YearClub 2026 Neurology session (dementia)

Question 1

What is dementia?

Answer 1

Dementia is irreversible, progressive decline in cognitive function of atleast 1 domain without altered conscious state.

Question 2

Dementia doesn’t have to be consistent or gradual. True/false?

Answer 2

True

Question 3

Frontotemporal dementia is the commonest form of dementia. True/false?

Answer 3

False. Alzheimer’s dementia is most common form of dementia.

Question 4

Hallmarks of Alzheimer’s dementia?

Answer 4

Neurofibrillary tangles (abnormal accumulations of a protein called tau that collect inside neurones).

Senile plaques (polymorphous beta-amyloid protein deposits found in the brain in Alzheimer disease and normal aging).

Loss of cortical neurones (neurones are lost in a progressive pattern that is relatively consistent among individuals).

Question 5

Polymorphisms in ApoE4 decrease dementia risk. True/false?

Answer 5

False.

Polymorphisms in ApoE4 increase risk.

In ApoE2 decrease risk of alzheimer’s

Question 6

Treatment of Alzheimer’s dementia?

Answer 6

Improves symptoms but doesn’t slow decline:

1st rivastigmine (Cholinesterase inhib)

2nd Memantine (NMDA receptor blocker)

Question 7

What is a cholinesterase (acetylcholinesterase) inhibitor?

Answer 7

Example = rivastigmine

Inhibit the enzyme acetylcholine from breaking down into acetate and choline. Leading to improved communication between nerve cells to temporarily improve dementia symptoms.

Question 8

What is an NMDA receptor blocker?

Answer 8

Examples = memantine, amantadine.

Block NMDA receoptors hence reducing glutamate production and slowing damage to nerve cells.

Question 9

What is vascular dementia?

Answer 9

Dementia due to micro-infarction of brain tissue. Can be focal post stroke, or generalised. Generally >65.

Question 10

Vascular dementia usually has a gradual progression. True/false?

Answer 10

False. Progression is often step-wise rather than gradual, as small strokes accumulate.

Step-wise is stable on between events.

Gradual has continuous decline (usually the case with Alzheimer’s).

Question 11

What does vascular dementia show in an MRI?

Answer 11

MRI shows severe small vessel disease

Question 12

Treatment for vascular dementia?

Answer 12

Treatment is to reduce vascular disease risk factors, monitor disease. Often overlap with Alzheimer’s in which case Rivastigmine can help

Question 13

Frontotemporal dementia tends to develop in people younger than 65. True/false?

Answer 13

True

Question 14

What does frontotemporal dementia present with?

Answer 14

Since frontal lobe often presents with behavioral symptoms, or disinhibition. Drastic personality change, hyperorality/ overeating.

Question 15

Appearance of frontotemporal dementia on imaging?

Answer 15

MRI/Spect show atrophy/ reduced uptake but specifically in the frontal/temporal lobes

Question 16

Management of frontotemporal dementia?

Answer 16

Aggressive disease which is hard to manage.

Trial of antipsychotics/ trazadone (serotonin antagonist and reuptake inhibitor).

Manage access to food, money, internet. Sort power of attorney.

Question 17

The deposition of what protein is the underlying cause of Lewy body dementia and Parkinson’s dementia?

Answer 17

Alpha synuclein protein

Question 18

How does Dementia with Lewy bodies and Parkinsons dementia present?

Answer 18

Presents usually >65 with fluctuating cognition and well formed visual hallucinations.

Question 19

What differentiates Dementia with Lewy bodies from Parkinson’s dementia?

Answer 19

If extrapyramidal (parkinsonian) features present atleast 1 year before cognitive: parkinsons dementia

If absent or present within a year/ after cognitive- dementia with Lewy Bodies

Extrapyramidal features include resting tremor, rigidity, akinesia (loss or impairment in power of voluntary movement) and affected posture and balance.

Question 20

Fluctuating cognitive impairment is a major sign in Lewy body dementia. true/false?

Answer 20

True
Also present in parkinson’s dementia

Fluctuating cognition is characterized by alternating periods of cognitive impairment and “normal or near-normal performance” and “pronounced variations in attention and alertness.

