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NEURO 210 > L16 Dementia > Flashcards

L16 Dementia Flashcards

1
Q

What is the official definition of dementia?

A

GLobal deterioration of intellectual function in the face of unimpaired consciousness
The person is awake and not just memeory issues

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2
Q

How do we approach and evaluate someone with dementia? (7)

A

General medical history
General neurological history
Neurobehavioural history
Psychiatric history
Toxic/nutritional/drug history
Family history
Objective examination (physical/ neurological/ NEUROPSYCHOLOGICAL)

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3
Q

What are the two bedside tests that are conducted? What are the domains of cognition that are tested?

A

Mini-mental status examination
Montreal Objective Cognitive Assessment

LOC (awake?)
Orientation (time/ place/ people)
Memory (remote/recent/immediate, 3 object recall)
Attention and concentration (serial 7s, digit span)
Knowledge/ insight
Language (fluency, comprehension, repetition, object naming, apraxia, reading/ writing)

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4
Q

TRUE OR FALSE
The symptoms of dementia are unrelated to the part of the brain that is reflected

A

FALSE
The symptoms always reflect the part of brain that is affected
Usually the frontal, parietal, and temporal lobes

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5
Q

Which common difficulty in dementia is reflective of parietal cortex involvement?

A

Visual-spatial difficulties (test the ability to conceptualize object that they should draw)

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6
Q

Neurological examination usually reveals abnormal reflexes related to dysfunction of frontal lobe. What are four reflexes that are affected?

A
  1. Pout reflex: tap lips with tendon hammer and pout respond
  2. Glabellar reflex: patient cannot inhibit blinking in response to stimulation (touch between eyes)
  3. Grasp reflex: stroking palm of hand induces grasp
  4. Palmo-mental reflex: quick scratch on palm of hand induces sudden contraction of mentalis muscles in face
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7
Q

What are the two ways to think about causes/types of dementia?

A
  1. The part of the brain that is most affected (frontal vs parietal lobes/ cortex’s)
  2. The rapidity of progression of the dementias
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8
Q

What types of symptoms/ of dementia is associated with the anterior part of the brain? (frontal lobe)

A

Frontal pre-motor cortex
Behavioural changes or loss of inhibition, antisocial behaviour, facile and irresponsible

Frontotemporal dementia (Pick’s)
Huntington’s disease (caudate nucleus)

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9
Q

What types/ symptoms of dementia is associated with the posterior part of the brain? (parietal and temporal lobes)

A

Disturbance of cognitive functions (memory and language) without marked changes in behaviour
Alzheimers

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10
Q

How many causes of dementia are there? What are they?

A
  1. Degenerative
  2. Cerebrovascular
  3. Structural
  4. Infections
  5. Toxic/ metabolic
  6. Immune disorders and cancer
  7. Depression (maybe not a cause, but always a co-morbidity)
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11
Q

What is involved in the degenerative cause of dementia?

A

Dysfunction of glial cells and neurons in the brain (Alzheimer’s, Lewy Body dementia, Huntingtons, parkinsons, wilsons, Tauopathies)
80-90% of all dementias

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12
Q

What is involved in the cerebrovascular cause of dementia?

A

Vascular dementia (multi-infarct dementia)
CNS vasculitis
Usually a stroke causes some element of cognitive dysfunction and gets worse with every stroke

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13
Q

What is involved in the structural and infections causes of dementia?

A

Structural: normal pressure, hydrocephalus, brain tumour, head injury, subdural hematoma

Infections: Creutzfeldt- Jacobs, HIV, Herpes, neurosyphilis

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14
Q

What is another test that is usually done to treat dementia?

A

Lab investigations (bloodwork, syphilis, HIV, neuroimaging, EEG, cerebrospinal fluid)

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15
Q

What are 4 common themes that run in dementia?

A
  1. There is usually an age-dependent progression and worsening of dementia reflecting loss of neurons and their connections in the CNS
  2. Some parts of the brain and neurons within these regions are more vulnerable to the insult (areas that use acetylcholine, SN)
  3. Proteins that are misfolded and abnormally deposited in specific brain areas seem to play a key role in these diseases
  4. For the most part, precise causes unknown and hence no definitive treatment available to stop progression of disease
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16
Q

What is Alzheimer’s disease?

A

An irreversible, progressive brain disease that slowly destroys memory and thinking skills
Symptoms usually appear after age 60, not a part of normal aging

17
Q

What are the three essential neurons jobs that AD disrupts?

