Diseases of abnormal cognition

Question 1

what does cognition involve

Answer 1

1. sensory perception
2. attention
3. memory
4. decision making
5. reasoning
6. problem solving
7. language

Question 2

what is normal ageing

Answer 2

everyone experiences slight cognitive changes during ageing

Question 3

what is preclinical ageing

Answer 3

1. silent phase- brain changes without measurable symptoms
2. individual may notice changes but not detectable on tests
3. a stage where the patient knows, but the doctor doesn’t

Question 4

what is MCI ageing

Answer 4

1. cognitive changes are of concern to individual/family
2. one or more cognitive domains impaired significantly
3. preserved activities of daily living

Question 5

when does dementia occur

Answer 5

when cognitive impairment is severe enough to interfere with everyday abilities

Question 6

describe the difference between amnestic vs non amnestic MCI

Answer 6

1. In amnestic MCI, memory is significantly impaired
   - other cognitive functions are spared
2. in non amnestic MCI, memory remains intact, but one or more cognitive abilities are significantly impaired

Question 7

what is the difference between single domain and multiple domain MCI

Answer 7

1. in single domain MCI, only memory or one other domain of cognition is impaired
2. in multiple domain MCI, memory plus one or more other cognitive abilities are affected

Question 8

describe the risk of developing dementia in people with MCI

Answer 8

1. patients are at increased risk of developing dementia
2. although theres an increased risk, not everyone with MCI will develop dementia
3. some patients with mCI remain stable and some improve and no longer experience symptoms
   - these different outcomes are one reason why doctors find aspects of MCI controversial

Question 9

what can be used to predict people who will go on to develop dementia

Answer 9

1. simple tests, based on memory recall
2. brain scans also used to detect changes in brain structure and function
3. amyloid and tau proteins in the CSF also analysed

Question 10

describe the treatment for mCI

Answer 10

1. donepezil, rivastigmine and galantine have no clear benefit, despite being AD medications
2. managing cardiovascular disease can prevent progression to dementia
3. currently no approved strategy for treating MCI

Question 11

what is frontotemporal dementia (FTD)

Answer 11

1. accounts for 10-15% of dementia cases
2. over 70% loss of spindle neurons
3. behavioural changes, blunting of emotions, and deficits in both expressive and receptive language
4. treatments focus on alleviating symptoms

Question 12

what is lewy body dementia

Answer 12

1. 10-25% of dementia cases
2. Lewy body deposits in neurons
3. symptoms include fluctuating cognition, REM sleep behaviour disorder, features of Parkinsonism, repeated visual hallucinations
4. donepezil and galantamine (AchEI inhibitors) and melatonin used to alleviate symptoms

Question 13

what is vascular dementia

Answer 13

1. second most common type of dementia
2. caused by small strokes
3. strokes deprive oxygen to areas of the brain
   - more strokes= worsening symptoms

Question 14

how long does mild cognitive impairment last, where does the disease begin, and what are its symptoms

Answer 14

1. duration= 7 years
2. disease begins in medial temporal lobe
3. symptoms- short term memory loss

Question 15

how long does mild alzhiemers last, where does the disease begin, and what are its symptoms

Answer 15

1. duration= 2 years
2. disease spreads to lateral temporal and parietal lobes
3. symptoms: reading problems, poor object recognition, and poor direction sense

Question 16

how long does moderate Alzheimers last, where does the disease spread to, and what are its symptoms

Answer 16

1. duration= 2 years
2. disease spreads to frontal lobe
3. symptoms include- poor judgment, impulsivity, short attention

Question 17

how long does severe Alzheimers last, where does the disease spread to, and what are its symptoms

Answer 17

1. duration= 3 years
2. disease spreads to occipital lobe
3. symptoms include- visual problems

Question 18

what is the Tau protein

Answer 18

1. located on chromosome 17
2. 6 isoforms produced from MAPT gene
3. abundant in the neurons of the CNS
4. primary role in normal physiology is to stabilise microtubules in axons

Question 19

what is the amyloid precursor protein

Answer 19

1. located on chromosome 21
2. several isoforms
3. integral membrane protein expressed in different tissues
4. unknown function in physiology
   - but implicated in synapse formation, neural plasticity, antimicrobial activity and iron export