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Year Two - Neurology System > Dementia > Flashcards

Dementia Flashcards

(100 cards)

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1
Q

What is dementia?

A

It is a neurodegenerative syndrome which results in progressive impairment of multiple cognitive domains, resulting in the loss of acquired skills and interference in the patient’s occupational and social roles

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2
Q

What are the four classifications of dementia?

A

Alzheimer’s Disease

Vascular Dementia

Lewy Body Dementia

Frontotemporal Dementia

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3
Q

What is the most common classification of dementia?

A

Alzheimer’s disease

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4
Q

What is Alzheimer’s disease?

A

It is a condition, in which there is cognitive decline related to hyperphosphorylation of the tau protein

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5
Q

What is the function of the tau protein?

A

It interacts with tubulin to stabilise microtubules and promote tubulin assembly into microtubules

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6
Q

What is the macroscopic change seen in Alzheimer’s disease?

A

Cerebral atrophy, involving the temporal neocortex and hippocampus

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7
Q

What are the three microscopic changes seen in Alzheimer’s disease?

A

Type-A beta amyloid protein plaques

Neurofibrillary tangles

Hyperphosphorylation of the tau protein

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8
Q

What are neurofibrillary tangles?

A

They are paired helical filaments composed of tau proteins

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9
Q

What is the biochemical change seen in Alzheimer’s disease?

A

Decreased acetylcholine levels

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10
Q

What four areas of the brain does Alzheimer’s disease tend to affect?

A

Hippocampus

Amygdala

Temporal neocortex

Subcortical nuclei

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11
Q

What are the five risk factors associated with Alzheimer’s disease?

A

White Race

Family History

Down’s Syndrome

Vascular Conditions

Smoking

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12
Q

What are the five genes associated with Alzheimer’s disease?

A

Apolipoprotein E4 (ApoE4)

Amyloid precursor protein (APP)

Presenilin-1 (PSEN1)

Presenilin-2 (PSEN2)

Trisomy 21 (Down’s Syndrome)

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13
Q

What three genes are associated with early onset familiar Alzheimer’s disease?

A

Amyloid precursor protein gene (APP)

Presenilin 1 gene (PSEN1)

Presenilin 2 gene (PSEN2)

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14
Q

What gene is associated with early onset familiar Alzheimer’s disease and Down’s syndrome?

A

Amyloid precursor protein (APP)

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15
Q

What are the five vascular conditions associated with Alzheimer’s disease?

A

Hypertension

Diabetes

Dyslipidaemia

Atrial fibrillation

Wilson’s disease

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16
Q

How long should clinical features be present for before a diagnosis of Alzheimer’s can be obtained?

A

> 6 months

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17
Q

What are the five clinical features associated with Alzheimer’ disease?

A

Dysmnesia

Dysphasia

Dyspraxia

Dysgnosia

Personality Changes

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18
Q

What is dysmnesia?

A

This is defined as memory impairment

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19
Q

What is dysphasia?

A

This is defined as communication impairment

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20
Q

What are the two types of dysphasia?

A

Expressive dysphasia

Receptive dysphasia

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21
Q

What is expressive dysphasia?

A

It is defined as the inability to formulate language - they struggle to get words out or use the wrong words

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22
Q

What is receptive dysphasia?

A

It is defined as the inability to comprehend language

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23
Q

What is dyspraxia?

A

It is defined as motor skill dysfunction

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24
Q

What is dysgnosia?

A

It isdefined as the inability to process sensory information, resulting in an inability to recognise objects, people, sounds, shapes or smells

