Dementia

Question 1

What is the definition of dementia?

Answer 1

Evidence of substantial cognitive decline from a previous level of performance in one or more of the cognitive domains

Question 2

What are the cognitive domains?

Answer 2

Language
Visuospatial awareness/perceptual motor function
Memory learning
Social cognition
Complex attention
Executive function

Question 3

How can you describe dementia?

Answer 3

Slowly progressive neurodegenerative disease leading to cognitive decline

Question 4

How can you test for executive dysfunction?

Answer 4

Category fluency (assess working memory, “name 5 animals”)
Tap test (tap when hear a letter said)
Attention (say months backwards)
Clock drawing test (good for diagnosing vascular dementia)

Question 5

What test is good for testing visuospatial and perceptual dysfunction?

Answer 5

Clock drawing test (hemi neglect)

Question 6

What is a cognitive assessment tool used when assessing dementia?

Answer 6

Montreal cognitive assessment

Question 7

What are the main 4 types of dementia?

What is another type of dementia?

Answer 7

Alzheimer’s
Vascular
Levy body
Frontotemporal

Alcohol induced dementia

Question 8

What is the most common dementia to least common dementia?

Answer 8

Alzheimer’s = most common
Vascular
Lewy body
Frontotemporal

Question 9

What type of disease can cause rapidly progressives neurodegenerative dementia/cognitive decline?

Answer 9

Prion diseases

Question 10

What is a prion disease?

Answer 10

Fatal accumulation of prion proteins within the brain leading to neuronal damage

Question 11

What are the risk factors for developing dementia?

Answer 11

Old age
Inactive
Smoking
Alcohol
Air pollution
Social isolation
Obesity
Hearing impairment
Depression
Diabetes
HTN
Less educated
Head injury

Question 12

What are the 2 methods of pathophysiology for Alzheimer’s dementia?

Answer 12

Insoluble B amyloid plaques aggregate inducing inflammation and neuronal death

Tau protein neurofibrillary tangles (hyperphosphorylation)

Question 13

What is the normal function of Tau proteins?

Answer 13

Stabilise microtubules in neuronal cytoskeleton

Question 14

What macroscopic changes occur with Alzheimer’s?

What part of the brain is affected first?

Answer 14

General brain atrophy

Hippocampus affected first (memory)

Narrowing of gyri
Widening of sulci
Ventricular enlargement

Question 15

What medications are often used to manage Alzheimer’s dementia and why?

Answer 15

Acetylcholine esterase inhibitors

Levels of Ach are low in Alzheimer’s and are needed to form memories in the hippocampus

Question 16

What are some examples of Acetylcholinesterase inhibitors used to manage Alzheimer’s dementia?

Answer 16

Donepazil
Rivastigmine
Galantanine

Question 17

How does Alzheimer’s dementia present?

Answer 17

Slow progressive decline

Short term memory loss
Motor and language decline
Long term memory loss
Disorientation
Immobilisation

Question 18

What are some differentials that need to be ruled out when considering Alzheimer’s dementia?

Answer 18

Hypothyroidism
Hypercalcaemia
B12 deficiency
Delirium

Question 19

What type of medication is given in very advanced Alzheimer dementia and why?

Answer 19

Memantine

Glutamate receptor antagonist

Lots of glutamate released by dying neurones, memantine protect neurones against these high levels

Question 20

What causes vascular dementia?

Answer 20

Small vessel damage to the brain (mini strokes)

Question 21

What are the risk factors for developing vascular dementia?

Answer 21

HTN
Smoking
Previous stroke/MI
Diabetes
AFib
Hypercholesterolaemia

Question 22

How does vascular dementia present?

Answer 22

Depends on the area of the brain that suffered the vascular damage:

-focal neurological deficit
-speech deficit
-motor paresis
-gait impairment
-emotional changes
-fluctuations in state

Question 23

How do you treat vascular dementia?

Answer 23

Treat the risk factors and the symptoms

Question 24

What is lewy-body dementia?

Answer 24

Rapid onset dementia caused by the formation of Lewy bodies which eventually causes Parkinsonism

Question 25

What makes up Lewy bodies?

Answer 25

Misfolded alpha synuclein proteins

Question 26

Where do the Lewy bodies form to cause the dementia symptoms? Where do the Lewy bodies form to cause the Parkinsonism symptoms?

Answer 26

Dementia = cortex Parkinsonism = substantia nigra pars compacta

Question 27

What is a characteristic feature of Lewy body dementia?

Answer 27

Visual hallucinations Parkinsonism

Question 28

What are the characteristic features of Parkinsonism?

Answer 28

Bradykinesia Hypertonia Pil rolling Tremor Lead pipe rigidity Instability

Question 29

What pathway is damaged in Parkinson’s and Lewy body dementia?

Answer 29

Nigrostriatal pathway specifically substantia nigra pars compacta

Question 30

How do you manage Lewy body dementia?

Answer 30

Acetylcholine esterase inhibitors like donepazil or rivastigmine L-dopa with carbidopa for the reduced dopamine in the Parkinsonism

Question 31

What medication is given to patients with Lewy body dementia if they are acting due too the hallucinations?

Answer 31

Antipsychotics like haloperidol

Question 32

How does a patient with Frontotemporal dementia present?

Answer 32

Changes in social behaviour Lack of behavioural inhibition / behavioural disinhibition Loss of empathy Lack of insight

Question 33

What are the other 2 types of Frontotemporal dementia?

Answer 33

Semantic dementia Progressive non fluent aphasia

Question 34

What is semantic dementia?

Answer 34

Type of Frontotemporal dementia Has fluent speech but lacks semantic knowledge

Question 35

What is progressive non fluent aphasia?

Answer 35

Type of Frontotemporal dementia Have apraxia and effortful speech