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Flashcards in Dementia Deck (22):

What is definition of dementia

Syndrome caused by group of brain disorders that cause decline in higher cortical function

Syndrome of:
Cognitive impairment
Psychiatric/behavioural changes
Difficulties with Activities of daily living

Decline must be progressive from previously higher level of cognitive functioning, and without impairment of consciousness


What are the common causes of dementia

Alzheimer’s disease (65%)
Vascular dementia (25%)
Dementia with Lewy Body (15%)
Frontotemporal dementia (5%)


What are the general symptoms of dementia

Memory: typically short term, progress to long term
Language: anomic aphasia (expressive), difficulty understanding
Other cognitive: orientation, problem-solving, calculation
Behavioural: personality change, emotional control, social behaviour
Difficulty with ADLs: driving, dressing, shopping
Apraxia (difficulty with motor planning to perform tasks when asked)


What is diagnosis of dementia based on

Comprehensive history
Neurological exam
Screen for cognitive impairment: MMSE
CAM score: rule out delirium
Bloods: TFTs, B12, folate (rule out organic causes)
CT/MRI: confirm diagnosis, rule out SOLs
Specialist assessment: determine subtype of dementia, in memory clinic


What is CAM score
What features are assessed

Confusion assessment method, tool for identifying delirium
1. Acute onset/Fluctuating mental state
2. Inattention
3. Altered state of consciousness
4. Disorganised thinking


What are the possible findings on ct scan

Dilated ventricles
Generalised cortical atrophy


What is Alzheimer’s disease

Brain disorder causing progressive degeneration of cerebral cortex
It is most common cause of dementia


What are macroscopic pathological features of AD

Wide sulci
Narrow gyri
Ventricular dilatation


What are microscopic features of AD

Neurofibrillary tangles: intracellular fibrils of tau protein
Amyloid beta plaques: extracellular deposits of amyloid beta protein


What is the pathophysiology of AD

Neuronal damage + loss due to Neurofibrillary tangles and amyloid beta plaques
Tau proteins phosphorylated, become stable, aggregate on microtubules
Build up of Amyloid beta proteins lead to abnormal extracellular deposition


Why do you get early onset dementia with Down’s syndrome

Chromosome 21 mutation
Upregulation of amyloid beta protein precursor + Mutation of enzymes for proteolysis
Build up of amyloid beta protein


What is the presentation of AD

Insidious onset, gradual progression of symptoms

2-4 years
Short term memory loss
Independent ADLs

2-10 years
Behavioural changes
Assistance with ADLs

1-3 years
Long term memory loss (loss of self)
Psychiatric: depression, hallucinations
Behavioural: withdrawal, aggression, disinhibition
Physical: dysphagia, incontinence, falls


What is vascular dementia

Group of syndromes of cognitive impairment caused by different mechanisms of ischaemia/haemorrhage secondary to cerebrovascular disease


What are the different rates of decline for different causes of dementia

AD: gradual decline
VD: stepwise decline (sudden, episodic)
DwLB: fluctuating decline


What is the pathophysiology of VD

Multi-infarct dementia: series of small strokes resulting in dementia
Single infarct dementia: single larger stroke resulting in dementia

Small vessel disease


What is the pattern of presentation of VD

Stepwise abrupt decline in cognitive function, with period of stability between each cerebrovascular accident


What is dementia with Lewy bodies

Type of dementia characterised by Lewy bodies in neocortex and brainstem


What are Lewy Bodies

Eosinophilic intracytoplasmic neuronal inclusion bodies


What is the presentation of DwLB

Fluctuating cognitive decline
Visual hallucinations
Frequent falls
Sleep disorders - restless leg syndrome, R.E.M. sleep disorder


What is frontotemporal dementia

Group of conditions that cause dementia by affecting frontal and/or temporal lobes


What is the pathophysiology of FTD

Atrophy of frontal and temporal lobes
Protein inclusions in neurones: Intracellular Protein aggregates


What are the clinical syndromes of FTD

Behavioural: early signs unlike in AD
Semantic: language impairment
Progressive non-fluent aphasia