Week 236 - Alzheimers Flashcards by Tom Lawson

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
Language
Praxis (learned motor tasks)
Gnosis (ability to recognize objects, faces)

These impairments must be severe enough to interfere with work, social activities and relationships.

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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.

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Week 236 - Alzheimers: What are the risk factors for developing alzheimers?

Age
Female
Genetics
Head injury
Environmental (eg. oxidative stress)

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Week 236 - Alzheimers: What are the risk factors for developing vascular dementia?

Smoking
Diabetes
High cholesterol
Hypertension
Male

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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.

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Week 236 - Alzheimers: What is the presentation of vascular dementia?

Sudden onset
Stepwise progression
Mood/behaviour change
Insight preserved

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Week 236 - Alzheimers: What is the presentation of Lewy body dementia?

Fluctuating cognition
Vivid visual hallucinations
Mild parkinsonian features
Repeated falls

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Week 236 - Alzheimers: What is Pick’s disease?

• A type of fronto-temporal dementia

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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

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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.

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Week 236 - Alzheimers: What are some of the causes of secondary dementia?

HIV, CJD
Inflammatory - SLE,MS
Renal failure - Vit def.
Hypothyroidism
Alcohol
Traumatic eg SDH

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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.

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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)

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Week 236 - Alzheimers: What are the genetics underlying late onset alzheimers? (>65yrs)

• Apolopoprotein E gene (chromosome 19)

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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.

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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.

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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

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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.

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Week 236 - Alzheimers: What are some of the behavioural and psychiatric features of dementia?

Agitation and agression.
Restlessness and wandering.
Depression, anxiety, sleep disturbance.
Delusions/hallucinations.
Disinhibition.

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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.

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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

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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?

Cholinergic

* Glutamergic

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?

* Glutamate | * Stroke, epilepsy, Huntingtons Disease, Alcohol withdrawal, Alzheimers (Hypothesis).

Week 236 - Alzheimers: Where is acetylcholine made?

Basal forebrain | - 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?

Striatum

Week 236 - Alzheimers: In which part of the brain is motor learning stored?

Cerebellum

Week 236 - Alzheimers: In which part of the brain is emotional conditioning stored?

Amygdala

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?

Prosopagnosia. | - 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. * Repetitive * 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.

Week 236 - Alzheimers: What is hyperactive delirium?

• Hyper-aroused, irritable, mood liability, perceptual abnormalities.