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Dementia Flashcards

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1
Q

What is cognition?

A

Mental action of acquiring knowledge and understanding through thought, experience and sense

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2
Q

What processes does cognition encompass?

A

Attention, social functioning, language, memory and executive

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3
Q

What is the literal definition of dementia?

A

Undoing of the mind = generally progressive/persuasive and associated with neurodegeneration

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4
Q

What is needed to diagnose dementia?

A

Evidence of significant cognitive decline in at least one cognitive domain = cognitive deficits interfere with independence and can’t be explained by another process

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5
Q

What are the cognitive domains?

A

Attention, executive, learning and memory, perceptuo-motor, social cognition

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6
Q

What is the epidemiology of dementia?

A

Prevalence in >= 65 y/o = 670000 cases

Incidence in >= 65 y/o = 210000 new cases per year

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7
Q

What is the greatest risk factor for dementia?

A

Ageing

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8
Q

What do focal deficits depend on?

A

The area of the brain that has been affected

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9
Q

What are the acute cognitive disorders?

A

Focal injury to brain, transient global amnesia and transient epileptic amnesia

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10
Q

What are some examples of focal injuries to the brain?

A

Viral encephalitis, head injury, stroke

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11
Q

What are some features of viral encephalitis?

A

Memory and language affected
Behaviour change
Patient pyrexial and unwell

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12
Q

What are some features of a head injury?

A

Attention, memory and executive dysfunction

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13
Q

What are the clinical features of transient global amnesia?

A

Abrupt onset antegrade > retrograde amnesia (repetitive), preserved knowledge of self, transient changes in the hippocampus

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14
Q

What is the duration of transient global amnesia?

A

4-6hr duration (always <24hrs)

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15
Q

What is the epidemiology of transient global amnesia?

A

Patients >50 = generally in 70s

Triggering factors = emotion, changes in temperature

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16
Q

What are some features of transient epileptic amnesia?

A

Short lived = forgetful with repetitive questioning, can carry out complex activities with no recollection of events

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17
Q

What is transient epileptic amnesia associated with?

A

Temporal lobe seizures = 30% seizures not seen

Should respond to anti-epileptic medication

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18
Q

What are some causes of subacute cognitive disorders?

A 
Toxins = alcohol, carbon monoxide
Infection = HIV, syphilis
Inflammatory = limbic encephalitis
Neurodegeneration and mood disorders
Metabolic and functional
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19
Q

What is functional cognitive impairment?

A

Everyday forgetfulness impacting on functioning = more extreme cases may result in fugue state

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20
Q

How do the symptoms vary in functional cognitive impairment?

A

They fluctuate = mismatch between symptoms and reported function

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21
Q

What may functional cognitive impairment be part of?

A

A generalised functional disorder = decreased concentration, attention and reaction time with subsequent memory difficulties

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22
Q

In what group of people is functional cognitive impairment more common in?

A

Those with previously good memories

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23
Q

How is functional cognitive impairment different from a mood disorder?

A

Functional cognitive impairment doesn’t have deficits in attention, executive function and memory

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24
Q

How is functional cognitive impairment treated?

