This is a well-rounded lecture summary of "Other Dementias” lecture in the Second Teaching Block in the Brain and Behaviour module, Year 1.
The collection of notes form both the slides provided before the lecture and the actual lecture. It contains all the key points necessary in the exam. Fo...
1. Vascular (multi-infarct) dementia
o Second most common cause of dementia in UK and Europe; commonest
cause in some parts of Asia (e.g., 50% in Japan).
o Loss of cognitive functioning due to disruption of blood supply to the brain, e.g., a series of small
‘strokes’ (= disruption to the supply of blood to the brain caused by:
- blocked artery (e.g., a blood clot: thrombosis) or
- bleed into the brain from a burst artery (haemorrhage)
o Blocked arteries are the most common cause of vascular dementia.
o Strokes deprive the brain of oxygen and nutrients. Cells die, leading to areas of cell
loss (‘lesions’ or ‘infarcts’).
o Each small stroke causes a further deterioration.
o Many patients have a history of hypertension (high blood pressure).
Arrows show small lesions in the brain of a
patient with multi-infarct dementia
o Other risk factors include smoking, diabetes, being obese, and high cholesterol.
o Symptoms can appear suddenly (e.g., after a mini stroke) and then show “stepped” progression.
o Progression can be slowed by improving cardiovascular function
o Yet prognosis is not good: 5-year survival rate < 40%
o What proportion of vascular dementia patients have hypertension? 80%
o Patients have ‘patchy’ deficits that vary case to case, depending on the area(s) affected. Some brain
areas are more vulnerable to stroke because they receive supply from a single artery. Frontal lobes seem
particularly prone:
- Problems with concentration and acute confusion
- Problems with organising complex thought and behaviour
- Behavioural symptoms: apathy, restlessness
NB Apathy at early stage in vascular dementia (later stage in AD)
- Physical weakness/paralysis (symptoms associated with frontal stroke)
o Margaret Thatcher (1923 - 2013)
- Conservative MP from 1959. Prime Minister 1979-1990.
- Series of small strokes since 2002.
- Daughter, Carol T, wrote in 2008 how she first noticed problems in 2000, when Mrs. T. was in her
mid 70s: “Mum started asking the same questions over and over again, unaware she was doing so”.
- Has to be reminded that her husband, Denis, is dead: “’Were we all there?’, she’d ask softly”
2. Focal dementias
o In Alzheimer’s, pathology and atrophy is widespread, affecting temporal, parietal, and frontal lobes.
o In focal atrophy, damage is restricted to limited parts of the cortex before becoming more widespread.
o Frontotemporal dementia
1. Frontal-variant (fvFTD)
2. Semantic dementia (SD)
3. Posterior cortical atrophy (PCA)
- Rare overall but more common in younger people; typically diagnosed
between 45 and 65 years.
- Different pathology from AD – No amyloid plaques or neurofibrillary tangles.
- Sometimes there are “Pick bodies” inside cells (clumps of tau protein).
- Different forms of FTD, depending on where the atrophy is:
Frontal variant (in 70% of cases): atrophy in frontal lobes
Semantic dementia: Atrophy in anterior temporal lobes – quiet rare
- Often a mixture of symptoms; start out different but become similar over time
- What is unlikely to be a symptom in fvFTD? Reduced visual acuity
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