B1: Dementia Flashcards

1
Q

What is the most common initial dementia symptom?

A

Impaired ability to learna nd retain new information

Impairments of higher cognitive functions deteriorate over months to years, resulting in complex isorder with multiple cognitive, emotional and behavioural abnormalities

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2
Q

Implications (for memory) of medial temporal lobe excision (including amygdala, cortex and part of hippocampus) to stop severe seizures?

A
  • Long term memory mainly retained, with partial retrograde amnesia
  • Profound anterograde amnesia
  • Working memory and procedural memory are normal
    Thus: constant rehearsal can lead to learning new tasts (involves cerebellum)
    and distraction from tasks will cause them to forget them
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3
Q

Role of hippocampus in memory

A
  • creating spacial map of environment
  • lesions to hippocampus can cause defecits in working memory
  • Links things happening all the time
  • Hippocampus + temporal lobe are necessary for relational memory (due to this linking)
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4
Q

Role of Striatum in memory

A

Procedural learning -> habit formation etc

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5
Q

Role of neocortex in memory

A

working memory, temporary storage (e.g. repeating number so don’t forget it)

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6
Q

Describe Hebbian Learning

A

A form of synaptic plasticity, where synaptic efficacy results in strengthening of the ‘wiring’ between certain neurons.

synaptic inefficiency leads to weakinging of the wiring between neurons

(i.e. if firing of A triggers response in B, that synapse will be strengthened. If firing of C does not elicit response in B, that synapse will be weakened)

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7
Q

How does synaptic plasticity work? (basics)

A

Changes in dendritic morphology (spine shape, size and number) alters synaptic strength - i.e. synapses can be potentiated or depressed

*spines are protrusions on endrites that can change in morphology over minutes or hours -> have effect on synaptic efficacy

Long Term Potentiation (LTP)
Long Term Depression (LTD)
can occur due to changes in protein composition at the post-synaptic density

LTP/LTD modifies the post-synaptic neuron’s response to glutamate signals -> either by increasing or decreasing the subsequent response.

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8
Q

What is associative learning?

A

learning that occurs due to associating two things together (typically stimulus and response -> learning that a given stimulus leads to a certain response, or associating 2 stimuli together)

Thought to be key to the formaiton of declarative memory (conscious recall of facts etc)

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9
Q

What is the relationship between Associative learning and Long Term Potentiation (LTP)

A

Long Term Potentiaiton (LTP) is triggered by either:
- high frequency stimulation
or by
-Synchronous activation of synapses (leading to v strong depolarization of the postsynaptic CA1 neuron)

E.g. Sight and smell of a rose occur simultaneously
-> inputs may undergp LTP, resulting in association (associative learning) between the two stimuli

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10
Q

How does LTP modify the postsynaptic neuron’s response to glutamate signalling from presynaptic neuron?

A

There are 3 tyoes of glutamate receptors at a synapse:

  • NMDA
  • AMPA
  • mGulR

NMDA receptors are voltage-sensitive and, at rest, are blocked by Mg++. Membrane depolarisation releases the Mg++ block, meaning that glutamate can bind.

NDMA receptor opening -> Ca++ influx

An LTP (effective and strong) stimulus produces a strong Ca++ signal via activation of many NDMA receptors

This in turn causes more AMPA receptors to be inserted into the membrane.

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11
Q

What are the 3 types of glutamate receptors?

A

NMDA
AMPA
mGluR

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12
Q

What is the relationship between LTP/LDP Ca++ signalling, and AMPA receptor expression

A

In LTD, there is low synaptic efficacy, and thus weak NMDA receptor activation and weak Ca++ signals. Weak Ca++ signals = AMPA receptors are internalised

In LTP, there is high synaptic efficacy, and thus strong NDMA receptor activation and strong CA++ signals. This causes more AMPA receptors to be recruited to membrane

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13
Q

How does LTP (long term potentiation) affect synaptic plasticity

A

High Ca++ influx associated with LTP leads to CAMKII activation. This leads to:

  • Polymerisation of actin (necessary for dendrite spine maturation)
  • Activation of local mRNA translation, for production of more NDMA and AMPA receptors, and more scaffold proteins, etc. being inserted into the membrane and postsynaptic density.

= Stronger synapse

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14
Q

How does LTD (long term depression) affect synaptic strength?

