Dementia and Disorders of Cognition

Question 1

What is dementia?

Answer 1

Clinical condition defined by:

• An acquired loss of higher mental function affecting 2 or more cognitive domains
• Being of sufficient severity to cause signif social or occupational impairment
• Being chronic and stable (different from delirium)

Question 2

Acute cognitive disorders example?

Answer 2

• Brain injury/head injury
• Stroke
• Viral encephalitis
• Transient global amnesia
• Transient epileptic amnesia

Question 3

What is functional/subjective cognitive impairment?

Answer 3

Everyday forgetfulness but ptnt perceived as having great impact on functioning

Question 4

Prion disease most common?

Answer 4

Creudzfelt-Jakob

Question 5

What does CFJ disease cause?

Answer 5

Rapidly progressive dementia leading to death within 6 months of onset

Question 6

Diagnosis of CFJ disease?

Answer 6

Aggressive presnettaion but can also do MRI, EEG, and CSF analysis to confirm

Question 7

Most common pathophysiology of prion disease?

Answer 7

Sporadic
Over 50s
Spontaneous mutations

Question 8

Variant CJD?

Answer 8

Affects young people and is linked to exposure of BSE from contaminated meat

Question 9

What is Alzheimer’s disease?

Answer 9

Most common form of dementia
-Pathological hallmarks include amyloid beta protein plaques, intracellular neurofibrillary tangles, amyloid angiography, loss of neurons and synapses

Question 10

Who gets dementia?

Answer 10

• Fam history increases risk

- Presenilin 1 gene assoc with early onset

Question 11

Clinical features of alzheimers?

Answer 11

• Memory loss in early stages
• Initial symptoms = forgetfulness, progressive loss of ability to learn and process new info

Progression: language becomes impaired, apraxia, agnosia, loss of frontal executive function

Basic personality and social behaviour remain intact until relatively late on

Question 12

Investigations for Alzheimers?

Answer 12

Imaging can be normal in early stages
MRI typically shows atrophy of temporal and parietal lobes
SPECT shows tempoparietal decreased metabolism

Question 13

Management of Alzheimer’s?

Answer 13

• Should address vascular risk factors as AD and VD are closely interlinked
• Rivastigmine, galantamine or other cholinesterase inhibitors increase ACh levels
• NMDA antagonist memantine is another drug option