Vascular dementia and frontotemporal dementia
16 important questions on Vascular dementia and frontotemporal dementia
Vascular cognitive impairment
Vascular dementia neuropathology
- the presence of:
-small or large vessel disease
-white matter leasions
-infarcts
-lacunes - absence of:
-confounding pathologies (plaques, tangles, lewy bodies)
White matter lesions
- lesions are varied and diffuse
- white matter hyperintensities (frequently present in older individuals)
- diffuse demyelization
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Vascular dementia is the result of:
- extensive white matter lesions and lucunar infarct due to small blood vessel disease
-results in a slow onset and gradual decline
OR
- one or more strokes in the main cerebral arteries
-results in a abrupt onset and stepwise decline related to one or more strokes
OR
- Both
Clinical manifestation anterior cerebra artery
- paraplegia (legs)
- abulia (absence of willpower or the inability to act)
- executive dysfunctions
- personality changes
Clinical manifestation middle cerebra artery
- hemiplegia
- aphasia (impairment of language)
- hemianesthesia (loss of tactile sensory information on one side of the body)
Clinical manifestation posterior cerebra artery
- homonymous hemianopia (loss of visual field on the left or right eyeside, in 1 or both eyes)
- alexia (severe reading problems) with or without agraphia (neurologcal disorder that results in the inability to communicate through writing)
- visual agnosia (problems with the processing of visual information)
- balint syndrome (Bálint's syndrome is an uncommon and incompletely understood triad of severe neuropsychological impairments: inability to perceive the visual field as a whole (simultanagnosia), difficulty in fixating the eyes (oculomotor apraxia), and inability to move the hand to a specific object by using vision (optic ataxia))
- prosopagnosia
Vascular dementia can result in:
- impaired learning and memory
- impaired executive functions
- impaired attention
- impaired language
-Naming difficulties - impaired visuoperceptual functions
-impaired performance on visual organisation tasks - impaired psychomotor skills
-impaired performance on tests of psychomotor speed
Alzheimers and vascular dementia comparison
- have comparable performance in cognitive domains
- differences are found in attention and executive functions
Alzheimers and vascular dementia
- alzheimers disease is common in patients with vascular dementia post mortem
- risk for alzheimers increases with more strokes
- pure alzheimers is post mortem associated with vascular pathology
- two theories
-two independent pathologies co-occur
-vascular changes stimulate the pathology of alzheimers disease
Behavioural variant of FTD brain areas
- dorsolateral frontal cortex
- orbitofrontal cortex
-disinhibition
-poor impulse control
-antisocial behaviour
-stereotyped behaviour
-decreased agreeableness - medial frontal cortex
-apathy (may be mistaken for depression)
-akinetic mutism - anterior cingulate cortex
-apathy (may be mistaken for depression)
-akinetic mutism
- mostly right hemisphere dysfunction
-dramatic changes in beliefs, attitudes, and/or religious sentiment
- dietary changes
-sweets craving
-decreased satiety - as disease progresses, features of kluver-bucy syndrome (compulsive eatinghypersexuality, hyperorality, visual agnosia, docility)
-language dysfunction
-left frontal cortex (progressive non-fluent aphasia)
FTD neuropsychological assessment
- executive functioning
-Impaired: phonemic fluency, trail making test, stroop test
- below average: semantic fluency, working memory - social cognition
- naming of emotions impaired - memory and visuospatial functions are relatively spared
- language impairment in later stages
Semantic FTD assessment
- category fluency test
-name as many animals as possible in 1 minute - naming tasks
- generation of verbal definitions of words and pictures
-early stages: loss of subordinate knowledge (misidentify orange apple)
-moderate-severe stages: loss of superordinate knowledge (orange and apple are identified as fruiit and eventually as food)
Semantic FTD later progression
- patients will eventually show behaviours like in behavioural variant of FTD
- these behaviours are more prsent in patients with a right temporal lobe semantic dementia
Progressive non-fluent aphasia FTD
- changes in:
-fluency
-pronounciation
-word finding difficulties (more significant for verbs than nouns) - pathology in brodmans areas 44 & 45
- behavioural changes are not present until later in the disease
- executive functions are often impaired
- episodic memory, semantic memory and visuospatial functions are preserved
Progressive non-fluent aphasia FTD language difficulties
- agrammatism
-omission or incorrect use of: articles, prepositions, verbs
-phonemic paraphasias: head instead of bed, efelant instead of elephant - stuttering
- impaired repetition
- alexia
- agraphia
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