A

Explanation +/- neuropsychology

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25
What is the most common human prion disease?
Creutzfeldt-Jakob disease = misfolded PrPsc causes neurodegenerative proteinopathy
26
What are the four types of Creutzfeldt-Jakob disease?
Sporadic, variant, iatrogenic and genetic
27
What are some features of sporadic Creutzfeldt-Jakob disease?
Usually aged 60 Rapid onset dementia and neurological signs with myoclonus = lasts 4 months Most common type and cause unknown
28
What are some features of variant Creutzfeldt-Jakob disease?
Usually aged 20 = due to exposure to BSE Painful sensory disturbance and neuropsychiatric decline = lasts 14 months Least common type
29
What are some features of iatrogenic Creutzfeldt-Jakob disease?
Usually aged 30 = lasts <2 years | Cerebellar or visual onset and multifocal neurological decline
30
What are some features of genetic Creutzfeldt-Jakob disease?
``` Occurs at any age = may mimic sporadic type GSS type = prolonged ataxic syndrome FFI type = insomnia Variable duration but usually <2years Due to mutation in PRNP ```
31
How is limbic encephalitis identified?
Inflammatory changes on MRI or in CSF | Antibodies identified in CSF or serum
32
What are some features of limbic encephalitis?
Short term memory deficits +/- seizures +/- behavioural changes May be associated with underlying malignancy or autoimmune disease
33
How is limbic encephalitis treated?
Treat tumour and give immunosuppressants
34
What are the most common dementia syndromes?
Alzheimer's disease, vascular dementia and mixed dementia
35
What is Alzheimer's disease?
Neurodegenerative proteinopathy = extracellular amyloid plaques disrupt normal cell function and induce apoptosis
36
What occurs in Alzheimer's disease?
Disruption of cholinergic pathways in the brain and spinal cord = intracellular neurofibrillary tangles disrupt cytoskeleton and cause cell death
37
What is the initial symptom of Alzheimer's disease?
Generally forgetfulness
38
What lobes of the brain are affected by Alzheimer's disease?
Degeneration of the medial hippocampus and later parietal lobes = forgetfulness then apraxia and visuospatial difficulties
39
What are some features of early onset Alzheimer's disease?
Age <65, genetic influences, may be atypical presentation
40
What are some features of sporadic Alzheimer's disease?
Age >65, more due to environmental influences, usually typical initial forgetfulness
41
What are the atypical presentations of Alzheimer's disease?
Occur in 15% Posterior cortical atrophy = visuospatial difficulty Progressive primary aphasia = semantic, logopentic aphasia (repeating), non-fluent aphasia
42
What investigations may be done for Alzheimer's disease?
MRI = atrophy of temporal/parietal lobes SPECT = decreased tempoparietal metabolism CSF = decreased amyloid:increased TAU ratio Amyloid ligand imaging
43
How is Alzheimer's disease treated?
Address vascular risk factor Cholinesterase inhibitors = rivastigmine, galantamine NMDA receptor blocker = memantine
44
When does frontotemporal dementia usually present?
Early onset dementia = most age <65
45
What is the pathogenesis of frontotemporal dementia?
Neurodegenerative proteinopathy = TAU-TDP43-ubiquitin | Protein aggregation causes cell damage
46
What are the three types of frontotemporal dementia?
Behavioural variant (60%), primary progressive aphasia, genetic cause (25%)
47
What are some features of frontotemporal dementia?
Early frontal features = disinhibition, apathy, loss of empathy, stereotypes/compulsive behaviours Early loss of insight May be part of MND-FTD spectrum
48
What investigations can be done for frontotemporal dementia?
``` MRI = atrophy of frontotemporal lobes SPECT = decreased frontotemporal metabolism CSF = increased TAU, normal amyloid ```
49
What is the treatment for frontotemporal dementia?
Trial trazadone or anti-psychotics
50
What age does vascular dementia present?
Late onset dementia = majority aged > 65
51
How is vascular dementia diagnosed?
Presence of cerebrovascular disease plus a clear temporal relationship between the onset of dementia and cerebrovascular disease
52
How can vascular dementia present?
Subcortical (small vessel) = decreased attention, executive dysfunction and slowed processing Post stroke dementia = 25% develop vascular dementia <3 months after stroke
53
What pathology is associated with vascular dementia?
Co-existent amyloid pathology = slow disease progression
54
How is vascular dementia treated?
Manage vascular risk factors +/- cholinesterase inhibitor, CPN
55
When does Lewy body dementia present?
Late onset dementia = majority aged >65
56
What is the pathogenesis of Lewy body dementia?
Neurodegenerative pathology = alpha-synuclein aggregates are insoluble which leads to cell dysfunction and damage
57
What effect do alpha-synuclein aggregates have on brain pathways in Lewy body dementia?
Disrupt cholinergic and dopaminergic pathways
58
How does Lewy body dementia present?
Fluctuating cognition plus recurrent well formed hallucinations +/- presence of extrapyramidal features May have additional neuroleptic sensitivity
59
What is the treatment for Lewy body and Parkinson's disease dementia?
Small dose levodopa, decrease acetylcholine
60
What investigations cane be done for Lewy body dementia?
Dopamine transport imaging | Alpha-synuclein ligand imaging
61
When does Parkinson's disease dementia present?
Late onset dementia = usually >65 years old
62
What does Parkinson's disease dementia overlap with clinically?
Lewy body dementia
63
How does Parkinson's disease dementia present?
Parkinson's = bradykinesia, rigidity, tremor | Decreased attention, slowness of processing, impaired visuospatial function and memory, hallucinations
64
When does Huntington's disease present?
Early onset dementia = mean age of onset is 30-50 years old
65
What causes Huntington's disease?
Expansion of the CAG nucleotide repeat on huntingtin gene produces neurodegenerative protein
66
What is dementia?
Dysexecutive syndrome and slowed speed of processing = eventual involvement of memory
67
What are some features of Huntington's disease?
Associated changes in mood, personality and chorea +/- later psychosis
68
What investigations are done for Huntington's disease?
Genetic testing | MRI = loss of caudate heads
69
How is Huntington's disease managed?
Mood stabilisers, drugs for chorea, HD nurse specialist
70
Who do you refer an >65 y/o with gradual onset dementia and no additional neurology to?
Old age psychiatry
71
Who do you refer an <65 y/o with additional neurology or any unusual features to?
Neurology
72
What are some features of the collateral history taken in the neurology memory clinic?
What were the first deficits? What has happened since? What are their functional difficulties?
73
How are patients assessed in the neurology memory clinic?
Cognitive assessment = Addenbrooke's +/- FAB Imaging = MRI, SPECT if MRI unrewarding Bloods = B12, TFTs, syphilis, HIV, Ca2+ +/- genetic panel

Neurology (48 decks)

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