A

Low Ca++ influx associated with LTD leads to activation of Calcineurin

Calcineurin activation leads to:

  • Depolymerisation of actin
  • Dephosphorylisation of proteins such as AMPA receptors -> increased endocytosis of receptors

= Weaker Synapse

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15
Q

What changes occur in dendritic spines in response to learning?

A

In response to learning new motor tasks:

  • Formation of new spines
  • Stabilization of dendritic filopodium
  • Direct emergence of new spines towards nearby axon(s)
  • Elimination of unused spines
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16
Q

Which receptor types are part of learning and memory formation?

A
  • ACh R
  • Glutaminergic Rs: NDMA, AMPA mGluR
  • Inhibitory receptors: GABAa,b,c and Glycine
17
Q

What are the overarching principles we know from studying LTP and LTD?

A
  • Learning and memory can result to modifications to synaptic transmission
  • These synaptic modifications can be triggered by conversion of neural activity into intracellular second messengers (i.e. intracellular cascades that result in production or deconstruction of proteins to increase/decrease receptor expression, or increase/decrease spine production)
  • Memories can result from alterations in existing synaptic proteins
18
Q

To diagnose dementia, what symptoms/signs need to be confirmed?

A

At least 2 of:

  • Impaired new learning
  • Impaired STM
  • Apraxia (disordered motor planning)
  • Agnosia (inability to recognise people, things, objects, smells, tastes, etc)
  • Language Disturbance
  • Loss of executive functions

*Note: attention and concentration are usually unimpaired in mild dementia

19
Q

Why is it important to diagnose the type of dementia?

A

Although there is no known ‘cure’ for most dementias, it is important to diagnose the type so that we can help the patient and family to:

  • Access information to help them deal with the specific functional difficulties
  • Find beneficial treatments specific for the type
  • Avoid drugs known to aggrevate problems
  • Make plans for the future (prognosis)
20
Q

What are some alternative causes of cognitive imairment that should be considered before diagnosing dementia?

A
  • Delirium (disordered attention, recent onset days-weeks, flactuation of symptoms over hours)
  • Depression (*often coexists with dementia)
  • Drug Effects
    commonly: anticholinergics, sedatives, hypnotics, antipsychotics, analgesics (these often cause features of delirium)
21
Q

List dementia subtypes:

A
Alzheimers
Vascular Dementia 
Dementia with Lewy Bodies
Parkinson's Disease with Dementia
Frontotemporal Dementia
Post-Traumatic Dementia
Toxic Encephalopathy
22
Q

Features of ALzheimers

A
Memory impairment
Language impairment
Executive function impairment
Motor function impairment
Agnosia
23
Q

Features of vascular dementia

A

Progressive -> associated with physical signs of stroke of history of transient ischaemic attack

24
Q

Features: dementia with lewy bodies

A
Progressive dementia
At least 2/3 of:
- flactuating cognition
- visual hallucinations
- Parkinsonism

*severely intolerant to adverse effects of antipsychotics
some evidence for efficacy of cholinesterase inhibitors

25
Q

Features: parkinsons w/ dementia

A

Ability to function is related to adequacy of dopa replacement. Often worse in ‘off’ periods
*may be part of spectrum of disease with dementia w/ lewy bodies

26
Q

Features: frontotemporal dementia

A

Tends to affect younger patients ( with changes to behaviour and personality is common
Delusions common
Aphasia
Memory relatively spared
Mini mental state examination is unreliable here*
Seteriorates w/ use of antipsychotics

27
Q

Features: post-traumatic dementia

A

History of injury w/ consistent imaging
Not progressive
**Appears to increase risk of later developing alzheimers

28
Q

Features: Toxic encephalopathy

A

History of toxin exposure - e.g. chronic alcohol abuse

29
Q

Describe the non-pharmacological treatment of dementia

A
  1. Monitor general health
    - CV risk factors
    - Optimise health and thus ability for independence
  2. Psychosocial Interventions for Carers
    - Teaching specific problem-solving skills
    - Involvement also of extended family and other carers
    - Can help reduce psychological burden on carers
    - Thus also reduces need for institutionalised care of dementia patient
  3. Community Based Occupational Therapy
    - Aims to improve the patient’s daily function
  • *Maintaining cognitive, physical and social activity
  • improves quality of life for patient
  • Reduces the burden of care
30
Q

For which non-pharmacological treatments is there no supportive evidence for, based on Cochrane reviews?

A
  • Aromatherapy
  • Music Therapy
  • Transcutaneous electrical nerve stimulation (TENS)
  • Bright light therapy