Cognition

Question 1

What is dementia?

Answer 1

progressive, global cognitive decline with significant impairment of normal function

Question 2

What are some symptoms of dementia?

Answer 2

memory loss
restless, repetitive, purposeless activity 
sexual disinhibition
dysphasia
confabulation
illusions 
emotional incontinence

Question 3

What are the 4As of alzheimer’s?

Answer 3

amnesia
aphasia
agnosia
apraxia

Question 4

How does mild alzheimer’s present?

Answer 4

amnesia and spacial disorientation

Question 5

How does moderate alzheimer’s disease present?

Answer 5

personality disintegration

focal parietal signs eg. dysphasia and apraxia

Question 6

How does severe alzeimer’s present?

Answer 6

neurovegetative changes with apathy, wasting, incontinence, +/- seizures, spasticity

Question 7

What is mild cognitive impairment?

Answer 7

cognitive decline greater than expected for an individual but without interfering notably with an individual’s life ie. no functional decline

Question 8

What are the functions of the frontal lobe?

Answer 8

executive function
planning
sequencing
impulse inhibition
personality
motor cortex

Question 9

What are the functions of the temporal lobe?

Answer 9

memory
speech
comprehension

Question 10

What are the functions of the parietal lobe?

Answer 10

visuospatial
map reading
dressing
numeracy
reading

Question 11

What are the functions of the occipital lobe?

Answer 11

vision

Question 12

Give some non-modifiable risk factors for developing dementia

Answer 12

age

? genetic factors/ proteins

Question 13

Give some modifiable risk factors for developing dementia

Answer 13

educational exposure
limited physical exercise
smoking
poor diet 
obesity
excess alcohol
hypertension
diabetes
hypercholesterolaemia

Question 14

What is a primary dementia?

Answer 14

no reversible cause eg Alzheimer’s

Question 15

What is a secondary dementia?

Answer 15

reversible cause eg. thyroid disease or B12 deficiency

Question 16

What constitutes young-onset dementia?

Answer 16

under 65

Question 17

What causes dementia over 65 from most common to least common?

Answer 17

Alzheimer’s disease
Vascular dementia
Lewy Body dementia
Frontotemporal dementia

Question 18

What is the aetiology of Alzheimer’s disease?

Answer 18

unknown exact cause
inc no of beta-amyloid plaques leads to neuronal cell death
dec acetylcholine

Question 19

What is receptive aphasia?

Answer 19

difficulty understanding information given

Question 20

What is expressive aphasia?

Answer 20

difficulty expressing information

Question 21

What is agnosia?

Answer 21

difficulty taking in sensory information

Question 22

What is prosopagnosia?

Answer 22

difficulty recognizing familiar faces

Question 23

What is the aetiology of vascular dementia?

Answer 23

embolism, haemorrhage or atherosclerotic plaques lead to poor circulation and neuronal death

Question 24

What increases risk of vascular dementia?

Answer 24

cardiovascular disease
diabetes
AF
uncontrolled high CV risk

Question 25

Describe the progression of vascular dementia

Answer 25

step-wise, gets worse then plateau until another event occurs

Question 26

What areas does vascular dementia affect?

Answer 26

problem solving planning communication emotional lability

Question 27

How are Lewdy Body dementia and Parkinson's disease dementia differentiated?

Answer 27

order of onset of symptoms lewy body: dementia before parkinsonism PDD: parkinsons for years then dementia

Question 28

What causes dementia symptoms in parkinson's?

Answer 28

lewy body deposits (alpha-synuclein protein) in nerve cells cause loss of connection between neurones and dec in neurotransmitters dopamine and ach

Question 29

What is parkinsonism?

Answer 29

bradykinesia resting remor rigidity

Question 30

What are the symptoms of lewy body dementia?

Answer 30

parkinsonism visual hallucinations - usually clear images fluctuations during the day REM sleep disorder

Question 31

What is frontotemporal dementia?

Answer 31

dec neurotransmitter and neurone death in the frontal and temporal lobes

Question 32

What is Pick's disease?

Answer 32

behavioural variant of frontotemporal dementia

Question 33

Who is affected by frontotemporal dementia?

Answer 33

younger onset | age 45-65

Question 34

What are the symptoms of Pick's disease?

Answer 34

``` disinhibited behaviour loss of empathy apathy obsessive-compulsive behaviours inc in fatty/sugary foods ```

Question 35

How many patients with MCI will go on to develop dementia in a year-18 months?

Answer 35

1/3 rd

Question 36

Is there pharmacological management of MCI?

Answer 36

no only once dementia diagnosed | no evidence it works

Question 37

How is a suspected dementia investigated?

Answer 37

blood tests inc. B12, folate, TFTs to exclude reversible causes CT head to exclude SOL, hydrocephalus, and check for atrophy/infarction

Question 38

Where is brain atrophy seen on CT of alzheimer's?

Answer 38

medial-temporal lobe | hippocampus

Question 39

Which pharmacological management can be used first-line in mild-mod dementia?

Answer 39

acetyl cholinesterase inhibitors

Question 40

How do acetyl cholinesterase inhibitors work?

Answer 40

stop acetylcholine being broken down to preserve neurotransmitter at the synaptic cleft of central nervous system neurones

Question 41

Name 3 acetyl cholinesterase inhibitors

Answer 41

donepezil galantamine rivastigmine

Question 42

Why might anticholinesterases not be tolerated?

Answer 42

``` bradycardia inc. gastric secretions diarrhoea COPD/asthma insomnia motor symptoms ```

Question 43

What medication is used first-line in mild/mod lewy body dementia?

Answer 43

rivastigmine

Question 44

What can be used if anticholinesterases are not tolerated?

Answer 44

memantine

Question 45

What is firstline therapy in severe dementia?

Answer 45

memantine

Question 46

What is the mechanism of action of memantine?

Answer 46

NMDA receptor antagonist which reduces glutamate and slows neuronal degeneration

Question 47

Which pharmacological treatment can be used in vascular dementia?

Answer 47

none will help | manage risk factors to stop it getting worse

Question 48

What is BPSD?

Answer 48

behavioural and psychological symptoms of dementia eg. agitation, aggression, apathy, disinhibition, hallucinations, delusions

Question 49

What pharmacological management can be used for severe BPSD?

Answer 49

anti-psychotic eg. risperidone, haloperidol

Question 50

What pharmacological management can be used in frontotemporal dementia?

Answer 50

cholinesterase inhibitors may make agitation worse | SSRI may help with behavioural but not cognitive features

Question 51

Manage delirum

Answer 51

haloperidol lorazepam if parkinson's