Week 3 - C - Brief dementia Cards - Alzheimers disease - Where it starts and treatment, Lewy body & parkinsons , Hachinski Ischaemic Score

Question 1

Even though there is no cure for most causes of dementia, there is still a lot we can do to help people with dementia to have a good quality of life! What are the 4 main primary dementias? What is the main secondary dementia?

Answer 1

Primary

• * Alzhiemer’s disease
• * Lewy body dementia
• * Fronto-temporal dementia
• * Huntington’s disease

Secondary

• * Vascular dementia

Question 2

What are the order of the 4 most common types of dementia?

Answer 2

Alzheimers disease is the ommonest type of dementia

Vascular demenita is the 2nd commonest type

Lewy body dementia is 3rd commonest

Fronto-temporal is the 4th commonest

Question 3

When does alzhimers dementi typically occur? What is one of the first areas of the brain to be affected by the neruopathological processes of Alzheimers disease?

Answer 3

Alzheimers dementia typically occurs in patients over 60 years of age

One of the first areas to be affected by Alzheimers is the nucleus basalis of Meynert

Question 4

Where is the ncuelus basalis of meynert located? What is the main function of the nucleus basalis of meynert?

Answer 4

The nucleus basalis of meynert is located in the basal forebrain of the brain

The nucleus basalis of meynert has the main function of being the main source of acetylcholine for the cortex

The disruption of cholinergic transmission is partly how alzheimers affects cognitive function

Question 5

Due to the disruption of the cholinergic pthwys due to Alzheimers disease affecting the main source of acetylcholine in the brain - the nucleus basalis of meynert - as one of the first areas effected, what would be a good start to consider for treatment of alzheimers disease?

Answer 5

Target the enzyme that breaks down acetylcholine

The drugs which target the enzyme which breaks down Ach are known as acetlycholinesterase inhibitors

Question 6

Name 3 acetylcholinesterase inhibitors?

Answer 6

Donepezil

Rivastigmine

Galantamine

Question 7

The cholinesterase inhibitors in current clinical use are donepezil, rivastigmine and galantamine. They do not affect the underlying pathological processes in Alzheimers disease, but do slow cognitive decline by increasing cholinergic transmission. They are licensed for use in mild to moderate Alzheimers disease Which of the three acetylcholinesterase inhibitors? (coliinesterase inhibitors) is also licensed for use in dementia with lewy bodies?

Answer 7

This would be rivastigmine

Question 8

What is the drug that is licensed for use in moderate to severe alzheimers disease? Why is this treatment given? (ie thought process behind the drug)

Answer 8

* Memantine is the drug that is licensed for use in moderate to severe alzhiemers disease

* It works by blocking the NMDA-type glutamate receptors (N-methyl-D-aspartate) It is thought that in alzheimer’s as well as many other neurodegenerative processes, there is the over excitation of glutamate &therefore this drug aims to block the NMDA-type glutamate receptors to slightly reducing this hyperactivity It is the calcium influx through the NMDA gltuamate receptor channels that is thought to be neurotoxic

Question 9

What is the quick and easy test that can help in the clinical differentiation of Alzheimers or vascular dementia?

Answer 9

This would be the hachinski ischaemic score (HIS)

Question 10

WHat score on the hachinski ischaemic score suggests vascular dementia? What score suggests alzheimers disease?

Answer 10

A score on the HIS of /= 7 suggests vascular dementia

Question 11

What is the treatment of vascular dementia?

Answer 11

Treat the reason for the multiple infarcts

Ie give antiplatelet if atherosclerotic disease or anticoagulant if cardioembolic cause of infarct

If high cholesterol then give a statin, if high BP then give anti-hypertensive

Question 12

Lewy body dementia (DLB) and Dementia in parkinsons disease (DPD) The clinical features of DLB and DPD are the same, although the neurobiology is different. The two conditions are distinguished clinically by the timing of the symptoms- What timing distinguishes between DLB and DPD?

Answer 12

In dementia lew body, the cognitive impairment occurs before or around the same time as the movement disorder

In dementia in parkinsons disease, the movement disorder is present for at least one year pior to the onset of cognitive impairment

Question 13

What are the clinical symptoms of parkinsons disease?

Answer 13

This would be bradykinesia, rigidity, tremor, postural instability, shuffling gait

Question 14

What are the diagnostic features of lewy body dementia?

Answer 14

There is the presence of dementia

+ Two of three core features:

• Fluctuating attention and concentration
• Recurrent well formed visual hallucinations and
• Spontaneous parkinsonian motor signs

Question 15

Suggestive clinical features include: Rapid eye movement (REM) sleep behavior disorder Severe neuroleptic sensitivity Low dopamine transporter uptake in basal ganglia demonstrated by SPECT or PET imaging What is the low dopamine uptake in the basal ganglia demonstrated by the SPECT or PET imaging known as?

Answer 15

This is known as low attenuation on SPECT scan

Question 16

The suggestive features that can implicate DLB do include REM sleep disorder and abnormal brain scans, PET or SPECT, ut they also include one other feature, what is this? It is a response to a certain type of drug

Answer 16

This would be severe neuroleptic sensitization - neuroleptic malignant syndrome may occur in patients who take these drugs - neuroleptics are also known as anti-psychotics

The treatment of DLB is basically the same as the treatment of AD, although only rivastigmine is licensed

Question 17

if a patient with Lewby body dementia is having psychotic symptoms, what can be given?

Answer 17

Can give atypical antipsychotics - ie quetiapine, risperidone, alanzapine

Atypicals act more on 5HT2a reuptake rather than blocking dopamine uptake

If becoming very aggressive or harm to themselves, can give a benzo - eg lorazepam