Flashcards in Week 236 - Alzheimers Deck (53):
Week 236 - Alzheimers: What is the ICD10 diagnostic criteria for dementia?
• Acquired impairment in memory for at least 6 months plus impairment in one of the following cognitive domains-
- Executive functioning
- Praxis (learned motor tasks)
- Gnosis (ability to recognize objects, faces)
These impairments must be severe enough to interfere with work, social activities and relationships.
Week 236 - Alzheimers: What is mild cognitive impairment?
Cognitive decline that is greater than we would expect for age but which does not notably interfere with activities of daily living.
Week 236 - Alzheimers: What are the risk factors for developing alzheimers?
• Head injury
• Environmental (eg. oxidative stress)
Week 236 - Alzheimers: What are the risk factors for developing vascular dementia?
• High cholesterol
Week 236 - Alzheimers: How are Parkinson's dementia and Lewy body dementia related and how do they differ?
• Parkinsons dementia
- Prominent motor features and motor symptoms predate dementia by at least 6 months.
• Lewy body dementia
- Parkinsonia motor features are mild and onset of memory and motor features are more closely related in time.
Week 236 - Alzheimers: What is the presentation of vascular dementia?
• Sudden onset
• Stepwise progression
• Mood/behaviour change
• Insight preserved
Week 236 - Alzheimers: What is the presentation of Lewy body dementia?
• Fluctuating cognition
• Vivid visual hallucinations
• Mild parkinsonian features
• Repeated falls
Week 236 - Alzheimers: What is Pick's disease?
• A type of fronto-temporal dementia
Week 236 - Alzheimers: How does fronto-temporal dementia present?
• Apathy, reduced motivation, self neglect.
• Disinhibited, decreased social awareness, lack of judgement.
• Change in personality
• Memory loss is variable
• Language difficulties are prominent
Week 236 - Alzheimers: How can depression be misinterpreted as dementia?
• They may get psychotic features.
• Impaired attention and concentration may lead to subjective complaints of memory loss.
Week 236 - Alzheimers: What are some of the causes of secondary dementia?
• HIV, CJD
• Inflammatory - SLE,MS
• Renal failure - Vit def.
• Traumatic eg SDH
Week 236 - Alzheimers: What is Korsakoff's dementia?
• A secondary cause of dementia that is related to a history of alcohol dependence.
• Caused by Vitamin B1 deficiency (thiamine)
• Follows acute Wernicke's encephalopathy.
- Ataxia, opthalmoplegia, nystagmus, confusion.
Week 236 - Alzheimers: What are the genetics underlying the early onset of Alzheimers (
• Presenilin gene 2 (chromosome 1)
• Presenilin gene 1 (chromosome 14)
• Beta amyloid precursor protein gene (chromosome 21)
Week 236 - Alzheimers: What are the genetics underlying late onset alzheimers? (>65yrs)
• Apolopoprotein E gene (chromosome 19)
Week 236 - Alzheimers: What is the medical treatment in alzheimers and Lewy body dementia?
• Mild-moderate dementia consider anti-cholinesterase.
• Moderate-advance dementia consider memantine.
Week 236 - Alzheimers: What is the medical management for vascular dementia?
Treatment of cardiovascular risks.
- Low dose aspirin, statin, management of BP, blood glucose.
- Lifestyle advice re smoking, low fat diet.
Week 236 - Alzheimers: What drugs are anti-cholinesterase's? What are they used to treat?
• Mild-moderate dementia. (Due to alzheimers or Lewy body)
• Aricept - Donepezil
• Exelon - Rivastigmine
• Reminyl - Galantamine
Week 236 - Alzheimers: Memantine is used in the treatment of moderate-severe dementia caused by alzheimers or Lewy bodies. What is it and what is its mechanism of action?
• NMDA antagonist.
• Blocks NMDA receptors and so blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction.
Week 236 - Alzheimers: What are some of the behavioural and psychiatric features of dementia?
• Agitation and agression.
• Restlessness and wandering.
• Depression, anxiety, sleep disturbance.
Week 236 - Alzheimers: What are the key for points for understanding whether someone has capacity?
Can the person-
• Understand information relevant to the decision.
• Retain that information.
• Use/weigh that info when making a decision.
• Communicate decision.
Week 236 - Alzheimers: What are the driving rules with dementia?
• Patient must notify DVLA
• Doctor may advise against driving
• DVLA 12 month license may renew
• On road test
• Patient must inform insurance company
Week 236 - Alzheimers: What are the macroscopic pathology findings of alzheimers?
• Cerebral atrophy
• Ventricular dilatation
Week 236 - Alzheimers: What are the three microscopic features of alzheimers disease?
• Amyloid plaques between neurones.
• Amyloid deposited in cerebral blood vessel walls.
