Week 236 - Alzheimers/Dementia

Question 1

Week 236

What is the commonest form of dementia?

Answer 1

Alzheimers
Dementia (50%+)

Question 2

Week 236

What is the second most common type of dementia?

Answer 2

Vascular dementia

Question 3

Week 236

What is the third most common type of dementia?

Answer 3

Lewy Body Dementia

Question 4

Week 236

What are the ICD 10 diagnostic criteria for dementia?

Answer 4

• Impairment in memory for at least 6 months
• Impaired executive functioning
• Impaired language
• Impaired praxix (learned motor tasks)
• Impaired gnosis (ability to recognise objects and faces)
• Severe enough to affect relationships, work etc.

Question 5

Week 236

What is the difference between dementia and mild cognitive impairment?

Answer 5

• Dementia is: Global impairment of intellect, memory and personality resulting in impaired performance
  in activities of daily living
• Mild cognitive impairment: Cognitive decline greater than that expected for an individual’s age and educational level but which does not notably
  interfere with activities of daily living.

Question 6

Week 236

What is presentation of Alzheimers dementia?

Answer 6

• Insidious onset
• Gradual deterioration

Question 7

week 236

What is the nueropathology of Alzheimers?

Answer 7

• Deficit in cholinergic neurtoransmission
• PLaques and tangles
• Especially degraded in Hippocampal region of the brain

Question 8

Week 236

What are the risk factors for Alzheimers dementia?

Answer 8

• Age
• Female sex
• Genetics
• Head injury
• Environmental stress

Question 9

Week 236

In Alzheimers dementia, what type of placque causes what type of entanglement?

Answer 9

• Amyloid plaques
• Neurofibrilliary tangles

Question 10

Week 236

As well as encouraging acetylcholine neurotransmitter to hang around, what other neurotransmitter is targeted in therapy for Alzheimers dementia?

Answer 10

• NMDA GLutamate receptors - you want to block them (low level activity of NMDA shown to have influence on AD)

Question 11

Week 236

What is the presentation of Vascular dementia?

Answer 11

• Sudden onset
  –
  Stepwise deterioration
  –
  Mood/behaviour
  change
  –
  Insight preserved

Question 12

Week 236

What are the risk factors for vascular dementia?

Answer 12

Smoking
–
Diabetes
–
High cholesterol
–
High blood pressure
–
Male sex

Question 13

Week 236

Name some differences between parkinsons dementia and Lewy body dementia.

Answer 13

• In parkinsons, motor symptoms predate dementia by at least 6 months.
• In lewy body: Motor symptoms are more mild, and there is no lag in display of motor/cognitive symptoms.

Question 14

Week 236

What are the symptoms of Lewy Body dementia?

Answer 14

Fluctuating cognition
–
Vivid visual hallucinations
–
Mild Parkinsonian features
–
Repeated falls

Question 15

Week 236

What is Pick’s Disease?

Answer 15

• TAlso called Fronto-temporal dementia
• Apathy/reduced motivation/self neglect
• Disinhibition
• Socially inappropriate
• Often male with age less than 65 years

Question 16

Week 236

What are the main differential diagnoses for Dementia?

Answer 16

• Depression (pseudodementia) - Low mood, low interest, impaired attention and interest. AWARE of memory loss, gives “don’t know” answers.
• Delirium -Acute onset, abnormal attention/arousal, impaired conscious level - usually associated with acute illness. Also known as acute confusional state.
• Secondary dementia (organic causes) - Infective, inflammatory, metabolic, endocrine, toxic, traumatic.
  *

Question 17

Week 236

What are the symptoms of Normal pressure hydrocephalus?

Answer 17

Recent onset dementia
–
Ataxia
–
Urinary incontinence
–
PMH SAH or meningitis in about 40%
–
Potentially reversible by CSF shunting

Question 18

Week 236

What is Korsakoff’s dementia? What are its symptoms?

