Flashcards in Dementia Deck (81):
What is dementia?
Chronic progressive disorder of mental processes due to brain injury/disease.
Does the area of the brain affected have an effect on the presentation?
How do frontal lobe (anterior) problems normally present?
-impaired judgement, abstract reasoning, incontinence
How do problems with the medial temporal lobe/hippocampus/amygdala/limbic system normally present?
Memory disorder and hallucinations.
How do temporal neocortex problems normally present?
Receptive dyshphasia and automatisms.
How do occipital lobe problems normally present?
Failure of visual sensory systems.
How do parietal lobe problems normally present?
-Decreased integration of sensory inputs (agnosia, apraxia)
Give some examples of neurodegenerative dementias. (4)
-Lewy body dementia
What is Lewy Body dementia?
Deposition of proteins (Lewy bodies) in brain cells in the brainstem/cortex.
What is Hungtington's?
Movement disorder in which nerve cells degenerate/waste away.
What is vascular dementia?
Dementia cause by a lack of blood supply to the brain.
-e.g. due to small strokes
What effect does treatment have on vascular dementia?
Treatment may reduce the progression of vascular dementia, but not cure it.
What is another name for Prion diseases?
Transmissible spongiform encephalopathies.
What are Prion diseases?
Collection of neurodegenerative diseases where pathogens >> abnormal folding of proteins.
-often accompanied by triphasic EEG waves
Give an example of a Prion disease.
Creutzfeldt-Jakob Disease (CJD).
Are Prion diseases treatable?
No, and they have rapid progression.
What type of neurodegenerative disease is smoking thought to prevent?
How do subcortical dementias normally present?
Apathetic, forgetful, movement disorders.
How do cortical dementias normally present?
Higher cortical abnormalities.
-dysphasia, agnosia, aparaxia
How can neurodegenerative diseases functionally clasified? (2)
-Dementias (e.g. Alzheimer's)
-Movement disorders (e.g. Parkinson's)
How are neurodegenerative diseases classified based on molecular-genetics? (3)
What is normal pressure hydrocephalus?
Abnormal build up of CSF in the brain's ventricles/cavities.
What is the triad of problems that accompanies normal pressure hydrocephalus?
What are the 2 types of normal pressure hydrocephalus?
What are possible causes of normal pressure hydrocephalus?
-Infection (e.g. meningitis)
What is 'pulvinar sign' a sign of?
Variant Creutzfeldt-Jakob Disease (vCJD).
What is VGKC Ab LE?
Limbic encephalitis due to voltage-gated potassium channel antibody.
What are possible symptoms of VGKC Ab LE ?
-Subacute memory loss
What may be present in the serum/CSF with GKC Ab LE?
Who was Auguste Deter?
The first person to be diagnosed with dementia.
Who was Alois Alzheimer?
Doctor who diagnosed Auguste Deter with dementia.
What are possible side effects of using anti-psychotics to treat dementia?
Increased risk of stroke and death.
How many stages of dementia are there to measure the level of independence?
What are the symptoms of stage 1 of dementia, and what are the healthcare focuses?
Changes in memory/personality/visuo-spatial abilities.
-rehabilitation and self-help
What are the symptoms of stage 2 of dementia, and what are the healthcare focuses?
Aphasia, apraxia, confusion, insomnia.
-Social care intervention, mental and physical services
What are the symptoms of stage 3 of dementia, and what are the healthcare focuses?
Resistiveness, incontinence, motor impairment.
-Same as stage 2 (social care intervention) & start advance planning
What are the symptoms of stage 4 of dementia, and what are the healthcare focuses?
Bedfast, mute, dysphasia.
-Advance planning, 1* and 2* care
How frequent is incapacity in acutely ill medical in-patients?
What proportion of patients with incapacity are cognitively impaired/unconscious?
What is the limbic system?
Network of nerves near the cortex.
What does the limbic system control?
Arousal, emotion, motivation, attention and memory.
Where is most new information stored?
What are the main functions of the hippocampus?
-Stores new information.
-Centre of emotion, memory and autonomic NS (>> integrate into the environment)
What is cognition?
The process of acquiring knowledge and understanding from thought and experience.
Give the basic process of a brain microcircuit.
Neuron >> synapse >> neurotransmitter >> action potential.
What are 4 different ways to classify neurodegenerative disorders?
-ANATOMICAL (e.g. coritcobasal dementia)
-ETIOLOGICAL (e.g. vascular)
-PROTEINOPATHY (e.g. taupathy)
Give an example of a dementia caused by temporal, parietal and frontal degeneration.
Give an example of a dementia caused by multifocal degeneration.
Give an example of a dementia that affects cognition and movement.
Dementia with Lewy Body.
What are the 4 main proteins involved with dementia?
How does B-amyloid cause dementia?
Mutated protein >> inappropriate folding and insoluble fibres.
>> accumulation of fibrils
>>amyloidosis & neurodegeneration
What is the function of Tau normally?
Proteins that stabilise microtubules in neurons.
How does a defect in Tau lead to dementia?
Defect >> unstable, dysfunctioning microtubules.
How does a-synuclein cause dementia?
Can globulise >> intereferes with the function of mitochondria & ER.
What disorders is a-synuclein present in?
Parkinsons and dementia.
What is the function of Ubiquitin normally?
Protein in eukaryotic cells that directs proteins to compartments in the cell.
-e.g. >> proteosomes to be broken down
How can Ubiquitin cause dementia?
Mutation can damage cell and cause death.
What are possible pathogenesis of dementia? (7)
-Accumulation of abnormal proteins
How can oxidative stress cause dementia?
Leads to production of free radicals.
How can excitotoxicity cause dementia?
How can cytokines cause dementia?
Cause an inflammatory response (?)
How can ageing cause dementia?
Decline in the efficiency of metabolic pathways.
What are the 2 locations that abnormal proteins accumulate?
Which proteins accumulate intracellularly? (4)
Which protein accumulates extracellularly?
What are the macroscopic findings with dementia? (6)
-Decreased brain weight
-Atrophy in cerebral gyri
-Atrophy in white matter (corpus callosum)
-Atrophy in brainstem and cerebellum
-Pale substantia nigra and locus ceruleus
What are the microscopical findings with dementia? (5)
-Neuron loss (hippocampus, cerebral cortex)
-Microvacuolation in cerebral neocortex
-Attenuation in white matter
-Wide perivascular spaces
-Accumulation of abnormal proteins
What sort of structures does amyloid form?
What sort of structures does Tau form?
What sort of structures does a-Synuclein form?
What sort of structures does ubiquitin form?
What neurological problems does hippocampal atrophy cause?
-Difficulty learning new skills/facts
-Start to forget old skills
What conditions are Braak and Braak stages used for? (2)
What are the macroscopic findings in Lewy Body dementia? (2)
-Pale substantia nigra
-Atrophy (amygdala, cingulate gyrus, T/F/P lobes)
What are the microscopic findings in Lewy Body dementia? (2)
-Neuronal loss (substantia nigra)
-Accumulation of a-Synuclein in neurons
What are the macroscopic findings in Alzheimer's? (3)
-Decreased brain weight
-Atrophy of gyri and widening of sulci
What are the microscopic findings in Alzheimer's? (3)
What is a normal brain weight?
What is the brain weight in people with Alzheimer's?
Name 3 forms of vascular dementia.