A

Ability to communicate with each other, carry out metabolism, repair themselves

18
Q

What is the most common cause of dementia?

A

Alzheimer’s disease (70-80%)

19
Q

What are the signs and symptoms of Alzheimer’s disease?

A

Symptoms: impairment of memory and attention, language and communication, abstract thinking, judgement, personality changes, depression, visuo-spatial disorientation
Signs: motor and gait disturbance, poverty of movement and slowness, falls, problems with bladder and bowel control, seizures

20
Q

What is the etiology of Alzheimer’s disease (4)?

A
  1. Familial forms (less than 10%)
  2. Sporadic (cause unknown), majority of cases, >90%
  3. Early onset (40-50)- usually familial and associated with susceptibility genes that include mutations of amyloid precursor protein (APP)
  4. Late onset (60)- mostly sporadic, apolipoprotein E4 gene is the main susceptibility gene, some others identified
21
Q

What are 5 things in the neuropathology of Alzheimer’s disease?

A
  1. Cortical atrophy (brain shrinkage)
  2. Synaptic and neuronal loss
  3. Neurofibrillary tangles with helical filaments, hyperphosphorylated tau protein
  4. Neuritic plaques with amyloid core
  5. Amyloid angiopathy
22
Q

AD involved the formation of plaques and tangles, what are these?

A

Beta-Amyloid Plaques: dense deposits of protein and cellular material that accumulate outside and around nerve cells

Neurofibrillary tangles: twisted fibers that build up inside the nerve cell

23
Q

Where is the majority of amyloid deposition in the brain?

A

Parietal, temporal and anterior

24
Q

What happens in the formation of beta-amyloid plaques?

A

Amyloid precursor protein (membrane protein) sits on the membrane surface and extends outwards, secretases cut the APP into fragments which are called a-beta (or beta-amyloid) and these cause AD
These fragments are sticky so they cling together with other materials outside the cell and form the plaques that are toxic to neurons

25
Q

What is a neurotransmitter abnormalities in AD?

A

Decrease in chemical messengers in the brain especially acetylcholine (cortex, hippocampus)
Acetylcholinergic drugs act in the synapse to make more Ach, or at the post-synaptic membrane to activate Ach receptors

26
Q

What are the two symptomatic drugs for Alzheimer’s disease?

A

Cholinergic agents: cholinesterase inhibitors that decrease the breakdown of Ach and they help symptoms but not disease progression

Non-cholinergic agents: memantine, glutamate receptor

27
Q

What are three other approaches for treating AD?

A

Possible treatments (amyloid vaccine, secretase inhibitor, anti-amyloid agents, drugs that lower cholesterol)

Unproven treatments (estrogens, NSAIDS, vasodilators, propentofylline)

Non-drug approaches: higher education, intellectual stimulation, exercise, diet, red wine

28
Q

How is neuroimaging used for AD?

A

CT/MRI : used to see atrophy in brain (hippocampus)
PET: radio labelled ligands show more AP in AD patients

29
Q

What is involved in dementia with Lewy bodies?

A

Fluctuating cognition with pronounced variation in attention and alertness
Recurrent visual hallucination
Parkinsonian features (rigidity, stiffness, slowness of movement, tremor)
Treatment with cholinesterase inhibitors, antipsychotic drugs to control behavioural problems and agitation

30
Q

What is a common structural result we see in the brain with both PD and AD?

A

Loss of pigmented (dopamine containing) neurons in the substantia nigra (decrease in melanin)
Lewy bodies containing alpha-synuclein protein

31
Q

What is involved in frontotemporal dementia? (Picks disease)

A

Female preponderance at a younger age than AD
Focal frontal and temporal lobe atrophy
Disinhibition, apathy, preservation, mental rigidity and affective symptoms
Tau pathology (Pick’s bodies)
Familial forms (chromosome 17)
Some forms associated with ALS and Lou Gehrig
NO CURE

32
Q

What is involved in vascular dementia?

A

10-15% of dementias
Dementia occurs “stroke by stroke” with progressive focal loss of function
Risk factors that cause stroke are present (hypertension, diabetes, high cholesterol, smoking)
May occur concurrently with neurodegenerative dementia
CT may show multiple areas of cerebral infarction
Treatment of hypertension and other vascular risk factors
Multiple strokes

NEURO 210 (24 decks)

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