Week 236 - Alzheimers/Dementia Flashcards Preview

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Flashcards in Week 236 - Alzheimers/Dementia Deck (35):
1

Week 236

 

What is the commonest form of dementia?

Alzheimers
 Dementia (50%+)

2

Week 236

 

What is the second most common type of dementia?

Vascular dementia

3

Week 236

 

What is the third most common type of dementia?

Lewy Body Dementia

4

Week 236

 

What are the ICD 10 diagnostic criteria for dementia?

  • Impairment in memory for at least 6 months
  • Impaired executive functioning
  • Impaired language
  • Impaired praxix (learned motor tasks)
  • Impaired gnosis (ability to recognise objects and faces)
  • Severe enough to affect relationships, work etc.

5

Week 236

 

What is the difference between dementia and mild cognitive impairment?

  • Dementia is: Global impairment of intellect, memory and personality resulting in impaired performance
    in activities of daily living
  • Mild cognitive impairment:  Cognitive decline greater than that expected for an individual’s age and educational level but which does not notably
    interfere with activities of daily living.
     

6

Week 236

 

What is presentation of Alzheimers dementia?

  • Insidious onset
  • Gradual deterioration

 

7

week 236

 

What is the nueropathology of Alzheimers?

  • Deficit in cholinergic neurtoransmission
  • PLaques and tangles
  • Especially degraded in Hippocampal region of the brain

8

Week 236

 

What are the risk factors for Alzheimers dementia?

  • Age
  • Female sex
  • Genetics
  • Head injury
  • Environmental stress

9

Week 236

 

In Alzheimers dementia, what type of placque causes what type of entanglement?

  • Amyloid plaques
  • Neurofibrilliary tangles

10

Week 236

 

As well as encouraging acetylcholine neurotransmitter to hang around, what other neurotransmitter is targeted in therapy for Alzheimers dementia?

  • NMDA GLutamate receptors - you want to block them (low level activity of NMDA shown to have influence on AD)

11

Week 236

 

What is the presentation of Vascular dementia?


  • Sudden onset

    Stepwise deterioration

    Mood/behaviour
    change

    Insight preserved
     

12

Week 236

 

What are the risk factors for vascular dementia?


Smoking

Diabetes

High cholesterol

High blood pressure

Male sex
 

13

Week 236

 

Name some differences between parkinsons dementia and Lewy body dementia.

  • In parkinsons, motor symptoms predate dementia by at least 6 months.
  • In lewy body: Motor symptoms are more mild, and there is no lag in display of motor/cognitive symptoms.

14

Week 236

 

What are the symptoms of Lewy Body dementia?


Fluctuating cognition

Vivid visual hallucinations

Mild Parkinsonian features

Repeated falls
 

15

Week 236

 

What is Pick's Disease?

  • TAlso called Fronto-temporal dementia
  • Apathy/reduced motivation/self neglect
  • Disinhibition
  • Socially inappropriate
  • Often male with age less than 65 years

16

Week 236

 

What are the main differential diagnoses for Dementia?

  • Depression (pseudodementia) - Low mood, low interest, impaired attention and interest. AWARE of memory loss, gives "don't know" answers.
  • Delirium -Acute onset, abnormal attention/arousal, impaired conscious level - usually associated with acute illness. Also known as acute confusional state.
  • Secondary dementia (organic causes) - Infective, inflammatory, metabolic, endocrine, toxic, traumatic.
  •  

17

Week 236

 

What are the symptoms of Normal pressure hydrocephalus?


Recent onset dementia

Ataxia

Urinary incontinence

PMH SAH or meningitis in about 40%

Potentially reversible by CSF shunting
 

18

Week 236

 

What is Korsakoff's dementia? What are its symptoms?


Related to history of alcohol dependence

Caused by Vitamin B1 deficiency (thiamine)

Follows acute Wernicke’s encephalopathy
(ataxia, ophthalmoplegia, nystagmus, confusion)
 

DIRECTLY RELATED TO ALCOHOL

19

Week 236

 

Genetics of Alzheimers: Presenilin  2, gene PS2 is found on which chromosome?

Chromosome 1

 

Associated with Early onset AD

20

Week 236

 

Genetics of Alzheimers: Presenilin  1, gene PS1 is found on which chromosome?

Chromosome 14

 

Associated with early onset AD

21

Week 236

 

Genetics of Alzheimers: Beta Amyloid precursor protein gene APP is found on which chromosome?

Chromosome 21

 

Associated with early onset AD

22

Week 236

 


Apolipoprotein E gene apoE4 is found on which chromosome?
 

Chromosome 19

Associated with Late onset dementia (above 65)

23

Week 236

 

Alzheimer type dementia and Lewy body dementia: What are the Treatment options?

  • If mild-moderate: Anticholinesterase
  • Moderate-advanced: Memantine (blocks NMDA receptors)

24

Week 236

 

What are the treatment options for Vascular Dementia?

  • Low dose aspirin
  • Statin
  • Manage BP and BLood sugars
  • Lifestyle advice

25

Week 236

 

Donsepezil, Rivastigmine, and Galantamine are what type of drug?

These Are anticholinesterases.

 

 

26

Week 236

 

What are the cautions associated with anti-cholinesterases?


Cardiac arrythmias esp bradyarrythmias

Epilepsy

Asthma

History of bleeding GI ulcer disease

Prostatism
 

27

Week 236

 

What are the general principles of the Mental Capacity Act 2005?


Presume capacity

Help people to have capacity

Allowed to make unwise decision

Decisions for those without capacity

Best interest

Least restrictive
 

28

Week 236

 

What is meant by the term "Praxis"?

Learned motor tasks

29

Week 236

 

What is meant by the term "Gnosis"?

The ability to recognise faces or things.

30

Week 236

 


Mr
D
is 83
and has had a failing short term memory for twelve to eighteen months. His wife died
many years ago and his daughter lives nearby. She has raised concerns regarding his memory and
worries that he forgets to eat. He has hypertension controlled by
Ramipr
il
and this is regularly
monitored by his G.P. He has been seen in the Old Age Psychiatric out
-
patient clinic where his
ACE
-
R score was 64/100
. His CT brain scan showed generalized age related atrophy. His FBC, B12 &
Folate, Lipids, U & E’s, LFT were w
ithin normal limits. His chest x
-
ray was normal and his MSU was
clear. The history suggests a gradual slow decline in his memory over twelve to eighteen months
associated with what the daughter describes as a reduction in his outside interests and a diff
iculty
expressing himself as he used to. He used to have a rather short fuse but is now more placid.

 

What type of dementia is most likely here?

This is most likely pick's disease. (Tempero-frontal) dementia.

 

 

31

Week 236

 

Give an example of a Dopadecarboxylase inhibitor.

Carbidopa, or Benserazide

 

This is a medication used in the treatment of Parkinsons disease.

32

Week 236

 

Give an example of a Catechol-O-methyltransferase inhibitor.

Entacapone.

 

Parkinsons medication.

33

Week 236

 

Name some Dopamine Receptor Antagonists.

Ropinirole

Rotigine

Apomorphine

 

PArkinsons medications, used either a lone or with Levodopa.

34

Week 236

 

What is Levodopa?

This is a Parkinsons medication. Broken down by Dopadecarboxylase enzyme to produce dopamine.

 

NOt a cure - will only slow the progression of the disease.

35