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Flashcards in Dementia Deck (66):
1

what is cognition?

mental action of acquiring knowledge and understanding through thought, experience and senses

2

what 5 processes is cognition often broken into?

attention
language
memory
executive function (problem solving etc)
perceptuo-motor
social functioning

3

what is the DSMV criteria for diagnosing dementia?

evidence of significant cognitive decline in at least 1 cognitive domain

plus cognitive deficits interfere with independence in every day activities

plus they are not better explained by another process / do not occur exclusively in delirium

4

dementias are generally due to what?

neurodegenerative proteinopathies

5

what symptoms do those with viral encephalitis usually present with?

frontal temporal problems - memory problems, behaviour change and language problems

6

what symptoms do those with head injury often present with?

global problems - attention, memory, executive dysfunction

7

what are the clinical features of transient global amnesia?

abrupt onset antegrade > retrograde amnesia (repetitive)

preserved knowledge of self

lasts 4-6 hours and generally once off

8

what is thought to be triggering factors of transient global amnesia?

emotion
change in temperature

9

the pathophysiology is transient global amnesia is uncertain but what is thought to happen?

transient changes in hippocampus

10

what are the clinical features of transient epileptic amnesia?

forgetful / repetitive questioning

carry out complex activities with no recollection

short (20-30 mins)

11

transient epileptic amnesia is associated with what kind of seizures?

temporal lobe

12

how is transient epileptic amnesia treated?

anti-epileptic

13

what are the clinical features of functional / subjective cognitive impairment?

everyday forgetfulness impacting on function

fluctuation of symptoms

mismatch between symptoms + reported function

14

what are symptoms of generalised functional disorder?

decreased concentration / attention / reaction time

subsequent memory difficulties as brain working too hard to correct things above

15

what is the treatment for functional cognitive impairment?

exclude a mood disorder

refer to neuropsychology for treatment

16

what is the most common human prion (type of neurodegenerative proteinopathy) disease?

creutzfeldt-jakob disease

17

what is age of onset and clinical features sporadic of CJD?

60s

rapid onset dementia + neurological signs + myoclonus which lasts 4 months

18

what is age of onset and clinical features of variant CJD?

20s

painful sensory disturbance + neuropsychotic decline which lasts 14 months

19

what causes variant CJD?

exposure to BSE (or contaminated blood)

MAD COW DISEASE

20

what is age of onset and clinical features of iatrogenic CJD?

30s

cerebellar / visual onset. Multifocal neurological decline which lasts <2 years

21

what causes iatrogenic CJD?

99% HGH + dura mater

22

what is age of onset and clinical features of genetic CJD?

may mimic sporadic

specific subtypes:
GGS (prolonged ataxic syndrome)
FFI (insomnia)

variable duration, often <2 years

23

what causes genetic CJD?

mutation of PRNP

24

what investigations should take place in CJD?

EEG
MRI
CSF

25

what are the two most common types of dementia?

alzheimers
vascular dementia

26

what is alzheimers disease?

neurodegenerative proteinopathy (amyloid)

27

what is the pathophysiology of alzheimers?

disruption of cholinergic pathways in brain + synaptic loss

extracellular amyloid plaques

intracellular neurofibrillary tangles

28

what parts of brain are degenerating in alzheimers?

medial hippocampus + later parietal lobes

29

what is the progress of alzheimers symptoms?

forgetfulness -> apraxia / visuospatial difficulties

30

what age is characterised as early onset alzheimers?

<65

31

what are two atypical variants of alzheimers disease?

posterior cortical atrophy

progressive primary aphasia

32

what are symptoms of posterior cortical atrophy?

visuospatial disturbance

starts here but then spreads out to forgetfulness etc

33

what do those with progressive primary aphasia have problems with?

semantic (naming)

logopenic aphasia (repeating)

non-fluent aphasia (effortful)

34

what investigations should take place in alzheimers?

