Dementia

Question 1

most common cause of dementia?

Answer 1

Alzheimers

Question 2

differences in aetiology between early onset and late onset dementia?

Answer 2

vascular dementia more common in early onset than late, AD still most common in both

Question 3

most useful tool for diagnosis?

Answer 3

History taking
Focuses on memory, language, executive skills, neglect phenomena, personality and social conduct, sexual behaviour, mood, eating etc.

chronology of each

Question 4

clinical course of dementia?

Answer 4

gradual decline over years (more exaggerated than natural decline with old age) with pre-clinical, mild cognitive impairment and dementia phases.

Question 5

possible definition of dementia?

Answer 5

severe loss of memory and other cognitive abilities which leads to impaired daily function

Question 6

what is examined in dementia patients?

Answer 6

Neurological /mental state

Question 7

what is an MMSE?

Answer 7

mini mental state examination

involves recall, attention, language, calculation and orientation assessment

Question 8

What might MMSS be supplemented with

Answer 8

ACE III (Addenbrooke’s Cognitive Examination) → longer and more memory focused

Question 9

what blood tests might be relevant?

Answer 9

FBC, inflammatory markers, thyroid/renal function, glucose, B12 and folate, clotting factors

also syphilis, HIV, ceruloplasmin (copper transport)

Question 10

18F florbetapir PET scans → usefulness?

Answer 10

higher scan presence indicates more beta-amyloid (associated with AD pathology)

Question 11

main causes of dementia

Answer 11

alzheimer’s (subtle,insidious amnestic/non amnestic presentation)

vascular (relates to cerebro vascular disease with multiple infarcts and gets worse progressively)

Lewy body (cognitive impairment within 1 year of parkinsonian symptoms,visual hallucinations and fluctuating cognition)

frontotemporal (behavior variant FTD,semantic dementia,non fluent aphasia)

depression

delirium

Question 12

signs of dementia with Lewy bodies?

Answer 12

cognitive impairment before/within a year of Parkinsonian symptoms, visual hallucination, fluctuating cognition

Question 13

signs of FTD?

Answer 13

behavioural variance, semantic dementia, progressive non-fluent aphasia (productive

Question 14

what is head turning sign?

Answer 14

look at whoever’s accompanying you for support when asked a question

Question 15

two factors involved in the pathophysiology of AD?

Answer 15

beta-amyloid and tau

Question 16

which becomes abnormal first?

Answer 16

amyloid then tau (then brain structure then cognition)

Question 17

AD CSF levels of beta amyloid (1-42)?

Answer 17

lower since it is deposited pathologically in the brain
Tau increases

Question 18

What about tau

Answer 18

Higher

Question 19

how does Lewy body dementia differ in presentation

Answer 19

REM sleep disorder → often visual hallucinations and Parkinson’s symptoms, not necessarily memory issues (less hippocampal degeneration)
high risk of falls

Question 20

how about FTD?

Answer 20

language issues more common, behavioural changes, memory problems still possible

Question 21

Neuropsychology

Answer 21

Profound impairment of episodic memory in relation to newly learned material

Question 22

Episodic memory

Answer 22

Memory for particular episodes in life
Depends on medial temporal lobe including hippocampus

Question 23

what may you see in mri of alzheimers

Answer 23

hippocampal degeneration and entorhinal cortex which are both in medial temporal lobe

Question 24

what is seen in mri of ftd

Answer 24

atrophy of frontal lobe

Question 25

does the hippocampus degenerate in lewy body dementia

Answer 25

less severely

Question 26

Reversible causes of dementia

Answer 26

Depression Alcohol related brain damage Endocrine (cushings,hypothyroidism,addisons) B1/6/12 deficiency Benign tumours Normal pressure hydrocephalus Infections such as hiv syphilis whipples disease Limbic encephalitis Inflammatory eg vasculitlis ms sarcoidosis

Question 27

Rare causes

Answer 27

Progesrrice supranuclear palsy Mupltipe system atrophy Corticobasal degeneration Huntingtons disease Creytzfeltd Jacob disease Subacute sclelrising pancephalitis Leucodystrophies Neuronal ceroid lipofuscinossi CADASIL Mitochondrial encephalopathy

Question 28

Issues present in Alzheimer’s

Answer 28

Neuronal tau Ab TDP-43 a synuclein Vessel wall pathology Parenchymal ischaemic changes

Question 29

What is episodic memory dependant on

Answer 29

Medial temporal lobes including hippocampus

Question 30

How is a Lewy body formed

Answer 30

a synculcein monomer joins together to form a a synuclein oligmler then an a synuclein fibril then Lewy body via neurofilaments ubiquitin and ab crystallin

Question 31

Difference in prevalence of causes of dementia in YOD LOD

Answer 31

YOD tend to have more prevalent familial autosomal dominant Alzheimer’s

Question 32

Alzheimer’s

Answer 32

Narrow gyri Wider sulci Medio temporal volume loss Hippocampus volume loss Cerebro cortical atrophy