dementia

Question 1

how is the APP gene related to alzheimers

Answer 1

it is a precursor for beta amyloid plaques.
people with downs syndrome inherit an extra APP on chromosome 21

Question 2

what is the most common cause of death in alzheimers

Answer 2

pneumonia because it affects the swallowing centre of the brain (medulla oblongata) causing aspiration

Question 3

what allele is associated with late-onset Alzheimer’s

Answer 3

apolipoprotein E4 (APOE)

Question 4

what allele is associated with early-onset familial Alzheimer’s

Answer 4

presenilin 1 and 2

Question 5

second line pharmacological management of Alzheimer’s?

Answer 5

NMDA receptor agonists (memantine)

Question 6

how does memantine work

Answer 6

prevents binding of glutamate so theres less influx of calcium into neuronal cells. this reduces excitoxicity and neuronal death

Question 7

who cannot have drug treatment for dementia

Answer 7

if MMSE < 12
too many side effects

Question 8

what APOE allele is associated with decreased risk of Alzheimer’s

Answer 8

E2

Question 9

which lobe is first effected in Alzheimer’s

Answer 9

medial temporal
shrinkage of amygdala - assocaited memory problems

Question 10

What is the first-line pharmacological management of Alzheimer’s?

Answer 10

acetylcholinesterase inhibitors
e.g. donepezil/galantamine

Question 11

What vitamin can be used for Alzheimer’s/vascular dementia to slow functional losses?

Answer 11

Vitamin E
acts as an antioxidant

Question 12

what MMSE score is normal and moderate

Answer 12

25-30 = normal
10-19 = moderate alzheimers

Question 13

how is lewy body dementia initially characterised

Answer 13

fluctuating cognition,
REM sleep behaviour disorder,
visual hallucinations,
followed by parkinson features

Question 14

Early-onset dementia with Parkinsonian features suggests which dementia

Answer 14

lewy body

Question 15

Lewy body dementia diagnostic critera 2/3 guide:

Answer 15

visual hallucinations
fluctauting mental state
parkinsonism

Question 16

which drug should be avoided in lewy body dementia

Answer 16

typical antipsychotics
may exhibit neuroleptic hypersensitivuty which worsens dementia

Question 17

What is the first-line pharmacological management of Lewy body dementia?

Answer 17

acetylcholineaterase inhibitors
donepezil/rivastigmine

Question 18

what investigation can be used for lwy body dementia

Answer 18

Da Tscan
type of SPECT scan which shows a loss of dophanergic neurons in the striatum
cant show difference between lewy and parkinsons dementia

Question 19

what is the main mangement of vascular dementia

Answer 19

controlling cardiovascular risk factors
e.g. hypertension, diabetes, smoking etc

there is no proven pharmacological methods unless managing comorbid alzheimers

Question 20

what is vascular dementia

Answer 20

result of multiple arterial infarcts and/or chronic ischemia e.g. hypertension, atherosclerosis

Question 21

A hypertensive patient presents with sudden cognitive decline, then remains stable for 8 months and experiences another sudden drop in decline. What should you suspect?

Answer 21

vascular dementia

Question 22

what are the most common dementias

Answer 22

1. alzheimers
2. vascular

Question 23

how to diagnose vascular dementia

Answer 23

history
cognitive impairment assessment
MRI
exclusion of other causess

Question 24

what conditions must be excluded in patients with cognitive impairment

Answer 24

hypothyroidism
depression

Question 25

what is pseudodementia

Answer 25

cognitive impairment thats secondaary to major depressive disorder

Question 26

what are the cognitive assessment tools

Answer 26

10-point cognitive screener 6-item cognitive impairment test MMSE - not NICE recomended

Question 27

A patient who is walking slowly and has developed kyphotic posture with poor arm swing , is indicative of what?

Answer 27

lewy body dementia - parkinsons symptoms

Question 28

what is the pathology of LBD

Answer 28

accumulation of alpha-synuclein in the brain

Question 29

pathology of alzheimers

Answer 29

deposition of type A beta-amyloid protein and intraneuronal neurofibrillary tangles which care caused by abonormal aggregation of tau protein - this causes cortical plaques

Question 30

mechanism of action of memantine

Answer 30

uncompetitive antagonist of NMDA receptors binds with low affinity to MNDA receptors to reduce the overactivation of the receptors by glutamate. Glutamate is the main excitatory NTMs of the brain and binds to NMDA receptors which allows an influx of calcium ions into neurons. - important process in learning and memory

Question 31

what is donepezil

Answer 31

drug for dementia symptoms especially in Alzheimer's. works by increasing acetylcholine