L24: Dementia

Question 1

main cause of dementia

Answer 1

alzheimer’s disease

Question 2

second commonest dementia

Answer 2

mixed

Question 3

what is mixed dementia

Answer 3

Alzheimer’s and vascular

Question 4

3rd commonest dementia

Answer 4

vascular dementia

Question 5

differential diagnosis (3)

Answer 5

• ageing and mild cognitive impairment
• depression
• Delirium (including infection)

Question 6

five As of alzheimer’s

Answer 6

• amnesia
• aphasia
• apraxia
• agnosia
• associated features

Question 7

amnesia=

Answer 7

memory

Question 8

aphasia=

Answer 8

speech

Question 9

apraxia=

Answer 9

motor

Question 10

agnosia=

Answer 10

recognition

Question 11

what part of the brain is most affected by alzheimer’s disease

Answer 11

medial temporal and parieto-temporal lobes

Question 12

what is often spared in alzheimers

Answer 12

primary sensory / motor/ visual cortex

Question 13

what is widened and narrowed in the brain

Answer 13

widened sulci

narrowed gyri

Question 14

2 general terms for the pathophysiology of alzheimers

Answer 14

plaques and tangles

Question 15

what are plaques

Answer 15

abnormal processing og amyloid precursor protein leading to excessive beta amyloid

Question 16

what does abnormal amyloid protein mean (3)

Answer 16

• calcium influx and cell death via glutamate excitotoxicity
• interference with nerve signalling
• associated inflammatory response

Question 17

what are tangles

Answer 17

hyper-phosphorylated tau protein

Question 18

what does tau protein disrupt

Answer 18

cerebral architecture and functioning

Question 19

2 treatments for alzheimers

Answer 19

• acetylcholinesterase inhibitors

- N-methyl D-aspartate (NMDA) antagonists

Question 20

name 3 acetylcholineesterase inhibitors

Answer 20

• donepezil
• galantamine
• rivastigmine

Question 21

name 1 NMDA receptor antagonists

Answer 21

memantine

Question 22

which drug is used in mild-moderate AD

Answer 22

acetylcholinesterase inhibitors

Question 23

what neurotransmitter does NMDA reduce

Answer 23

glutamate

Question 24

which drug is used in moderate- severe AD

Answer 24

NMDA antagonist -memantine

Question 25

reason for vascular dementia

Answer 25

problems with blood supply to brain

Question 26

4 risk factors for vascular dementia

Answer 26

- hypertension - raised cholesterol - diabetes - smoking

Question 27

treatments for vascular dementia

Answer 27

- lifestyle change - control of Bp ect - Aspirin/ clopidogrel

Question 28

what is MID

Answer 28

multiple infarct dementia following a stroke

Question 29

what is MID often associated with

Answer 29

physical problems especially posterior circulation

Question 30

what is often preserved in small vessel disease

Answer 30

higher cortical functions

Question 31

what would be diagnosis if ; early cognitive symptoms, rapidly progressing dementia, hallucinations and mild parkinsonian features

Answer 31

dementia with lewy bodies

Question 32

what would be diagnosis if; motor symptoms >1 year, apathy, slowing of thought and executive functioning, forgetfulness

Answer 32

parkinsons disease with dementia

Question 33

what is the difference between DLB and parkinsons disease with dementia

Answer 33

which way round the diagnosis is

Question 34

for DLB you need 2 out of 3 of these:

Answer 34

- fluctuations in cognition - persistent hallucinations - spontaneous parkinsonism

Question 35

what is syncope

Answer 35

temporary loss of consciousness

Question 36

what is the pathophysiology of DLB

Answer 36

degeneration of brainstem substantia nigra

Question 37

what is the substantia nigra involved in

Answer 37

dopamine production

Question 38

what do the remaining nerve cells in DLB contain

Answer 38

Lewy bodies

Question 39

where is atropy of the brain common in DLB | 4

Answer 39

- midbrain - temporal lobe - parietal lobe - cingulate gyrus

Question 40

when is the onset for frontotemporal dementia

Answer 40

early onset mainly

Question 41

what mutation is in the 10% of familial frontotemporal dementia

Answer 41

tau gene

Question 42

3 common syndromes of frontotemporal dementia

Answer 42

- frontal lobe atrophy - progressive non fluent aphasia - semantic dementia

Question 43

what does frontal lobe atrophy effect

Answer 43

emotions and behaviour

Question 44

what is progressive non fluent aphasia

Answer 44

progressive difficulty in language

Question 45

what is semantic dementia

Answer 45

loss of knowledge of meaning of words

Question 46

what does frontotemporal dementia usually present with

Answer 46

emotional or behavioural changes (rather than STM loss)

Question 47

what is relatively preserved in frontotemporal dementia

Answer 47

memory