Dementia

Question 1

what is dementia characterised by

Answer 1

global cognitive decline

- impaired memory, thinking, orientation, comprehension, language and judgement

Question 2

common presenting complaints of memory problems

Answer 2

forgetting a message/ peoples names/ faces
losing track of conversation 
forgetting to do things
inability to navigate in familiar places
increased misplacing of things

Question 3

symptoms of dementia

Answer 3

global cognitive decline
mood disturbance
personality change
psychosis

Question 4

routine bloods for people presenting with symptoms of dementia

Answer 4

FBC
thyroid function
serum B12/folate

Question 5

screening test for dementia

Answer 5

MMSE

Question 6

normal MMSE score

Answer 6

greater than 27 out of 30

Question 7

MMSE score indicative of dementia

Answer 7

<24

Question 8

most common type of dementia

Answer 8

alzheimers

Question 9

where does alzheimers first affect in the brain

Answer 9

nucleus basalis of Meynert

Question 10

what is special about the nucleus basalis of Meynert

Answer 10

main source of acetylcholine for the cortex

Question 11

microscopic changes in alzheimers

Answer 11

intracytoplasmic neurofibrillary tangles
beta amyloid plaques
extensive neuronal loss with astrocytosis
amyloid antipathy

Question 12

what are neurofibrillary tangles

Answer 12

abnormally phosphorylated tau protein

Question 13

effects of beta amyloid plaques in Alzheimers

Answer 13

prevent synapses from transmitting acetylcholine

Question 14

what genetic condition increases risk of Alzheimers

Answer 14

Down syndrome

Question 15

other risk factors for Alzheimers

Answer 15

previous head injury
hypothyroid
parkinsons

Question 16

how is the progression of Alzheimers described

Answer 16

stage 1
stage 2
stage 3

Question 17

stage 1 Alzheimers symptoms

Answer 17

amnesia

spatial disorientation

Question 18

stage 2 Alzheimers symptoms

Answer 18

personality change- aggression, agitation, psychosis, depression

dysphasia, apraxia

parkinsonism

Question 19

stage 3 Alzheimers symptoms

Answer 19

apathy 
wasting 
immobility 
incontinence
siezures 
spacisity

Question 20

1st line treatment of Alzheimers

Answer 20

cholinesterase inhibitors

Question 21

examples of cholinesterase inhibitors

Answer 21

galantamine
rivastigmine
donepezil

Question 22

side effects of cholinesterase inhibitors

Answer 22

GI upset
tiredness
headache
bradycardia 
sleep disturbance

Question 23

2nd line treatment of Alzheimers

Answer 23

memantine 5mg

Question 24

mode of action of memantine

Answer 24

blocks NMDA receptors

Question 25

side effects of memantine

Answer 25

sedation

Question 26

which lobes are affected in Alzheimers

Answer 26

temporal- parietal

Question 27

what is used to differentiate between Alzheimers and vascular dementia

Answer 27

Hachinski score

Question 28

hachinksi score <4 | what type of dementia ?

Answer 28

alzheimers

Question 29

hachinksi score >7 | what type of dementia

Answer 29

vascular

Question 30

SPECT scan of vascular dementia

Answer 30

patchy uptake throughout

Question 31

risk factors for vascular dementia

Answer 31

``` >60 years old obesity hypertension smoking vascular disease ```

Question 32

what is jaw jerk a sign of

Answer 32

frontal cognitive syndrome

Question 33

management of vascular dementia

Answer 33

maintain BP in normal range | antiplatelet (aspirin/ clopidogrel) + statin

Question 34

second most common type of dementia

Answer 34

dementia with lewy body

Question 35

what are lewy bodies

Answer 35

eosinophilic alpha synuclein protein cytoplasmic inclusions

Question 36

how can lewy bodies be detected

Answer 36

immunochemical staining for ubiquitin protein

Question 37

classical presentation of lewy body dementia

Answer 37

fluctuating symptoms of hallucinations, decline in cognition, gait abnormalities

Question 38

what can Lewy body dementia be confused with

Answer 38

dementia in parkinson disease

Question 39

difference between Lewy body + parkinson disease dementia

Answer 39

Lewy body- cognitive impairment occurs around the same time as movement disorder dementia in parkinsons- movement disorder is present for at least a year before onset of cognitive decline

Question 40

what sleep disorder is seen in Lewy body dementia

Answer 40

REM sleep disorder

Question 41

what is picks disease

Answer 41

type of fronts-temporal dementia onset 50-60years

Question 42

characteristics of picks disease

Answer 42

slow progression changes in personality + social deterioration impaired intellect, memory + language

Question 43

what are pick cells

Answer 43

swollen neurones

Question 44

what are picks bodies

Answer 44

intracytoplasmic filamentous inclusions

Question 45

effects of picks disease in the brain

Answer 45

extreme atrophy of frontal + temporal lobes

Question 46

diagnosis of alcohol related dementia

Answer 46

memory impairment + 1 of: - apraxia (can't perform purposeful actions) - aphasia (inability to understand/ produce speech) - agnosia (inability to interpret sensations) - disturbance in executive function - function impairment

Question 47

pathology behind alcohol related dementia

Answer 47

thiamine deficiency

Question 48

triad of thiamine deficiency

Answer 48

confusion, ataxia, ophthalmoplegia

Question 49

what is ophthalmoplegia

Answer 49

paralysis of muscles around or in the eyes

Question 50

treatment of alcohol related dementia

Answer 50

thiamine

Question 51

anterograde amnesia

Answer 51

difficulty remembering new material + events since onset of illness/injury

Question 52

retrograde amnesia

Answer 52

difficulty remembering info prior to onset of the illness/injury