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Flashcards in Dementia Deck (38):
1

Function of the occipital lobe?

Visual cortex and visual processing

2

Function of the temporal lobe

Language
Recognition of faces and objects
Emotional response eg stranger vs close family member
Memory

3

Functions of the frontal lobe?

Motor cortex
Personality
Motor expression of speech (Broca's)

4

Functions of the parietal lobe?

Sensation
Perception
Two-point discrimination
Joint position sense
Fine touch
Temperature

Right - spacial layout of world, awareness of self and relationship to the environment

Left - reading, writing, arithmetic, abstraction, word finding, metaphors, orchestration of skilled movement

5

What is homonymous hemianopia a sign of?

Damage to occipital lobe on one side

6

What is loss of macula vision a sign of? What can cause it?

Stroke affecting the occipital pole

7

What is visual anosognosia?

Where there has been damage to the occipital lobes on both sides causing cortical blindness, however people deny that they are blind.

8

What is dementia?

The progressive decline of cognitive function, usually affecting the cortex as a whole.

9

What deteriorates in dementia?

Memory
Intellect
Behaviour
Personality
Speech

10

What is dementia due to?

Death of neurones in the cortex

11

What are the different types of dementia?

Alzheimer's
Lewy body dementia
Vascular dementia
Fronto-temporal lobe dementia

12

What happens in vascular dementia?

Multiple infarcts occur throughout the cortex, causing neuronal death in tiny areas

13

Symptoms of vascular dementia?

Rigidity of thinking
Apathy
Personality change

14

Treatment of vascular dementia?

Manage vascular risk factors

15

What is neurodegenerative dementia caused by?

Accumulation of abnormal proteins that cannot be cleared leading to neuronal cell death

16

What is the most common type of dementia?

Alzheimer's

17

How does Alzheimer's present?

Progressive memory loss
Various aphasias
Apraxia
Agnosia
Behavioural changes eg aggression, agitation, wandering
Depression

18

What are the neurofibrillary tangles that develop in Alzheimer's?

Intracellular twisted filaments of Tau protein
It normally binds to and stabilises microtubules in the cells but in AD, they become hyperphosphorylated and very stable, producing neurofibrillary tangles

19

What are the senile plaques that develop in Alzheimer's?

Foci of enlarged axons, synaptic terminals, and dendrites, with amyloid deposition in the vessels in the centre of the plaque

20

How do the amyloid proteins form in Alzheimer's?

As a result of up-regulation of amyloid precursor protein and mutation to the enzymes that would normally breakdown the amyloid proteins

21

Other than amyloid proteins and senile plaques, what else can happen in Alzheimer's?

Atrophy of cholinergic fibres running from the hippocampus to the cerebral cortex
Initially there is a reduction in cholinergic transmission, and later a reduction in the synthesis of ACh

22

What is seen on an MRI in Alzheimer's?

Atrophy of the brain tissue, especially the frontal and temporal cortex
Enlargement of ventricles to compensate
Exaggerated gyri and sulci
Bilateral atrophy of hippocampus

23

What is Lewy body demetia characterised by?

Fluctuation in cognition from day to day - especially attention and alertness

Memory loss may not occur in early stages

Visual hallucintations
Delusions and paranoia
REM sleep behaviour disorder

Later resembles AD with movement difficulties, problems with speech and swallowing, challenging behaviour

More rapid onset than Alzheimer's

24

What is seen at autopsy in Lewy body dementia?

Cortical lewy bodies

25

What are Lewy bodies made of?

Alpha-synuclein

26

Prognosis of Lewy body dementia?

Live for around eight years after first symptoms

27

What happens in fronto-temporal dementia?

Deposition of Tau proteins
Can effect either of those two lobes, or both

28

What are the different types of fronto-temporal dementia?

Behaviour-variant FTD - frontal lobe affected so behaviour and personality affected

Semantic dementia - don't know the meaning of words

Progressive non-fluent dementia - damage to Broca's field

29

Signs of fronto-temporal behaviour?

Disinhibitions
Loss of interest in people and things
Loss of motivation
Loss of sympathy/empathy
Show repetitive, compulsive or ritualised behaviours
Crave sweets or fatty foods, binge on junk foods, alcohol, cigarettes
Lose table etiquette

30

Differential diagnoses of dementia?

Delirium
Drugs
Depression

31

Causes of dementia?

Infection:
-CJD/HIV
-Viral encephalitis
-Progressive multifocal leucoencephalopathy - caused by JC virus in immunocompromised patients and new MS treatments

Metabolic
-hepatic disease
-parathyroid disease
-Cushing's

Nutritional
-Wernicke-Korsakoff (thiamine deficiency)
-B12/folate deficiency

Malignancy
-subfrontal meningioma - pseudodementia

Toxic poisoning of the brain
Drug-induced neuronal death
Trauma
-head injury

Chronic inflammatory disease
-collagen vascular disease
-vasculitis
-MS

Normal pressure hydrocephalus

32

What is seen in normal pressure hydrocephalus from imaging?

Ventriculomegaly

33

What happens in normal pressure hydrocephalus?

Increase in CSF volume but CSF pressure remains normal due to enlarged ventricles which squash the brain

34

Is normal pressure hydrocephalus communicating or not?

Communicating

35

What is the classic triad of signs/symptoms in normal pressure hydrocephalus?

Dementia
Dyspraxic gait
Urinary incontinence

36

How is a basic dementia screening carried out?

FBC
Biochemistry - electrolytes, Ca, glucose, renal and liver function tests
Thyroid function tests
Serum B12 and folate levels

37

Other than screening, what else is done in suspected dementia?

MSU if delirium is suspected

Investigations as determined by presentation - CXR and ECG

Imaging
-MRI - early diagnosis and can detect subcortical vascular changes
CT

Functional imaging

38

Management of dementia?

Manipulation of neurotransmitters
MDT required
Mostly supportive