MRI - atrophy of temporal / parietal lobe

SECT - temporoparietal decreased metabolism

CSF - decreased amyloid, increased tau ratio

35

what treatments can be given for alzheimer disease?

address vascular risk factors

acetylcholine boosting

36

what kinds of acetylcholine boosters can be given in alzheimers?

cholinesterase inhibitors (rivastigmine / galantamine)

NMDA receptor blocker (memantine)

37

what is frontotemporal dementia?

early onset dementia (majority <65 years old)

38

what is pathophysiology of frontotemporal dementia?

neurodegenerative proteinopathy

Tau > TDP-43 > ubiquitin

protein aggregation = cell damage

39

what are the symptoms of frontotemporal dementia?

early frontal features (disinhibition, apathy, loss of empathy, stereotyped or compulsive behaviours, hyperorality)

early loss of insight (collateral history vital)

40

what investigations should take place in frontotemporal dementia?

MRI - atrophy of frontotemporal lobes

SPECT - frontotemporal decreased metabolism

CSF - increased tau / normal amyloid

41

what can be used to treat frontotemporal dementia?

trazadone / antipsychotics

safety - control food, money etc

CPN

42

what is vascular dementia?

late onset dementia (majority >65 years old)

43

what is the core criteria of vascular dementia diagnosis?

presence of cerebrovascular disease plus

a clear temporal relationship between the onset of dementia and cerebrovascular disease

44

what is the presentation of vascular dementia?

subcortical (small vessel disease) - decreased attention, executive dysfunction and slowed processing

45

what medical event is a significant risk factor for vascular dementia?

stroke

46

how is vascular dementia managed?

vascular risk factors +/- cholinesterase inhibitor

CPN

47

what is dementia with lewy bodies?

another type of late onset dementia (>65)

48

what is the pathophysiology of dementia with lewy bodies?

neurodegenerative proteinopathy (a-synuclein)

a-synuclein aggregates = insoluble -> cell dysfunction -> cell damage

leads to disruption of cholinergic and dopaminergic pathways

49

what is the core criteria of dementia with lewy bodies diagnosis?

fluctuating cognition plus

recurrent well formed visual hallucinations +/-

presence of extrapyramidal features

50

what additional feature can be seen in dementia with lewy bodies?

neuroleptic sensitivity

51

what investigations should take place in dementia with lewy bodies?

DaT (dopamine transporter imagine)

new: a-synuclein ligand imaging / in CSF

52

how can dementia with lewy bodies be treated?

small dose levodopa (decreases acetylcholine)

trial cholinesterase inhibitors

53

what is parkinsons disease dementia?

late onset dementia (>65) which 80% of PD sufferers develop after 20 years of disease

54

what other type of dementia does PDD overlap with?

DLB

55

how do you differentiate PDD and DLB?

DLB = <1 year of presentation

PDD = >1 year of presentation

56

what are symptoms of PDD?

mix of parkinsons + dementia symptoms

57

how is PDD managed?

same as DLB:

small dose levodopa (decreases acetylcholine)

trial cholinesterase inhibitors

58

what are the clinical features of huntington's disease?

dysexecutive syndrome + slowed speech of processing

eventual involvement of memory

associated changes in mood / personality and chorea +/- later psychosis

59

what investigations should take place in huntington's disease?

genetic testing

MRI (loss of caudate heads)

60

who should you refer to if patient is >65 with gradual onset dementia / no additional neurology?

old age psychiatry

61

who should you refer to if patient is <65 / any unusual features (inc onset speed) / additional neurology?

neurology

62

what is treatment for huntington disease?

mood stabiliser
rx for chorea
HD nurse specialist

63

what are the psychiatric symptoms in HD?

depression
anxiety
psychosis
blunted affect
aggression
suicidality
compulsions

64

what are the cognitive symptoms in HD?

decline in executive function (planning, abstract thinking)
short and long term memory deficits
dementia - decline in global cognition

65

what are motor symptoms in HD?

choreiform movements
rigidity
writhing movements
gait disturbance
problems chewing / speaking / swallowing
all actions requiring muscle control become impaired

66

what happens when father passes HD on to daughter?

even more repeats so presents earlier

when mother passes on to son = same number