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Flashcards in Week 3- dementia Deck (39)
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1
Q

What is dementia?

A

An acquired and persistent generalised disturbance of higher mental functions in an otherwise fully alert person.

2
Q

What is the difference between primary and secondary dementias?

A

Secondary dementias are other disorders giving rise to dementia. Whereas primary is just the dementia alone.

3
Q

Give examples of primary dementias?

A

Alzheimer’s disease, Lewy body dementia, Picks disease, Huntington’s disease.

4
Q

Describe Alzheimer’s disease?

A

Progressive impairment of higher intellectual function. Associated with mood and behaviour changes. As it progresses- progressive disorientation, memory loss and aphasia indicating severe cortical dysfunction.

5
Q

Macroscopically- what changes would you see in the brain in a patient with Alzheimer’s disease?

A

Atrophy of the cortex- typically affecting frontal and parietal lobes.
Reduction in weight
Narrowing of gyri and widening of the sulci.
Compensating dilatation of the ventricles.
Brainstem and cerebellum are normal.

6
Q

Microscopically- what changes would you see in a brain of a patient with Alzheimer’s disease?

A

Neuronal loss with associated astrocyte proliferation. Gliosis.
Neurofibrillary tangles (intracytoplasmic accumulations of microtubules and proteins called Tau)
Neuritic plaques- formed by A beta amyloid plaques. Surrounding astrocytes and microglia.

7
Q

What is the importance of amyloid AB in Alzheimers disease?

A

It forms the central element of the neuritic plaques. Also found in patients with trisomy 21 (downs syndrome)- meaning they have early onset Alzheimer’s.

8
Q

Genes associated with Alzheimers and inheritance

A

Implicated genes are the amyloid precursor protein (APP) and presenillin 1 and 2.
May have a familial connection.

9
Q

Who is affected by Alzheimers disease?

A

Its a disease of the elderly (over the age of 65).

10
Q

Brief pathogenesis of Alzheimer’s?

A

Depositation of Alpha- beta amyloid is the initial event. These form neuritic plaques which activate inflammatory cells.
Real disruption is caused by a-beta oligomers that get into the synaptic cleft.

11
Q

What is amyloid angiopathy?

A

A beta peptide accumulates in vessel walls- can disrupt the blood brain barrier. Stains Congo red.

12
Q

Describe Lewy body dementia?

A

This is the third most common form of dementia. It is a progressive dementia with hallucinations and fluctuating levels of attention/cognition.

13
Q

How does Lewy body dementia differ from Alzheimers disease?

A

Lewy body dementia fluctuates in severity on a day to day basis.

14
Q

What features present early in Lewy body dementia?

A

Parkinson features present at onset or shortly after.

15
Q

Describe features of Parkinson’s?

A

Loss of facial expression, pill rolling resting tremor, rigidity, slow and difficult initiation of movement.

16
Q

Describe the pathology of Lewy body dementia?

A

Degeneration of the substantia nigra as seen in Parkinson’s.
Accumulation of lewy bodies in vulnerable sites.

17
Q

Macroscopically- what will the substantial nigra look like in Lewy body dementia?

A

Loss of pigment- pale.

18
Q

Microscopically- what does Lewy body dementia present as?

A

Loss of pigmented neurones
Reactive gloisis
Remaining neurones show Lewy bodies. Lewy bodies are eosinophilic, round, elongated bodies with a dense core and surrounding pale halo.

19
Q

What is Huntington’s disease and what is the classic triad?

A

A neuropsychiatric disorder that presents in the younger population.
Triad of emotional, cognitive and motor disturbances.

20
Q

Symptoms of Huntington’s disease?

A
Chorea (dance like movements) 
Myoclonus (spasmodic jerky contractions of a group of muscles)
Clumsiness
Slurred speech
Depression
Irritability
Dementia develops later.
21
Q

How is Huntington’s disease inherited?

A

Autosomal dominantly

22
Q

Describe the macroscopic appearance of a sufferer of Huntington’s disease’s brain?

A

Atrophy of the basal ganglia- especially the caudate nucleus.

23
Q

What is Pick’s disease also known as?

A

Fronto-temporal dementia

24
Q

Describe Picks disease

A

Progressive dementia affecting a slightly younger age group than Alzheimers disease and Lewy body dementia. Characterised by progressive changes in character and social deterioration leading to impairment of intellect, memory and language.

25
Q

Describe what happens to the brain in Picks disease?

A

Extreme atrophy of the cerebral cortex especially in the frontal and temporal lobes. Huge degree of atrophy means the brain can weigh less than 1kg.

26
Q

Microscopically what happens to the brain in Picks disease?

A
Neuronal loss and gliosis. 
Picks cells (swollen neurones) are the histological landmark.
27
Q

Describe multi-infarct dementia?

A

Disorder involving a deterioration in mental function due to progressive damage.

28
Q

What occurs to the brain (pathophysiology) in multi-infarct dementia?

A

Successive, multiple cerebral infarcts cause increasingly larger areas of cell death. When a sufficient area of the brain is damaged, dementia occurs.

29
Q

Who gets multi-infarct dementia?

A

Commonly over the age of 60 however also seen in middle aged hypertensives.

30
Q

Sufferers of multi-infarct dementia are aware of their mental deficit and can develop depression. T or F

A

True.

31
Q

What differentiates multi-infarct dementia from the other dementias?

A

The other dementias tend to be relatively smoothly progressing, whereas multi-infarct dementia shows a step-wise change in neurological function.

32
Q

Morphological appearance of multi-infarct dementia?

A

Large vessel infarcts.
They will be scattered throughout hemispheres. Atheroma of large cerebral arteries provoke thromboemboli. Also lacunar infarcts add to these.

33
Q

What is key in a history to ascertain with a patient with dementia?

A

How it affects their activities of daily living e.g. finances, medications etc.

34
Q

What is vascular dementia also known as? What can point you towards this diagnosis?

A

Also known as multi-infarct dementia.
Lots of infarcts amounting to progressive cognitive decline. Look for evidence of vascular pathology e.g. hypertension, previous strokes etc.

35
Q

Which dementia is most likely to cause behavioural and personality change?

A

Frontotemporal dementia.

36
Q

What drugs can be offered as aid for Alzheimers patients to try to prevent further cognitive decline?

A

Acetylcholinesterase inhibitors- e.g. Donepezil, Rivastigmine and galantine
And also some evidence for use in Parkinson’s dementia
Be wary in peptic ulcer disease.

Also folic acid and B vitamins.

37
Q

What drug may improve behavioural symptoms in Lewy body dementia?

A

Rivastigmine.

38
Q

In late stage dementia, what drug may be affective against further cognitive decline?

A

Memantine- an NMDA antagonist

However side effects include hallucinations, confusion, hypertonia, hypersexuality.

39
Q

What drug can be used to target beta amyloid?

A

Solanezumab- can be used in mild Alzheimers disease patients.