Q

Week 236 - Alzheimers: What are the three microscopic features of alzheimers disease?

A
  • Amyloid plaques between neurones.
  • Amyloid deposited in cerebral blood vessel walls.
  • Neurofibrillary tangles - made up of the tau protein.
24
Q

Week 236 - Alzheimers: What are the two hypotheses behind alzheimers disease?

A
  • Cholinergic

* Glutamergic

25
Q

Week 236 - Alzheimers: What is the cholinergic hypothesis of alzheimers?

A
  • Acetylcholine is vital in memory and cognition.

* Pathological processes result in an extensive deficit of cholinergic neurotransmission.

26
Q

Week 236 - Alzheimers: What is the glutamergic hypothesis of Alzheimers?

A

• Neuronal damage linked to over-activation of NMDA receptors by glutamate.

27
Q

Week 236 - Alzheimers: High levels of which neurotransmitter are ‘excitotoxic’? It is the major mechanism of neuronal death in which conditions?

A
  • Glutamate

* Stroke, epilepsy, Huntingtons Disease, Alcohol withdrawal, Alzheimers (Hypothesis).

28
Q

Week 236 - Alzheimers: Where is acetylcholine made?

A

Basal forebrain

- Projections to the cortex and hippocampus.

29
Q

Week 236 - Alzheimers: What are the three main types of memory? (Temporally)

A
  • Short-term memory - Sensory processing
  • Working-memory - Info is held whilst you work out what to do with it.
  • Long-term memory - Turn working memory into ‘permanent’
30
Q

Week 236 - Alzheimers: What are the two types of memory? (Functionally)

A

• Declarative (explicit)

  • Semantic (concepts)
  • Episodic (autobiographical)
  • Medial temporal lobe, hypothalamus, thalamus.

• Non-declarative (implicit memory)

  • Procedural memory, skills, habits - striatum
  • Motor learning - cerebellum
  • Emotional conditioning - amygdala
31
Q

Week 236 - Alzheimers: In which part of the brain are procedural memory, skills and habits stored?

32
Q

Week 236 - Alzheimers: In which part of the brain is motor learning stored?

A

Cerebellum

33
Q

Week 236 - Alzheimers: In which part of the brain is emotional conditioning stored?

34
Q

Week 236 - Alzheimers: What is retrograde amnesia?

A

Loss of memories from before the occurrence of the event.

35
Q

Week 236 - Alzheimers: What is anterograde amnesia?

A

Inability to form new declarative memories.

36
Q

Week 236 - Alzheimers: What is transient global amnesia?

A

This is transient retrograde and anterograde amnesia.

37
Q

Week 236 - Alzheimers: What does the parietal cortex do?

A
  • Attending to stimuli - Where is it?
  • Integrates visual, auditory and somatosensory info.
  • Damage to it leads to ‘neglect’.
38
Q

Week 236 - Alzheimers: ‘Neglect’ results from damage to the parietal cortex, what are four main ways in which it can present?

A
  • Sensory neglect - incoming sensory information from the contralateral hemispace is ignored.
  • Conceptual neglect - Neglect of the body and external world in the contralateral hemifield.
  • Hemiasomatognsia - Patient denies that affected side of body belongs to them.
  • Motor neglects - fewer movements in contralateral space.
39
Q

Week 236 - Alzheimers: What does the temporal cortex do?

A

• Identifies the nature of a stimuli - What is it?

40
Q

Week 236 - Alzheimers: What is agnosia and what is it caused by?

A
  • Inability to recognize sensory stimuli.

* Caused by damage to the temporal cortex.

41
Q

Week 236 - Alzheimers: What is visual agnosia?

A

Patient can see but cannot identify.

42
Q

Week 236 - Alzheimers: Damage to the fusiform gyrus will cause what type of agnosia?

A

Prosopagnosia.

- Inability to recognise individuals from their face.

43
Q

Week 236 - Alzheimers: What is movement agnosia?

A

This is where a person cannot distinguish between moving and stationary.

44
Q

Week 236 - Alzheimers: What does the frontal cortex do?

A

Selects and plans an appropriate response. - What shall I do about it?

45
Q

Week 236 - Alzheimers: What are some of the symptoms of frontal cortex damage?

A
  • Inability to plan a sequence of events needed to complete a task.
  • Loss of spontaneous interactions.
  • Loss of flexibility in thought.
  • Inability to focus on task.
  • Socially inappropriate behaviour.
  • Personality change.
  • Difficulty with problem solving.
46
Q

Week 236 - Alzheimers: What is aphasia?

A

Speech disorder where the patient has difficulty in naming objects and repetition of words is impaired.

47
Q

Week 236 - Alzheimers: What is dysarthria?

A

Inability to move the muscles of the face and tongue that mediate speaking.

48
Q

Week 236 - Alzheimers: What are the major speech areas?

A

Brocas area and Wernickes area.
• Brocas - Making speech
• Wernickes - Understanding speech

49
Q

Week 236 - Alzheimers: What are the consequences of Wernickes aphasia?

A
  • Unable to understand language.
  • Fluent speech but makes no sense.
  • Little repetition.
  • Contrived or inappropriate speech.
50
Q

Week 236 - Alzheimers: What are the consequences of Brocas aphasia?

A
  • Able to understand language but not able to construct their own.
  • Halting speech.
  • Repetitive
  • Disordered syntax, disordered grammar.
  • Disordered structure of individual words.
51
Q

Week 236 - Alzheimers: What is senescence?

A

Impact of time on the body - Biological ageing.

52
Q

Week 236 - Alzheimers: What is hypoactive delirium?

A

This is delirium where the individual will become quiet and lethargic.
- This has a markedly increased rate of mortality due to under-recognition.

53
Q

Week 236 - Alzheimers: What is hyperactive delirium?

A

• Hyper-aroused, irritable, mood liability, perceptual abnormalities.

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