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25
Which investigation is used to diagnose Alzheimer's disease - in addition to cognitive function tests and blood tests?
SPECT Scan
26
What is a SPECT scan? What information does it provide?
It is a nuclear imaging test involving the injection of a gamma-emitting radioisotope into the patient’s bloodstream It provides information about the blood flow to tissues and organs
27
What is a feature of Alzheimer's disease on SPECT scans?
Hypoperfusion within the temporal and parietal lobes of the brain
28
What is the second most common classification of dementia?
Vascular dementia
29
What is vascular dementia?
It is a condition in which there is cognitive decline related to ischaemia or haemorrhage to the cerebral blood vessels
30
What are the eight risk factors of vascular dementia?
Stroke/Transient Ischaemic Attack Coronary Artery Disease Hyperlipidaemia Hypertension Atrial Fibrillation Diabetes Mellitus Smoking Obesity
31
How does vascular dementia generally present?
The onset is sudden The progression is stepwise
32
What are the six clinical features of vascular dementia?
Dysmnesia Dysarthria Dysphagia Seizures Gait Disturbance Emotional Disturbance
33
What is dysarthria?
It is defined as slowed speech
34
What investigation is used to diagnose vascular dementia - in addition to cognitive function tests and blood tests?
MRI scan
35
What are the two features of vascular dementia on MRI scans?
Cerebral infarcts Extensive white matter changes
36
What criteria is used to diagnose vascular dementia?
NINDS-AIREN criteria
37
What does the NINDS-AIREN criteria state?
It states that there must be evidence of a correlation between cognitive decline and cerebrovascular disease... - The onset of dementia within three months following a stroke - An abrupt deterioration in cognitive functions - A stepwise progression of cognitive deficits
38
What is the third most common classification of dementia?
Lewy body dementia
39
What is Lewy body dementia?
It is a condition in which there is cognitive decline related to an accumulation of Lewy bodies within the brain
40
What are Lewy bodies?
They are deposits of alpha synuclein proteins
41
In what three cerebral locations do Lewy bodies accumulate?
Substantia nigra Paralimbic areas Neocortical areas
42
What are the triad of clinical features associated with Lewy body dementia?
Cognitive Impairment Visual Hallucinations Parkinsonism
43
What is a key clinical feature of Lewy body dementia?
There are FLUCTUATIONS in cognitive impairment
44
How do we differentiate between Lewy body dementia and Parkinson's disease?
Lewy body dementia = The cognitive impairment present a year before the Parkinsonism Parkinson's disease = The motor features present a year before cognitive impairment
45
What is the additional clinical feature associated with Lewy body dementia?
Sleep disturbances
46
What are the two investigations used to diagnose Lewy body dementia – in addition to cognitive function tests and blood tests?
DIAMOND Screening Test DAT Scan
47
What is a DIAMOND screening test?
It is a series of questions used to identify features of Lewy body dementia
48
What is a DAT scan? What information does it provide?
It is a nuclear imaging test involving the injection of a gamma-emitting radioisotope into the patient’s bloodstream – subtype of SPECT scans It provides information about dopamine transporter levels within the brain
49
Describe the features of a normal DAT scan
There is normal re-uptake of the dopamine transporter in the head of the caudate nucleus and putamen, resulting in the shape of a comma
50
How does Lewy body dementia present on DAT scans?
There is reduced re-uptake of dopamine in the putamen, resulting in the presentation of a ‘full-stop’ sign
51
What is the fourth most common type of dementia?
Frontotemporal dementia
52
What is another term for frontotemporal dementia?
Pick's disease
53
What is the frontotemporal dementia?
It is a condition in which there cognitive decline related to atrophy of nerve cells and their connections within the frontal and temporal lobes of the brain These are the areas generally associated with personality, behaviour and language
54
What is the macroscopic change seen in frontotemporal dementia?
Cerebral atrophy in frontal and temporal lobes
55
What are the four microscopic changes seen in frontotemporal dementia?
Spherical aggregations of tau proteins (pick bodies) Gliosis Neurofibrillary tangles Senile plaques
56
What are the three clinical features of frontotemporal dementia?
Personality Changes Behavioural Changes Speech Disorders
57
What are the three key features of frontotemporal dementia?
Onset < 65 Years Old Insidious Onset A relatively preserved memory and visuospatial skills
58
In general how do we differentiate between a diagnosis of frontotemporal dementia and bipolar, schizophrenia or borderline personality disorder?
Frontotemporal dementia tends to present later on in life
59
What investigation is used to diagnose frontotemporal dementia?
MRI scan
60
What is a feature of frontotemporal dementia on MRI scans?
Focal gyral atrophy with a knife-bade appearance
61
What are three investigations used to diagnose dementia?
Cognitive Function Test Blood Tests Neuroimaging
62
What are cognitive function tests?
These tests involves the patient answering a series of questions and performing simple tasks They are designed to test various domain functions, including memory, language, visuospatial awareness, emotion, apraxia, agnosia, etc