Answer 18

Related to history of alcohol dependence
–
Caused by Vitamin B1 deficiency (thiamine)
–
Follows acute Wernicke’s encephalopathy
(ataxia, ophthalmoplegia, nystagmus, confusion)

DIRECTLY RELATED TO ALCOHOL

Question 19

Week 236

Genetics of Alzheimers: Presenilin 2, gene PS2 is found on which chromosome?

Answer 19

Chromosome 1

Associated with Early onset AD

Question 20

Week 236

Genetics of Alzheimers: Presenilin 1, gene PS1 is found on which chromosome?

Answer 20

Chromosome 14

Associated with early onset AD

Question 21

Week 236

Genetics of Alzheimers: Beta Amyloid precursor protein gene APP is found on which chromosome?

Answer 21

Chromosome 21

Associated with early onset AD

Question 22

Week 236

Apolipoprotein E gene apoE4 is found on which chromosome?

Answer 22

Chromosome 19

Associated with Late onset dementia (above 65)

Question 23

Week 236

Alzheimer type dementia and Lewy body dementia: What are the Treatment options?

Answer 23

• If mild-moderate: Anticholinesterase
• Moderate-advanced: Memantine (blocks NMDA receptors)

Question 24

Week 236

What are the treatment options for Vascular Dementia?

Answer 24

• Low dose aspirin
• Statin
• Manage BP and BLood sugars
• Lifestyle advice

Question 25

Week 236 **Donsepezil**, **Rivastigmine**, and **Galantamine** are **what type of drug**?

Answer 25

These Are **anticholinesterases.**

Question 26

Week 236 What are the **cautions** associated with **anti-cholinesterases**?

Answer 26

Cardiac arrythmias esp bradyarrythmias Epilepsy Asthma History of bleeding GI ulcer disease Prostatism

Question 27

Week 236 What are the general principles of the **Mental Capacity Act 2005**?

Answer 27

Presume capacity  Help people to have capacity  **Allowed to make unwise decision** Decisions for those without capacity – Best interest – Least restrictive

Question 28

Week 236 What is meant by the term "**Praxis**"?

Answer 28

Learned motor tasks

Question 29

Week 236 What is meant by the term "**Gnosis**"?

Answer 29

The ability to recognise faces or things.

Question 30

Week 236 Mr D is 83 and has had a failing short term memory for twelve to eighteen months. His wife died many years ago and his daughter lives nearby. She has raised concerns regarding his memory and worries that he forgets to eat. He has hypertension controlled by Ramipr il and this is regularly monitored by his G.P. He has been seen in the Old Age Psychiatric out - patient clinic where his ACE - R score was 64/100 . His CT brain scan showed generalized age related atrophy. His FBC, B12 & Folate, Lipids, U & E’s, LFT were w ithin normal limits. His chest x - ray was normal and his MSU was clear. The history suggests a gradual slow decline in his memory over twelve to eighteen months associated with what the daughter describes as a reduction in his outside interests and a diff iculty expressing himself as he used to. He used to have a rather short fuse but is now more placid. **What type of dementia is most likely here?**

Answer 30

This is most likely **pick's disease**. (Tempero-frontal) dementia.

Question 31

Week 236 Give an example of a **Dopadecarboxylase inhibitor**.

Answer 31

**Carbidopa**, or Benserazide This is a medication used in the **treatment of Parkinsons** disease.

Question 32

Week 236 Give an example of a Catechol-O-methyltransferase inhibitor.

Answer 32

Entacapone. Parkinsons medication.

Question 33

Week 236 Name some Dopamine Receptor Antagonists.

Answer 33

Ropinirole Rotigine Apomorphine PArkinsons medications, used either a lone or with Levodopa.

Question 34

Week 236 What is Levodopa?

Answer 34

This is a Parkinsons medication. Broken down by Dopadecarboxylase enzyme to produce dopamine. NOt a cure - will only slow the progression of the disease.