Dementia

Question 1

What is dementia?

Answer 1

Syndrome encompassing progressive deficits in several cognitive domains

Question 2

What are 2 causes of dementia?

Answer 2

Ameliorable
neurodegenerative

Question 3

How do you diagnose dementia?

Answer 3

Loss of semantic & episodic knowledge

Question 4

What is episodic memory?

Answer 4

activities of daily life & ability to cope with daily tasks

Question 5

What is semantic memory?

Answer 5

Autobiographl memory

Question 6

What metabolic causes induce ameliorable demetntia?

Answer 6

VitB1/3/12 deficiency
T4 reduction

Question 7

What are space occupying causes of ameliorable dementia?

Answer 7

tumours
subdural haematoma
normal pressure hydrocephalus

Question 8

What are 4 infectious causes of ameliorable dementia?

Answer 8

Syphilis
CNS cysticercosis
HIV
Whipple’s disease

Question 9

What is a type of neurodegenerative dementia?

Answer 9

Alzheimers

Question 10

What are 5 earliest signs of alzheimers?

Answer 10

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

Question 11

What is a second type of NGD dementia?

Answer 11

Vascular dementia

Question 12

What does vascular dementia represent?

Answer 12

Cumulative effects of many small strokes

Question 13

What are 3 signs for vascular pathology of vascular dementia?

Answer 13

High BP
past strokes
focal CNS signs

Question 14

What is a third type of NGD dementia?

Answer 14

Lewy body dementia

Question 15

What are symptoms of Lewy body dementia/

Answer 15

cognitive impairment
visual hallucinations
parkinsonism
Lewy bodies in brainstem & neocortex

Question 16

What is the fourth type of NGD dementia?

Answer 16

Fronto-temporal (PIcks’s) dementia

Question 17

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

Answer 17

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

Question 18

What is the 5th NGD dementia?

Answer 18

Huntington’s disease

Question 19

What are symptoms of Huntington’s disease?

Answer 19

movement disorders
mood swings
depression
progressive decline in memory, concentrating

Question 20

What is chronic traumatic encephalopathy?

Answer 20

Repeated head trauma leading to NGD dementia

Question 21

What is the most popular cognitive testing/

Answer 21

Montreal cognitive assessment (MOCA)

Question 22

What are 2 other dementia assesments?

Answer 22

Mental state & physical examination

Question 23

What sex is alzheimers more prevalent in?

Answer 23

Female

Question 24

What are 3 principal histopathology of alzheimers?

Answer 24

Neurofibrillary tangles
amyloid plaques
diffuse loss of neurons
enlargement of ventricles

Question 25

Can Alzheimer's be genetic?

Answer 25

Yes Inherited in an autosomal dominant pattern in a small fraction

Question 26

What are 5 presentations in alzheimers?

Answer 26

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

Question 27

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

Answer 27

irritability mood disturbance behavioral change agnosia

Question 28

What are features of Alzheimer's disease patholohy?

Answer 28

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

Question 29

What are risk factors for alzheimers?

Answer 29

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

Question 30

How can Alzheimer's be prevented?

Answer 30

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

Question 31

How can Alzheimer's disease be managed?

Answer 31

Acetylcholinesterase inhibitors eg. Donepezil

Question 32

What does aceytlcholineesterase inhibition cause?

Answer 32

enhances cholinergic transmission slows down progression of alzheimers

Question 33

What are 3 types of acetylcholinesterase inhibitors?

Answer 33

Donepezil Rivastigmine Galantamine

Question 34

What are S/Es of acetylcholinesterase inhibitors?

Answer 34

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

Question 35

What is an antiglutamergic treatment?

Answer 35

Memantine (NDMA anatgonist) effective in late stage

Question 36

How is beta amyloid targeted for AD treatments?

Answer 36

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

Question 37

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

Answer 37

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