63
What are the two cognitive function tests recommended in non-specialist settings?
10 Point Cognitive Screener (10-CS) 6 Item Cognitive Impairment Test (6CIT)
64
What are the two cognitive function tests recommended in specialist settings?
Mini-Mental Screening Examination (MMSE) Montreal Cognitive Assessment (MOCA)
65
What is the MMSE test?
It involves a series of questions designed to test a range of everyday mental skills, focussing on the deficits present in Alzheimer’s disease
66
What MMSE score indicates Alzheimer's disease?
< 24
67
What MMSE score indicates mild Alzheimer's?
20-24
68
What MMSE score indicates moderate Alzheimer's?
13-20
69
What MMSE score indicates severe Alzheimer's?
<12
70
What is the MOCA test?
It involves a series of questions designed to test a range of everyday mental skills
71
What is the first line cognitive function test in a secondary care setting?
MOCA
72
What MOCA score indicates a diagnosis of dementia?
< 26
73
What is the investigation used to investigate dementia in a primary care setting?
Blood tests
74
How are blood tests used to diagnose dementia?
They are used to exclude reversible causes of dementia – such as hypothyroidism, Addison’s disease, vitamin B12 deficiency, folate deficiency, thiamine deficiency
75
What are the nine blood tests used to diagnose dementia?
Full Blood Count Urea & Electrolytes Liver Function Tests Thyroid Function Tests CRP/ ESR Levels Glucose Levels Vitamin B12 Levels Folate Levels Bone Profile
76
What is the investigation used to investigate dementia in a secondary care setting?
Neuroimaging
77
How is neuroimaging used to diagnose dementia?
It is used to exclude reversible causes of dementia - such as subdural haematomas and normal pressure hydrocephalus
78
What are the twelve differential diagnoses of dementia?
Hypothyroidism Addison’s disease Vitamin B3 deficiency Vitamin B12 deficiency Folate deficiency Thiamine deficiency Syphillis Brain tumour Normal pressure hydrocephalus Subdural haematoma Depression Chronic drug use
79
How do we conservatively manage dementia?
It involves providing the patient and their families with adequate social and physical support This may involve the use of dementia services, occupational therapists, social workers or care home admission
80
What occurs when dementia patients are exposed to new surroundings?
Delirium
81
What two classes of dementia can be managed pharmacologically?
Alzheimer's disease Lewy body dementia
82
What are the two pharmacological management options available for dementia?
Acetylcholinesterase Inhibitors NDMA Antagonists
83
What is the first line pharmacological management option of dementia?
Acetylcholinesterase inhibitors
84
What are the mechanism of acetylcholinesterase inhibitors?
They are drugs that inhibit the normal breakdown of acetylcholine, thus increasing its levels within the brain This slows the progression of disease
85
Name three acetylcholinesterase inhibitors used to treat dementia
Donepezil Galantamine Rivastigmine
86
What is a contraindication of donepezil?
Bradycardia
87
What is a side effect of donepezil?
Insomnia
88
What is the second line management option of dementia?
NDMA antagonists
89
In which three circumstances do we administer NDMA antagonists to manage dementia?
In moderate Alzheimer’s disease and Lewy body disease, in which individuals have an intolerance or contraindication to acetylcholinesterase inhibitors In moderate to severe Alzheimer’s disease and Lewy body dementia, as an add on drug to acetylcholinesterase inhibitors In severe Alzheimer’s disease, as monotherapy
90
What are the mechanism of NDMA antagonists?
They are drugs that inhibit the N-Methyl-D-aspartate receptor
91
Name an NDMA antagonist used to manage dementia
Memantine
92
Can antidepressants be used to manage dementia?
It is recommended by NICE that antidepressants are not used to treat mild to moderate depression in dementia
93
Which drug class should be considered with caution in dementia, due to its significant increase in mortality rate?
Antipsychotics
94
When can antipsychotics be used to manage dementia?
It is recommended by NICE that antipsychotics should only be used for patients at risk of harming themselves or other, OR when the agitation, hallucinations or delusions are causing severe distress
95
Which drug class should be considered with caution in dementia, due to its side effect of cognitive impairment?
Tricyclic Antidepressants
96
In which dementia classification should neuroleptics be avoided? Why?
Lewy body dementia It can cause irreversible Parkinsonism
97
Do individuals need to notify the DVLA of a dementia diagnosis?
Yes
98
How do we differentiate between dementia and delerium?
Delirium is indicated by the following features... - Acute onset - Impaired consciousness - Fluctuating symptoms - Abnormal perceptions (hallucinations, illusions) - Agitation - Delusions
99
How do we differentiate between dementia and depression?
Depression is indicated by the following features... - A short history, rapid onset - Biological features, such as weight loss and sleep issues - The patient is worried about poor memory - A variable cognitive test result - A global memory loss
100
What memory loss is associated with dementia?
Recent memory loss

Year Two - Neurology System (25 decks)

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