Donepezil preserves cognition in what condition?
Dementia
Dementia is a decline in memory/cognition and learning new info. What is the awareness of envionment like?
-It is preserved (unlike delerium)
What are the 4 types of Dementia in order of common?
- Alzehimers
- Vascular Dementia
- Dementia with Lewy Bodies
- Frontotemporal dementia
Suggest the diagnosis pathway for dementia following a GP visit:
(as well as investigating reversible causes like b12,folate, thyroid)
- memory clinic referral
- cognitive test e.g. Adam Brookes test /100
- home/care home visit
- history/collateral
Alzheimer’s presentation is usually a 2-3yr decline, scan will show atrophy where? Memory and concentration may be impaired, what is more intact?
Hippocampal atrophy
Language and visuospatial more intact
Name as many of the 7As of Alzheimers:
- Anosognosia
- Aphasia
- Altered perception
- Apathy
- Agnosia
- Apraxia
- Amnesia
List 4 non-cognitive features of Alzheimer’s disease:
- depression, anxiety, psychosis, hallucinations
- agitation, aggression, wandering
- day-night reversal
- personality change, apathy, disinhibition
Give 4 risk factors for developing Alzheimers:
e.g. head trauma..
- increasing age
- vascular risk factors (DM, HT, AF, smoking)
- Family history
- Apo E4 allele
- hypothyroidism
What are the 3 main features contributing to the pathophysiology of Alzheimer’s disease along with Apo E, vascular pathology and inflammation..
- neuronal cell death esp. cholinergic
- B amyloid plaques cleaved from APP
- neurofibrillary tangles with hyperphosphoryl. Tau
Cholinesterase inhibitors e.g. Donepezil and Rivastigme treat early Alzheimers..what is given in later stages?
NMDA receptor antagonists (e.g. Memantine) calms the hyperalertness/anxiety
Vascular Dementia is characterised by what kind of deficits? Give scenarios VD could develop:
- patchy deficits e.g. language, attention..
- post stroke/large vessel infarct
- multiple cortical grey matter infarcts (MID)
- extensive small vessel disease e.g. lacunar infarcts, deep perforating artery occlusion
How is Parkinson’s Disease Dementia (PDD) differentiated from Lewy Body Dementia (DLB)? NB: they are a spectrum of exactly the same disease
- PDD is parkinsonian symptoms for 12months+ before dementia
- DLB if both motor and cognitive symptoms develop within 12 months of Parkinsons
Lewy body dementia exhibits neuronal inclusions-abnormally phosphorylated neurofilaments such as?
Ubiquitin
alpha-synuclein
In Lewy body dementia Ubiquitin and alpha-synuclein are found with a marked decrease in ACh in what brain areas?
in paralimbic, neocortical and brainstem areas
Lewy neurites and amyloid plaques are present in what disease?
Lewy Body Dementia
What drug class should be avoided in dementia patients due to there effect on a certain NT?
Antipsychotics as they block DA
Fronto-temporal dementia is aka. whose disease? This name comes from tau inclusions in 40% people with FTD also called..?
- Pick’s disease
- 40% have “Pick bodies” or “Pick cells”
Where is the atrophy in FTD?
-frontal and ANT. Temporal lobes
There are 2 language types of FTD. What are they? and 1 behavioural type-what sorts of features?
- Semantic and Progressive Non-fluent Aphasia
- Behavioural: personality/social conduct changes, disinhibition, apathy, perseveration…
What is the relation of alcohol related brain changes and Dementia?
-frontal lobe changes with the vascular changes, head injuries from falls and poor diet can increase risk
What reversible syndrome associated with alcoholism arises as a result of a vit deficiency causing impaired conciousness, ataxia, opthlamoplegia - what vitamin?
Wernicke’s Encepalopathy
B1/thiamine deficiency
If untreated what can the reversible Wernicke’s Encepalopathy cause which is irreversible, what are the features?
Korsakov’s psychosis - profound amnesia for new learning, confabulation. Good attention/working memory still.
What is usually the cause of “challenging behaviour” (= a manifestation of distress/suffering) ?
-a poorly communicated need
How are challenging behaviours recorded with the ABC charts?..antecedent…b…c…
A-ntecedent - what happened before
B-ehaviour - what happened during
C-onsequence - what happened after
