Dementia

Question 1

What is Lewy body dementia

Answer 1

Depositions of abnormal proteins called Lewy bodies in brain cells

Question 2

Course of lewy body dementia

Answer 2

Fluctuating course

Question 3

Symptoms and signs of lewy body dementia

Answer 3

Global brain dysfunction, visual hallucinations, parkinsonian signs

Question 4

Areas of brain affected in lewy body dementia

Answer 4

Alpha-synuclein cytoplasmic inclusions in substantia nigra, paralimbic and neocortical areas

Question 5

Treatment of lewy body dementia

Answer 5

Cholinesterase inhibitors, dopamine replacement, avoiding antipsychotics

Question 6

Symptoms of frontotemporal dementia

Answer 6

Language, personality and behavioural changes and disorders

Question 7

Cause of frontotemporal dementia

Answer 7

Severe atrophy of frontal and temporal lobes

Question 8

Diagnosis of frontotemporal dementia

Answer 8

Microscopy shows severe neuronal loss and gliosis, abnormal protein aggregates

Question 9

Onset of frontotemporal dementia

Answer 9

Earlier age onset of >35 years

Question 10

Risk of vascular dementia

Answer 10

Stroke, vascular disease, atherosclerosis of arteries

Question 11

Time course of vascular dementia

Answer 11

Acute cognitive decline in step-wise course from cerebro-vascular events

Question 12

Causes of multifactorial vascular dementia

Answer 12

Multiple infarcts producing deterioration, infarcts primarily in white matter.

Question 13

Associations with subcortical vascular dementia

Answer 13

Small vessel disease, lacunes in basal ganglia, can be small cavitating lesions, small infarcts or enlarged perivascular spaces

Question 14

Treatment of vascular dementia

Answer 14

Prophylaxis against cerebral emboli with aspirin/warfarin. Control of HTN, and can use AchEI or memantidine

Question 15

What is dementia

Answer 15

Group of chronic progressing signs and symptoms involving multiple higher cortical functions such as memory, orientation, thinking, language and comprehension

Question 16

Types and prevalence of dementia

Answer 16

Alzheimer’s - 70%
Dementia with Lewy bodies
Vascular dementia
Frontotemporal dementia
Others such as Huntingtons, Wernickes. CJD

Question 17

Diagnosis of dementia

Answer 17

History, cognitive testing, MMSE, MOCA, biomarkers, brainscans, bloods, DNA and CSF

Question 18

Clinical features of Alzheimer’s

Answer 18

Amnesia, aphasia, agnosia, apraxia

Question 19

Brain pathology in Alz

Answer 19

Enlarged and wider asymmetrical ventricles from atrophy, no well defined cortex, gyri widen, sulci have gaps, atrophy of hippocampus, frontal and temporal lobes

Question 20

Proteins deposits in Alz

Answer 20

Amyloid protein plaques deposited around neurons and tau proteins tangle within brain

Question 21

Genetic causes of Alz

Answer 21

Autosomal dominant and sporadic

Question 22

Autosomal dominant causes of Alz

Answer 22

<65, early onset AD, frontotemporal and huntingtons

Question 23

Sporadic causes of Alz

Answer 23

> 65 years, late onset AD, dementia with lewy bodies

Question 24

Drug options for Alz

Answer 24

Anticholinesterases - Donepezil, Galantamine, Rivastigmine. NMDA receptor antagonists - Memantine

Question 25

When are anticholinesterases used

Answer 25

Given in mild-moderate AD to temporarily improve cognitive function in early stages. Increase cholinergic transmission

Question 26

Side effects of AChEI

Answer 26

Anorexia, nausea, vomiting, diarrhoea, abdo pain, hallucinations, drowsiness, agitation, dizziness, insomnia, headache, bradycardia

Question 27

Use of NMDA antagonists

Answer 27

With AChEI in moderate AD or severe AD, or if intolerant to AChEI.

Question 28

Side effects of NMDA antagonists

Answer 28

Constipation, ehadache, dizziness, drowsiness, HTN, dysopnoea

Question 29

Cause of Huntington's disease

Answer 29

Inherited autosomal dominant disorder, usually presenting at 50. Repeats of CAG trinucleotide, more repeats coresponds to earlier onset

Question 30

Symptoms of Huntington's disease

Answer 30

Personality change, depression, dementia, choreoathertosis, jerky movements

Question 31

Diagnosis of Huntington's

Answer 31

Genetic testing, loss of striatal volume, increased size of frontal horns in lateral ventricles on CT/MRI. Intranuclear aggregates of prtoein

Question 32

Treatment of Huntington's

Answer 32

Treat psychosis, depression, chorea. No treatment to stop progression of disability

Question 33

Prognosis of Huntington's

Answer 33

After diagnosis patients can live from 5 - 30 years