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Flashcards in Dementia Deck (52):
1

What encompasses cognition?

Attention
Social functioning (judgement, evaluation, reasoning)
Language (comprehension and production of language)
Executive function (problem solving, decision making)
Formation and knowledge of memory

2

What is the clinical definition of dementia?

Evidence of significant cognitive decline in at least 1 cognitive domain (attention, executive, learning and memory, perceptuo-motor or social cognition)
PLUS: cognitive deficits interfering with independence of everyday activities
PLUS: not better explained by another process/ do not occur exclusively in the context of delirium

3

What are acute cognitive disorders?

Viral encephalitis
Head injury
Stroke

4

What are the symptoms of viral encephalitis?

Memory
Behaviour change
Language

5

What are the symptoms of acute cognitive disorder in the context of head injury?

Attention
Memory
Executive function

6

What are the clinical features of transient global amnesia?

Abrupt onset antegrade more than retrograde amnesia
Preserved knowledge of self
Always less than 24 hours
Generally a once off

7

What are triggering factors for transient global amnesia?

Emotion/ changes in temp

8

What are the clinical features of transient epileptic amnesia?

Forgetful/ repetitive questioning
Can carry out complex activities with no recollection of events
Short lived (20-30 mins)

9

What is transient epileptic amnesia associated with?

Temporal lobe seizures

10

What is the differential for sub-acute cognitive disorders?

Toxins; alcohol, carbon monoxide
Neurodegeneration: CJD
Metabolic: B12, calcium, thyroid
Infection: HIV, syphilis
Functional
Mood disorders
Inflammatory: limbic encephalitis

11

What are the clinical features of functional cognitive impairment?

Everyday forgetfullness impacting on functioning
Fluctuation of symptoms
Mismatch between: symptoms + reported function/ symptoms _ symptoms of known neurodegenerative disorders

12

What is the treatment for functional cognitive impairment?

Exclude a mood disorder
Refer to neuropsychology

13

What is the most common prion disease?

CJD

14

What are the 4 subtypes to CJD?

Sporadic
Variant
Iatrogenic
Genetic

15

What causes variant CJD?

Exposure to BSE

16

What can be seen in histology of CJD?

Spongiform change

17

What can be seen in the CSF of CJD?

14-3-3
S100b
RT-QuIC

18

What is the commonest dementia syndrome?

Alzhemiers

19

What is the pathology behind alzheimer's disease?

Neurodegenerative amyloid proteinopathy
Disruption of cholinergic pathways in the brain + synaptic loss results in extracellular amyloid plaques and intracellular neurofibrialty tangles

20

Which proteinopathy is assoc with alzheimer's disease?

Amyloid

21

What are the initial symptoms of alzheimer's disease?

General forgetfulness

22

Which areas of the brain are most commonly affected by alzheimer's disease?

Medical hippocampus and lateral parietal lobes (apraxia and visuospatial difficulties)

23

What will posterior cortical atrophy result in?

Visuospatial disturbance
Commonly referred from ophto

24

What are the different types of progressive primary aphasia?

Semantic
Logopenic aphasia
Non-fluent aphasia

25

What investigations should be ordered in alzheimer's disease?

MRI; atrophy of temporal/ parietal lobes
SPECT; temporoparietal decreased metabolism
CSF: decreased amyloid: increased TAU

26

What is the treatment for alzheimer's disease?

Address vascular risk factors
ACh boosting: cholinesterase inhibitors (rivastigmine)
NMDA receptor blockers; memantine

27

What ages will be affected by frontotemporal dementia?

Early onset; before age 65

28

What will be seen on pathology in FTD?

Pick body

29

Which protein is involved in the progression of FTD?

Tau and ubiquitin

30

What are the presentations of FTD?

Frontal features; disinhibition, apathy, loss of empathy, stereotyped or compulsive behaviours, hyperorality
Early loss of innsight

31

What are the genetic causes of FTD?

C9orf

32

What investigations should be done in FTD?

MRI; atrophy of frontotemporal lobes
SPECT; frontotemporal decreased metabolism
CSF; Increased TAU/ normal amyloid

33

What is the treatment for FTD?

Trial of trazadone/ antipsychotics
Not really anything
Safety management; controlled access to food/ money/ internet
Power of attorney
Support

34

What is the core criteria for vascular dementia?

Presence of CVD
A clear temporal relationship between the onset of dementia and CVD

35

What are the presentations of vascular dementia?

Subcortical (small vessel disease): decreased attention, executive dysfunction and slowed processing
Post-stroke dementia
Co-existing amyloid with a prognosis similar to AD

36

What is the management of vascular dementia?

Vascular risk factors +/- cholinesterase inhibitor
CPN (community psychiatric nurse)

37

What protein is involved in the progression of lewy body dementia?

Alpha-synuclein

38

What is the pathogenesis of lewy body dementia?

Alpha synuclein aggregates which build up in the cell resulting in dysfunction and a lack of cholinergic and dopaminergic pathways

39

What is the core criteria for DLB?

Fluctuating cognition
Recurrent well-formed visual hallucinations
Presence of extrapyramidal features (parkinsonism)
Neuroleptic sensitivity; gets MUCH worse with haloperidol

40

What investigations should be performed in DLB?

DaT (dopamine transporter imaging)

41

What is the treatment for DLB?

Small dosages of levodopa if motor features
Trial cholinesterase inhibitors
PD nurse specialist

42

What is the difference between parkinson's disease dementia and dementia with lewy bodies?

DLB; dementia within 1 year of presentation
PDD; dementia presents after 1 year

43

Cardinal symptoms of PD?

Bradykinesia
Ridigidy
Tremor
Dementia (decreased attention, slowness of processing, impaired visuospatial functions and memory) +/- hallucinations

44

What is the pathogenesis of huntington's disease?

CAG repeats on huntingtin gene

45

What is the protein involved in the progression of huntington's disease?

Huntingtin

46

What dementia is assoc with huntington's disease?

Dyexecutive syndrome + slowed speed of processing
Eventual involvement of memory
Changes in mood/ personality
Chorea
Psychosis

47

What is the treatment for huntington's disease?

Mood stabilisers
Treatment for chorea
HD nurse specialist

48

What will the MRI for huntington's disease show?

Atrophy of caudate lobes

49

Who should you refer to neurology with symptoms of dementia?

Under 65 or any unusual features with additional neurology

50

What bloods are involved in the "dementia screen"?

B12
TFTs
Syphilis
HIV
Ca2+
+/- genetic panel

51

What cognitive assessment should be performed in a memory clinic?

Addenbrooke's cognitive assessment

52

Describe the main neurodegenerative proteinopathies

AS = amyloid
PDD/DLB = alpha-synuclein
CJD = prion
FTD = Tau
HD = huntingtin