stroke and dementia

what are the different lobes of the brain and its functions

• what does the central sulcus separate

Frontal lobe  

• Planning, practical thinking, behaviour and problem solving  

Parietal lobe 

• Perception, sensory inputs from different parts of the brain 

Temporal lobe  

• Memory, concentration and attention 

Occipital lobe 

• Vision and object recognition 

 

• Central sulcus separates the frontal lobe and parietal lobe  

 

where is the motor homunculus

where is the sensory homunculus

• MOTOR homunculus = PRE central gyrus 

• SENSORY homunculus = POST central gyrus 

blood supply of the brain

• whats the circle called

• what is each lobe supplied by

• circle of willis

• frontal lobe - MCA (laterally) ACA (superiorly)

• parietal - MCA (laterally) ACA (superiorly)

• temporal - MCA (laterally) PCA (inferiorly)

• occipital - PCA

• insula - MCA

what are the ventricles in the brain called

• 2 lateral ventricles - located in each hemisphere, produces most CSF

• third ventricle - middle structure connecting the lateral ventricles

• cerebral aqueduct - connects3-4th

• 4th ventricle - drains CSF into subarachnoid space

what is a stroke

• two types

• characteristics

• clot in the brain - ischemic/infarct

• bleeding - haemorrhagic

• both mean that brain tissue doesnt receive enough nutrients or oxygen and leads to damage

• rapid onset

stroke risk factors

• Hypertension  

• High cholesterol  

• Smoking  

• Excess alcohol intake  

• Age gender, ethnicity, family history  

• Diabetes 

• Ischaemic heart disease   

• Atrial fibrillation 

treatment in the first 24 hours

• Confirm onset of symptoms  

• Quick assessment  

• Urgent CT head, CT angio, CT perfusion  

• Decision: thrombolysis (dissolving blockage) /thrombectomy (removal) 

what are the 4 memory types and what does each do

• W

• E

• S

• P

Memory types 

Working: 

• Use this to store information for short term  

• Remembering numbers  

Episodic: 

• Needed to recall past events, recent or distant 

• Personal experiences  

• Usually linked to emotions/feelings 

• Memories linked to positive or negative feelings are easier to recall 

Semantic: 

• Used to remember the meaning of words or facts 

• Used to remember familiar faces or objects  

• If you have a problem with semantic memory, find it hard to use the right words or recognise things 

Prospective: 

• Future memory, remember future dates, appointments  

• Problem with prospective memory, may forget to do something at a certain time 

• Forget planned events  

What are the 4 stages of processing memory

• R

• E

• S

• R

1. Receiving 

• Memory is received through 1/5 senses 

• Sight, smell, hearing, touch, taste 

 

2. Encoding 

• Brain converts info into a form that it can be stored  

• Its all held in short term memory at first  

3. Storing 

• Only some of the information is transferred to long term memory  

• Can take from a few seconds to months 

• Helped by repeating it over again = rehearsal  

 

4. Retrieving 

• Recall information stored in LT memory  

what can hinder memory processing

• Stress 

• Anxiety 

• Low mood  

(brain is too focused on other thoughts) 

• Medications (eg opioids) 

• Lack of sleep  

• Hearing, visual impairment!! 

(seen in many older patients) 

what is dementia, what characterises it

Dementia is a syndrome (group of syndromes) that include: 

1. Progressive memory loss 

2. Difficulty with weighing information and making a decision  

3. Language difficulties including comprehension and expression  

4. Personality changes  

Dementia is characterised by marked impairment in 2+ cognitive domains 

• Must be severe enough to cause significant impairment in personal, family, social, educational, occupational or other imp areas of functioning/ everyday life (ICD11) 

dementia risk factors

• Women live longer and thats why there are more cases of women than men, same odds 

• Age 65+ 

• Genetics, not the strongest risk factor  

• Lifestyle, obesity, exercise, smoke, sleep 

• Cognitive reserve  

• The more connections in the brain made over ones life they will experience the effects of the disease less/ it will take longer to have an effect 

• Health conditions  

name the 4 types of dementia

• A

• VD

• DLB

• FTD

alzheimer’s

vascular dementia

dementia with lewy bodies

frontotemporal dementia

alzheimer’s

• cause

• effect on which part of the brain

• what chemical is decreased

• what can medication help with increasing

• what is the extend of the degree dependent on (CR)

• Caused by the formation of abnormal deposits of proteins in the brain 

• Plaques – amyloid, tangles – tau, these are present in healthy brain but function abnormally in Alzheimer's disease 

• Amyloid forms plaques outside cells, tau forms tangles in cells damaging nerve cell death 

• Nerve cell death -> brain shrinks 

• Hippocampus affected seen in early stages of stroke 

• Affects the formation of new memories because hippocampus is affected  

• Amygdala affected later, they can rmb memories because of the emotion associated with it  

• Patients have less NT, worse communication between nerve cells  

• Medication helps increase the amount of NT  

• The effect of the disease is dependent on the cognitive reserve 

• Study performed on nuns who had large CRs but the pathology of their brain showed Alzheimer's  

vascular dementia

• causes

• anatomical effect

• what reduces risk

• signs

• Caused by blood supply problems, reduced oxygen and nutrients can cause n cells to die 

• Strokes can cause damage to the brain and the same symptoms of dementia (post-stroke dementia) 

• Many strokes that gradually cause damage (multi-infarct dementia) 

• Small vessel disease (common cause of V dementia), vessels get smaller 

• Can take them longer to think 

• Reduce risk by exercising, eating healthy, not smoking 

• Experience concentration issues, planning and organising  

dementia with lewy bodies

• cause

• what does it prevent in the brain

• what can it affect

• Lewy bodies are proteins that build up in N cells 

• Prevent communication of n cells, disrupting NTs 

• Can affect many parts of the brain, can affect movement, concentration, cause hallucinations, memory 

• Affects sleep 

frontotemporal dementia

• what is damaged in the brain

• who is most at risk

• what is affected

• cause

• genetic effect?

• Range of conditions where frontal and temporal lobe cells are damaged 

• Less common, affects more under 65 yrs 

• These lobes control language, behaviour, emotional responses  

• Early damage to frontal lobe, change in personality/behaviour, loss of inhibitions 

• Others have early temporal lobe damage, language struggles  

• Happens when tau builds up in nerve cells, kills them  

• Stronger genetic effect  

 

name some non-pharmacological management techniques

Prevention: 

• Education  

• Lifestyle advice  

Diagnosis and post diagnostic support: 

• Availability of services 

• Getting the right help early 

• Give tips on how to live well with dementia, keep memories  

Carer support: 

• Memory clinic refers them to voluntary services, carer support, education 

• Links to social care, government benefits if eligible  

• Legal, lasting power of attorney LPA, nominee to make decisions on behalf  

pharmacological management

Acetylcholinesterase inhibitors and friends: 

• Boost ACh in brain 

• Evidence for good function 

• Memantine, works on glutamate and improves nerve signal transmission 

• Helps boost NT, doesn't modify illness 

• ONLY Alzheimer drugs  

General health: 

• Manage blood pressure 

• Diabetes, blood thinners  

• Mainly for vascular dementia, prevents clotting 

Coming soon... 

• DMTs, dementia modifying treatments, first treatment to actually modify disease directly 

• Biomarkers – change how we diagnose 

• Amyloid plaque destroyers – Alzheimer's