• Neurofibrillary tangles - made up of the tau protein.
Week 236 - Alzheimers: What are the two hypotheses behind alzheimers disease?
Week 236 - Alzheimers: What is the cholinergic hypothesis of alzheimers?
• Acetylcholine is vital in memory and cognition.
• Pathological processes result in an extensive deficit of cholinergic neurotransmission.
Week 236 - Alzheimers: What is the glutamergic hypothesis of Alzheimers?
• Neuronal damage linked to over-activation of NMDA receptors by glutamate.
Week 236 - Alzheimers: High levels of which neurotransmitter are 'excitotoxic'? It is the major mechanism of neuronal death in which conditions?
• Stroke, epilepsy, Huntingtons Disease, Alcohol withdrawal, Alzheimers (Hypothesis).
Week 236 - Alzheimers: Where is acetylcholine made?
- Projections to the cortex and hippocampus.
Week 236 - Alzheimers: What are the three main types of memory? (Temporally)
• Short-term memory - Sensory processing
• Working-memory - Info is held whilst you work out what to do with it.
• Long-term memory - Turn working memory into 'permanent'
Week 236 - Alzheimers: What are the two types of memory? (Functionally)
• Declarative (explicit)
- Semantic (concepts)
- Episodic (autobiographical)
- Medial temporal lobe, hypothalamus, thalamus.
• Non-declarative (implicit memory)
- Procedural memory, skills, habits - striatum
- Motor learning - cerebellum
- Emotional conditioning - amygdala
Week 236 - Alzheimers: In which part of the brain are procedural memory, skills and habits stored?
Week 236 - Alzheimers: In which part of the brain is motor learning stored?
Week 236 - Alzheimers: In which part of the brain is emotional conditioning stored?
Week 236 - Alzheimers: What is retrograde amnesia?
Loss of memories from before the occurrence of the event.
Week 236 - Alzheimers: What is anterograde amnesia?
Inability to form new declarative memories.
Week 236 - Alzheimers: What is transient global amnesia?
This is transient retrograde and anterograde amnesia.
Week 236 - Alzheimers: What does the parietal cortex do?
• Attending to stimuli - Where is it?
• Integrates visual, auditory and somatosensory info.
• Damage to it leads to 'neglect'.
Week 236 - Alzheimers: 'Neglect' results from damage to the parietal cortex, what are four main ways in which it can present?
• Sensory neglect - incoming sensory information from the contralateral hemispace is ignored.
• Conceptual neglect - Neglect of the body and external world in the contralateral hemifield.
• Hemiasomatognsia - Patient denies that affected side of body belongs to them.
• Motor neglects - fewer movements in contralateral space.
Week 236 - Alzheimers: What does the temporal cortex do?
• Identifies the nature of a stimuli - What is it?
Week 236 - Alzheimers: What is agnosia and what is it caused by?
• Inability to recognize sensory stimuli.
• Caused by damage to the temporal cortex.
Week 236 - Alzheimers: What is visual agnosia?
Patient can see but cannot identify.
Week 236 - Alzheimers: Damage to the fusiform gyrus will cause what type of agnosia?
- Inability to recognise individuals from their face.
Week 236 - Alzheimers: What is movement agnosia?
This is where a person cannot distinguish between moving and stationary.
Week 236 - Alzheimers: What does the frontal cortex do?
Selects and plans an appropriate response. - What shall I do about it?
Week 236 - Alzheimers: What are some of the symptoms of frontal cortex damage?
• Inability to plan a sequence of events needed to complete a task.
• Loss of spontaneous interactions.
• Loss of flexibility in thought.
• Inability to focus on task.
• Socially inappropriate behaviour.
• Personality change.
• Difficulty with problem solving.
Week 236 - Alzheimers: What is aphasia?
Speech disorder where the patient has difficulty in naming objects and repetition of words is impaired.
Week 236 - Alzheimers: What is dysarthria?
Inability to move the muscles of the face and tongue that mediate speaking.
Week 236 - Alzheimers: What are the major speech areas?
Brocas area and Wernickes area.
• Brocas - Making speech
• Wernickes - Understanding speech
Week 236 - Alzheimers: What are the consequences of Wernickes aphasia?
• Unable to understand language.
• Fluent speech but makes no sense.
• Little repetition.
• Contrived or inappropriate speech.
Week 236 - Alzheimers: What are the consequences of Brocas aphasia?
• Able to understand language but not able to construct their own.
• Halting speech.
• Disordered syntax, disordered grammar.
• Disordered structure of individual words.
Week 236 - Alzheimers: What is senescence?
Impact of time on the body - Biological ageing.
Week 236 - Alzheimers: What is hypoactive delirium?
This is delirium where the individual will become quiet and lethargic.
- This has a markedly increased rate of mortality due to under-recognition.