Dementia (20.2)

Question 1

Gross neuropath changes associated with AD?

Answer 1

Cerebral atrophy especially affecting temporal, parietal, and frontal areas, together with ventricular enlargement

Question 2

What are the microscopic neuropath changes associated with AD?

Answer 2

1- Amyloid plaques–> extracellular deposits of A-beta

2- A-Beta deposits in cortical and leptomeningeal arteries–> amyloid angiopathy

3- Neurofibrillary tangles/ Neuropil threads–> intracellular inclusions of tau protein

4- Granulovacuolar degeneration

5- Hirano bodies

Question 3

What cleaves APP?

Answer 3

secretase proteases…gamma is most common

Question 4

What is a major component of gamma secretase?

Answer 4

presenilin

Question 5

What is the major component of neurofibrillary tangles?

Answer 5

HYPERphosphorylated tau protein

Question 6

Name the major risk factors for AD?

Answer 6

1- Increasing age
2- Female
3- Family history of dementia
4- Lower income and education
5- Lower occulational status
6- Depression
7- Head injury
8- Postop delirium
9- Presence of apo E4
10- Elevated plasma homocystein levels

Question 7

What are the THREE key features of AD?

Answer 7

Impaired cognition, impaired function, behavioral disturbance

Question 8

Early symptoms of AD?

Answer 8

trouble keeping appointments, difficulty finding words, misplacing objects, difficulty driving, difficulty selecting clothes, missing appointments subtle changes in personality, social withdrawal, depression

Question 9

How can you differentiate depression and dementia?

Answer 9

Depression has less motivation during cognitive testing, expresses cognitive complaints that exceed measured deficits, and they maintain language and motor skills

Question 10

What is seen on brain imaging for AD?

Answer 10

Non specific findings are common–> lacunar infarcts, small vessel and white matter disease

Question 11

What are some characteristics of frontotemporal dementia (pick’s disease)?

Answer 11

Insidious onset

Early decline in social interpersonal conduct and impairment of personal conduct with loss of insight

Question 12

What can be used to treat frontotemporal dementia?

Answer 12

Divalproex for behavioral control

SSRI for irritability, depression, impulsive behaviors

Question 13

What is used to treat alzheimers?

Answer 13

anticholinergic agents

NMDA receptor antagonists

Question 14

What are the clinical characteristics of vascular dementia?

Answer 14

“step-wise progression”

emotional lability

Question 15

What are the pathological characteristics of vascular dementia?

Answer 15

Multiple infarcts

Cerebral amyloid angiopathy

Hypertension related small vessel disease

Question 16

Describe hypertensive small vessel disease?

Answer 16

Arteriosclerosis of small arteries and arterioles supplying deep gray and white matter–> lacunar infarcts and subcortical leukoencepholopathy

Question 17

What are the symptoms that hypertensive small vessel disease can create?

Answer 17

Cognitive slowing, impaired problem solving, visuospatial abnormalities, disturbances of mood and affect

Question 18

How is vascular dementia treated?

Answer 18

Controlling cardiovascular risk factors

Cholinesterase inhibitors

Question 19

Name the two synucleinopathies:

Answer 19

1- Parkinson’s disease

2- Dementia with Lewy bodies

Question 20

What are the symptoms of parkinson’s disease?

Answer 20

Resting tremor

Akinesia (difficulty initiating movement)

Bradykinesia

Rigidity

Shuffling gait

Postural instability

Question 21

What is the deficit in Parkinsons?

Answer 21

Dopamine is deficient

Question 22

What are the gross pathological changes in parkinsons?

Answer 22

Pallow of the substantia niagra

Question 23

What are the microscopic changes seen in parkinsons?

Answer 23

Degneration and loss of the pigmaneted, dopaminergic neurons of the substantia nigra

Neurons contain inclusions of Lewy bodies

Question 24

What are Lewy bodies made of?

Answer 24

fibrillar aggregates of alpha- synuclein

Question 25

What are the clinical features of dementia with Lewy bodies?

Answer 25

Short term memory loss (gradual onset), Visual hallucinations, cognitive fluctuations, REM sleep disorder frequent falls, autonomic dysfunction

Question 26

What are the gross pathological findings of lewy body dementia?

Answer 26

Nigral pallor and cortical atrophy

Question 27

What are the microscopic pathological changes seen in lewy body dementia?

Answer 27

“Cortical” type LPs, Ligral LBs, LNs in the hippocampus

Question 28

How is Lewy body dementia treated?

Answer 28

Cholinesterase inhibitors, REM sleep disorders