Flashcards in Dementia Symposium Deck (41)
How many thousand people in the UK are affected by dementia?
What percentage of over 65s and over 80s suffer from dementia?
over 65s - 5%
over 80s - 20%
In a typical district general hospital what percentage of patients have dementia?
Abnormality in the frontal lobe leads to what 5 defects?
1) Impaired judgement
2) Impaired abstract reasoning and strategic planning
3) Impaired emotional restraint
4) Impaired control over appetite
Diseases of the parietal lobe give rise to what 2 things?
1) Impairment of visuospatial skills leading to apraxias
2) Impaired integration of sensory inputs leading to sensory agnosias
Diseases of the medial temporal lobe, hippocampus, amygdala and limbic system leads to what 2 features?
1) Disorders of memory
Diseases of the temporal neocortex is associated with what 2 features?
1) Receptive dysphasia
2) Automatisms (performance of actions without concious thought)
Diseases of the occipital lobe leads typically to what?
Failure of the visual sensory systems
What 8 'treatable' conditions can cause dementia?
2) Iatrogenic (anticholinergics, sedatives, narcotics, H2 blockers, multiple meds)
4) B12 deficiency
6) Normal pressure hydrocephalus
7) Subdural hematoma
Give the 4 main types of neurodegenerative dementias?
1) Alzheimer's dementia
2) Lewy Body dementia
3) Frontotemporal dementia
4) Huntington's disease (and many others)
What are the other 2 main types of dementias which are not classed as neurodegenerative dementias?
1) Vascular dementia
2) Prion disease
Can vascular dementia be treated?
Treatment can slow down progression but cannot cure
What is the prognosis of prior disease?
Untreatable but with rapid progression
In addition to type how else can dementias be classified?
By site - ie anterior/posterior, cortical/subcortical
How do the symptoms of anterior dementia tend to differ from posterior dementia?
Anterior - behaviour changes - ie loss of inhibition, antisocial etc.
Posterior - disturbance of cognitive function (memory and language) without marked changes in behaviour
What is the common site of Alzheimer's disease?
Name 2 types of dementias which tend to be sub cortical?
1) Parkinson's disease
2) AIDS dementia complex
How do the symptoms of subcortical dementias tend to differ from cortical dementias?
Subcortical - apathetic, forgetful and slow, associated with other neurological signs and movement disorders
Cortical - Higher cortical abnormalities - dysphasia, agnosia, apraxia
Traditionally, which 3 neurodegenerative disorders were classified as dementias (as opposed to movement disorders)?
1) Alzheimer's disease
2) Frontotemproal dementia
3) Dementia with Lewy bodies
Traditionally which 4 neurodegenerative disorders were classified as movement disorders (Rather than dementias)?
1) Parkinson's disease
2) Parkinson plus syndromes (progressive supranuclear palsy, multiple system atrophy, corticobasal degeneration)
3) Huntington's disease
4) Motor neuron disease
What are the 3 current molecular-genetic classifications of neurodegenerative disorders?
Which molecular genetic classification does Alzheimer's disease fall into?
Which molecular genetic classification does Parkinson's disease and Dementia with Lewy bodies fall into?
What 2 types of dementia fall under the classification of ubiquinopathies?
1) MND and MND/Dementia
2) Semantic dementia
(Both subtypes of frontotemporal dementia)
Normal pressure hydrocephalus is a triad of which 3 symptoms occurring in conjunction with what?
2) Gait disturbance
3) Urinary incontinence
Occurring in conjunction with hydrocephalus and normal CSF pressure
What are the 2 types of normal pressure hydrocephalus (NPH)?
1) NPH with a preceding cause (SAH, meningitis, trauma, radiation induced)
2) NPH with no known preceding cause - idiopathic (50%)
Why is CJD described as a transmissable spongiform encephalopathy?
Under a microscope, the affected brain tissue looks like a sponge
How would an EEG appear in a person with CJD?
Triphasic waves - on repeat testing
What would be the 2 typical symptoms of someone with CJD?
1) Rapid cognitive decline
2) Myoclonic jerks (quick involuntary muscle jerks)
What would be the main feature of an MRI of a patient with sporadic CJD?
Non specific changes in the basal ganglia
What is the characteristic abnormality in MRI in patient with variant CJD?
Abnormality in the posterior thalamic region - called pulvinar sign which is highly sensitive and specific for vCJD
Corticobasal degeneration falls into which molecular genetic classfication?
What is the main feature corticobasal degeneration on electron microscopy?
Phospho-tau filaments with the neurons (also cytoplasmic tangles, neuropil threads)
If a patient presents with fitting and ongoing confusion what is the most likely diagnosis?
Encephalitis due to Voltage gated postassium channel Ab (VGKC Ab LE) is what kind of encephalitis?
What are the 4 common signs and symptoms of VGKC Ab LE)
1) Subacute memory loss
2) Psychiatric/behavioural disturbances
3) Seizures - usually partial
4) Hyponatraemia in common
What sign do 60% of people with VGKC Ab LE shown on MRI?
Medial temporal lobe high signal on MRI
Does VGKC Ab LE cause treatable or untreatable dementia?
Treatable dementia - type of autoimmune enecephalitis which can be treated with steroid treatment
What is the prognosis of VGKC Ab LE?
Thymoma/SCLC (Small cell lung cancer) may also be present but isnt commonly associated
If no tumour is present then the prognosis is very good with immuno modulation
What kind of conditions are neurologists mainly concerned with in regards to dementia?