dementia

Question 1

what are the main risk factors

Answer 1

age and family history

Question 2

what cognitive tests can you do

Answer 2

MMSE, ACE (Addenbrookes Cognitive Examination)

Question 3

what does clock drawing test

Answer 3

parietal lobe

Question 4

what reflexes should you check

Answer 4

primitive reflexes- grasp, pout

Question 5

how can you test praxis

Answer 5

copying hand gestures, miming

Question 6

investigations

Answer 6

FBC, ESR, B12, TFT, LFT, U&E, glucose. CT

Question 7

what further investigations should be done in a younger patient

Answer 7

EEG, genetic testing HIV serology, metabolic tests, brain biopsy

Question 8

what is the main cause of dementia

Answer 8

alzheimers

Question 9

features of alzheimers

Answer 9

memory impairment, language impaired, apraxia- cant carry out skilled motor activities, agnosia, frontal executive function (organising, planning), anosognosia, visuospatial

Question 10

what lobe is associated with visuospatial

Answer 10

parietal

Question 11

what is anosognosia

Answer 11

lack of insight

Question 12

what is agnosia

Answer 12

cant recognise objects, people

Question 13

what are late non cognitive features AD

Answer 13

myoclonus, seizures, sleep wake cycle reversal, incontinence

Question 14

what happens to personality in AD

Answer 14

stays relatively intact until late

Question 15

what is the pathology in AD

Answer 15

B amyloid deposition in plaques, formation of tau containing intracellular neurofibrillary tangles

Question 16

what does having a first degree relative do to your chance of having AD

Answer 16

doubles the lifetime risk

Question 17

what are the genes involved in AD

Answer 17

amyloid precursor protein, presenilin 1 and 2

Question 18

what other environmental risk factors AD

Answer 18

head trauma, vascular risk factors

Question 19

what are the degenerative causes dementia

Answer 19

AD, dementia with lewy bodies, frontotemporal dementia, huntingtons, parkinsons, prion

Question 20

what other causes for dementia

Answer 20

vascular, metabolic (uraemia, liver failure), toxic (alcohol, solvent abuse), vitamin (B12, thiamine), intracranial (tumour, haematoma, hydrocephalus), infections, psych

Question 21

what are the features of dementia with Lewy bodies

Answer 21

visual hallucinations (animals, people, sense of a presence- extracampine); fluctuating cognition, sleep disorders, Parkinsonism. memory loss may not occur at early stages. delusions, transient LOC

Question 22

what are there aggregations of in DLB

Answer 22

alpha-synuclein protein

Question 23

what happens in Parkinsons disease dementia

Answer 23

cognitive problems are a late feature- at least 1 year after onset and above 75.

Question 24

what may DLB and PDD respond to

Answer 24

cholinesterase inhibitors

Question 25

what is vascular dementia course

Answer 25

can be progressive and similar to AD, can be a hx of TIAs or lots of cerebrovascular events. stepwise manner

Question 26

additional signs in vascular dementia

Answer 26

apraxic gait disorders, pyramidal signs, urinary incontinence

Question 27

what do you see on MRI in vascular dementia

Answer 27

widespread small vessel disease

Question 28

what happens in frontotemporal dementia

Answer 28

frontal and temporal lob atrophy on MRI

Question 29

when is the onset typically in frontotemp

Question 30

what is the presentation frontotemporal dementia

Answer 30

frontal presentation- personality change, emotional blunting, apathy, disinhibition, carelessness, behavioural change. MEMORY IS PRESERVED. temporal presentation- progressive impairment language function

Question 31

what is the incubation of prion disease

Answer 31

long- can be several years. but death happens soon after start getting symptoms

Question 32

pathology prion disease

Answer 32

accumulation misfolded native prion protein PrPc

Question 33

what is the commonest form of Creutzfeldt Jakob disease and what is the course

Answer 33

sporadic. spontaneous mutations. rapidly progressive dementia leads to death within 6months. myoclonus

Question 34

what is iatrogenic CJD

Answer 34

from neurosurgical instruments as prion resistant to sterilisation; transplant material; cadaveric pituitary derived GH from pt with CJD

Question 35

what is variant CJD

Answer 35

affects younger people. neuropsychiatric symptoms. ataxia and dementia with myoclonus/chorea. longer course- a few years

Question 36

what drugs can be used in dementia

Answer 36

cholinesterase inhibitors (donezepil, rivastigmine), memantine (NMDA receptor antagonist)