Week 7

Question 1

Cortical Functions

Answer 1

1. Frontal: executive functions (reasoning, problem solving), Brocas, Bladder functions, eye movement.
2. Temporal: Memory, auditory/taste/smell perception, Wernickes.
3. Parietal: Praxis, somatosensory perception, calculating/reading/writing.
4. Occipital: visual perception and interpretation.

Question 2

4 subtypes of Dementia

Answer 2

Alzheimers disease (62%).
Vascular dementia (17%).
Lewy Body dementia (4%).
Frontotemporal dementia (2%).

Mixed dementia = 10%

Question 3

Alzheimers Disease

Answer 3

Mesial temporal lobe and generalized atrophy.
Extracellular = β-amyloid plaques.
Intracellular = hyperphosphorylated tau.
Reduced transmission of acetylcholine pathways.

Mesial temporal = hippocampus, amygdala, parahippocampus.

62% of dementia.
More common in women.
Gene (ApoE4).

Question 4

Vascular Dementia

Answer 4

Two pathologies:
Multi-infarct dementia - stepwise progression, focal deficits, speech/memory/executive function.
Small vessel - bradyphrenia, executive function, urinary incontinence, emotion lability, march a petit pas (walk w/ small steps).

Bradyphrenia = slowed thinking/thought processing.

Question 5

Lewy Body Dementia

Answer 5

Lewy body - eosinophilic inclusion of neurones made from α-synuclein protein.

4 clinical features:
i. fluctuating cognition.
ii. complex visual hallucinations.
iii. Parkinsonism tremor/rigidity.
iv. REM sleep disorder.

Question 6

Frontotemporal Dementia

Answer 6

Younger; 45-65.
Most genetic; 1/3 autosomal dominant.

Need 3/6:
Disinhibition
Apathy
Loss of sympathy
Perseveration (stuck on repeat)
Hyperorality
Loss of exec. function

Question 7

Rarer causes of Dementia

Diseases

Answer 7

1. Parkinsons
2. Huntingtons
3. Creutzfeldt Jakob
4. HIV associated dementia

Question 8

ANS vs SNS

Answer 8

ANS works on muscarinic receptors.
SNS works on nicotinic receptors.

Question 9

Role of neuroplasticity in chronic pain

Answer 9

Peripheral & Central sensitisation.
Central re-organization.
Chronic pain states.

Question 10

Peripheral Sensitisation

Answer 10

Increased firing of peripheral nociceptor.

Caused: tissue injury activates inflammatory mediators (H+/K+/ATP/5HT, PG, Leuotrienes) that stimulate peripheral nociceptor. Triggering release of transmitter via Ca+2 channels. Increased stimulation of spinal neurone.

Question 11

Central Sensitisation

Answer 11

Increased primary afferent release of substance P and glutamate.
NMDA receptor activation.
Transcriptional changes.

Results in inbalance between inhibitory and excitatory pathways.

Question 12

Donepezil

Answer 12

Acetylcholinesterase inhibitor.

Used in dementia.

Question 13

8 fundamental needs for dementia care

Answer 13

1. Physical comfort
2. Safety
3. Positive touch
4. Occupation
5. Fun
6. Love and belonging
7. Esteem
8. Control over environment

PSPOFLEC