Dementia & Cognitive Neurology Flashcards
(45 cards)
What are the different brain functions which together make up cognition?
Attention Social Function - i.e. how to act in situations Language Executive function - i.e. planning Memory
What criteria do patients usually meet before a diagnosis of dementia?
Cognitive decline in 1 domain (attention, executive, memory, language, praxis, social)
+ deficits interfere everyday activities/ independence
Most patients with dementia are >65 years. TRUE/FALSE?
TRUE
BUT dementia is NOT a consequence of ageing
What types of brain insult can cause acute cognitive disorders?
Viral encephalitis
Head injury
Stroke
What symptoms are characteristics of transient global amnesia?
- abrupt onset antegrade amnesia => struggle to lay down new memories
- no retrograde amnesia => preserved self knowledge
- Transient 4-6 hours (always <24 hours)
What factors are thought to trigger transient global amnesia
emotion
changes in temperature
What features characterise transient epileptic amnesia?
- Forgetful / repetitive questioning
- Carry out complex activities with no recollection
- Short lived (20 – 30 minutes)
What type of seizure is associated with transient epileptic amnesia?
Associated with temporal lobe seizures
What are the potential causes of sub-acute cognitive disorders?
Toxins Neurodegeneration e.g. CJD Metabolic: B12 Inflammatory Mood disorders Functional Infection
What is functional cognitive impairment also referred to as?
Subjective cognitive impairment
What is functional cognitive impairment?
- patient has everyday forgetfulness that is impacting on functioning
- However, they can usually hold down a higher functioning job without issue
=> symptom and function mismatch
CJD is a neurodegenerative subacute cognition problem. What is the other name for this condition and why?
Prion disease (due to defect in prion protein)
What are the 4 main types of Prion disease/CJD?
Sporadic
Variant (due to mad cow disease exposure)
Iatrogenic (growth hormone inj. from infected cadavers)
Genetic
What histological change is seen in all types of CJD?
Spongiosis
What proteinopathy is responsible for alzheimers dementia?
Amyloid protein deposition
Explain what is seen extra- and intra-cellularly in alzheimers dementia?
Extra-cellular = amyloid plaques (disrupt cholinergic pathways) Intra-cellular = neurofibrillary tangles (tau protein)
Where in the brain does alzheimers degeneration start and progress to? And what symptoms does each cause?
Degeneration of:
- medial hippocampus (forgetfulness)
- later parietal lobes (apraxia)
What would usually cause an alzheimers presentation before the age of 65?
- Genetic influences (familial)
- atypical presentation
Alzheimers cortical atrophy in this region of the brain causes difficulties in facial recognition and depth perception on stairs etc.
Posterior cortical atrophy
What are the different types of primary progressive aphasia in alzheimers?
Semantic (difficulty naming objects)
Logopenic aphasia (repeating things)
Non-fluent aphasia (staccato speech, difficult for patient)
What investigations can be carried out on suspicion of alzheimers and what do these show?
MRI: Atrophy of temporal / parietal lobes
SPECT: temporoparietal ↓metabolism
CSF : ↓amyloid as it is in plaques
How is Alzheimers disease treated?
- Address vascular risk factors
- ACh boosting medication
=> Cholinesterase inhibitors (eg Rivastigmine)
=> NMDA receptor blocker (eg Memantine)
What age group normally gets Fronto-temporal dementia?
Early onset dementia (majority <65 years old)
What features do patients with fronto-temporal dementia present with?
- disinhibition
- loss of empathy
- compulsive behaviours
- hyperorality (want to put anything in their mouth, will often continuously eat biscuits/sweet food
- Early loss of insight