Question 21

Preferred investigation for Lewy body and Parkinson’s dementia?

Answer 21

Investigation of choice is DaT scan (dopamine transporter activity on SPECT)

Question 22

Some features of Lewy body dementia include hallucinations, memory problems and some parkinsonian features such as poor arm swing. true/false?

Answer 22

True

Question 23

What is huntington’s disease?

Answer 23

An Autosomal Dominant Disorder causing distinctive symptoms due to degeneration of the basal ganglia and cerebrum.

Tends to affect patients at an early age, onset 30-50 years.

Question 24

Underlying cause of huntington’s disease?

Answer 24

Mutations in the huntington gene (ch 4). Causes CAG trinucleotide expansion leading to long glutamine strings which are toxic to cells.

Question 25

Investigations for huntington’s disease?

Answer 25

MRI: focal atrophy of caudate heads. Genetic test is gold standard

Question 26

Medications for huntington’s disease?

Answer 26

Amantadine, antipsychotics.

Question 27

Wernicke-korsakoff syndrome is the combination of wernickes encephalopathy and korsakoff syndrome. true/false?

Answer 27

True

Question 28

What is the main cause of wernicke encephalopathy and korsakoff syndrome?

Answer 28

Both neurological conditions caused by thiamine deficiency (deficiency of vitamin B1) often associated with chronic alcoholism.

Question 29

main difference between wernickes encephalopathy and korsakoff syndrome?

Answer 29

The key difference is that Wernicke encephalopathy is an acute, reversible condition that can be treated with thiamine supplementation.

Korsakoff syndrome is an irreversible, chronic condition that occurs after incomplete recovery from Wernicke encephalopathy.

Wernicke encephalopathy is characterized by a triad of eye abnormalities (ophthalmoplegia), ataxia, and confusion.

Korsakoff syndrome is characterized by anterograde and retrograde amnesia with preserved long-term memory.

Question 30

What is anterograde and retrograde amnesia?

Answer 30

Retrograde amnesia is the inability to recall past memories while anterograde amnesia is the inability to create new memories.

Question 31

What is ophthalmoplegia?

Answer 31

paralysis of the muscles within or surrounding the eye.

Question 32

Another name for vascular dementia?

Answer 32

Multi-infarct dementia

Question 33

What is Huntington’s disease and it’s features?

Answer 33

A genetic disease inherited in an autosomal dominant pattern that affects the brain.

Symptoms can include:
- Rapid involuntary movements (chorea)
- Cognitive decline
- Behavioural changes
- Confusion
- Gait disturbances (walking slowly with irregular stepping patterns, and finding it hard to initiate each step)

Question 34

What is a change in the brain that can be seen in Alzheimer’s disease on post-mortem?

Answer 34

Widespread cerebral atrophy

Question 35

What feature is typically seen in the early stages of Alzheimer’s disease?

Answer 35

Amnesia for recent memories

Question 36

What is the triad of features for Lewy Body dementia?

Answer 36

REM sleep disorder
History of falls (secondary to falls)
Hallucinations

Question 37

What are the anti-cholinergic side-effects of mild stage Alzheimer’s drugs?

Answer 37

Diarrhoea

Nausea

Vomiting

Bradycardia

Urinary incontinence

Increased salivary production

Question 38

What is pseudo dementia?

Answer 38

the condition in which depression causes cognitive deficits that masquerade as dementia.

Question 39

What are the features of pseudo dementia?

Answer 39

Depression mimicking dementia

Features include:
- Normal MMSE (mini mental state examination)
- Sleep disturbance
- Irritation
- Global memory loss

Question 40

When is donepezil usually indicated in Alzheimer’s?

Answer 40

Used for symptomatic treatment of mild to moderate Alzheimer’s disease.

Question 41

Main examples of acetylcholinesterase inhibitors?

Answer 41

Donepezil, rivastigmine and galantamine

Question 42

Memantadine is an example of an acetylcholinesterase inhibitor. True/false?

Answer 42

False

Memantadine is an example of a NMDA receptor antagonist which slows down the progression of Alzheimer’s. Typically used near the end stages of the disease.