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Dementia Flashcards

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1
Q

What is dementia?

A

Syndrome encompassing progressive deficits in several cognitive domains

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2
Q

What are 2 causes of dementia?

A

Ameliorable
neurodegenerative

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3
Q

How do you diagnose dementia?

A

Loss of semantic & episodic knowledge

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4
Q

What is episodic memory?

A

activities of daily life & ability to cope with daily tasks

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5
Q

What is semantic memory?

A

Autobiographl memory

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6
Q

What metabolic causes induce ameliorable demetntia?

A

VitB1/3/12 deficiency
T4 reduction

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7
Q

What are space occupying causes of ameliorable dementia?

A

tumours
subdural haematoma
normal pressure hydrocephalus

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8
Q

What are 4 infectious causes of ameliorable dementia?

A

Syphilis
CNS cysticercosis
HIV
Whipple’s disease

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9
Q

What is a type of neurodegenerative dementia?

A

Alzheimers

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10
Q

What are 5 earliest signs of alzheimers?

A

impairment of recent memory, function , attention
failure of language skills, visual-spatial orientation, abstract thinking & judgement

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11
Q

What is a second type of NGD dementia?

A

Vascular dementia

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12
Q

What does vascular dementia represent?

A

Cumulative effects of many small strokes

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13
Q

What are 3 signs for vascular pathology of vascular dementia?

A

High BP
past strokes
focal CNS signs

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14
Q

What is a third type of NGD dementia?

A

Lewy body dementia

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15
Q

What are symptoms of Lewy body dementia/

A

cognitive impairment
visual hallucinations
parkinsonism
Lewy bodies in brainstem & neocortex

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16
Q

What is the fourth type of NGD dementia?

A

Fronto-temporal (PIcks’s) dementia

17
Q

What are symptoms of Fronto-temporal (PIcks’s) dementia?

A

Frontal & temporal atrophy without alzheimers histology
exectutive impairment
behavioural/personality change
disinhibitoon

18
Q

What is the 5th NGD dementia?

A

Huntington’s disease

19
Q

What are symptoms of Huntington’s disease?

A

movement disorders
mood swings
depression
progressive decline in memory, concentrating

20
Q

What is chronic traumatic encephalopathy?

A

Repeated head trauma leading to NGD dementia

21
Q

What is the most popular cognitive testing/

A

Montreal cognitive assessment (MOCA)

22
Q

What are 2 other dementia assesments?

A

Mental state & physical examination

23
Q

What sex is alzheimers more prevalent in?

A

Female

24
Q

What are 3 principal histopathology of alzheimers?

A

Neurofibrillary tangles
amyloid plaques
diffuse loss of neurons
enlargement of ventricles

25
Q

Can Alzheimer’s be genetic?

A

Yes
Inherited in an autosomal dominant pattern in a small fraction

26
Q

What are 5 presentations in alzheimers?

A

Dysfunction of:
visuo-spatial skills
sematic & episodic memory
verbal abilities
executive function
anosognosia

27
Q

What are 4 symptoms of alzheimers that present at later stages?

A

irritability
mood disturbance
behavioral change
agnosia

28
Q

What are features of Alzheimer’s disease patholohy?

A

environmental & genetic factors
deficit in clearance of beta amyloid peptide
altered microglial expression
neuronal loss
proliferation of astrocytes
shrinkage of hippocampus

29
Q

What are risk factors for alzheimers?

A

1st degree relative with AD
Down syndrome
homozygosity for ApoE
mutations in PICALM, CL1, CLU
High Bp
depression, loneliness
reduced physical activity
alcohol?
smoking

30
Q

How can Alzheimer’s be prevented?

A

detect changes in CSF beta amyloid seen ~25yrs before onset of symptoms
detection of CSF tau protein & atrophy (15yrs before)
cerebral hypometabolism & impaired episodic memory
PUFA, folic acid & B vitamins can help

31
Q

How can Alzheimer’s disease be managed?

A

Acetylcholinesterase inhibitors eg. Donepezil

32
Q

What does aceytlcholineesterase inhibition cause?

A

enhances cholinergic transmission
slows down progression of alzheimers

33
Q

What are 3 types of acetylcholinesterase inhibitors?

A

Donepezil
Rivastigmine
Galantamine

34
Q

What are S/Es of acetylcholinesterase inhibitors?

A

cramps, incontinence, exacerbates peptic ulcer disease, hypotension, bradycardia

35
Q

What is an antiglutamergic treatment?

A

Memantine (NDMA anatgonist)
effective in late stage

36
Q

How is beta amyloid targeted for AD treatments?

A

Humanized monoclonal IgG1 antibody directed against mid-domain of Abeta peptide

37
Q

How can folic acid & B vitamins helpful in AD treatment?

A

decreases mild cognitive impairment
decreases rate of MRI brain atrophy in MCI

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