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Symptoms > 042015 dementia > Flashcards

042015 dementia Flashcards

1
Q

mental status change that is chronic suggests

A

dementia
other neurodegen diseases
psychiatric disease

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2
Q

mild cognitive impairment

A

more than normal aging, but can still get things done

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3
Q

dementia-history-things to ask for?

A 
personality changes?
vascular dementia? mini strokes?
education level?
alcohol use? (alcohol related dementia)
smoker? (vascular dementia?)
illicit drug use? (HIV?)
hypoglycemia?
hypothyroid?

family history?
functional history doing ADLs?

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4
Q

differential diagnosis for dementia

A 
AD
vascular disease
Lewy body disease
depression
frontotemporal degeneration
hypothyroidism
traumatic brain injury
substance abuse
medication side effect
HIV infection
prion disease
Parkinson's
Huntington's
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5
Q

mini cognitive test

A

remember three words
draw face of clock and put time
recall three words

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6
Q

lab work up for suspected dementia

A

all patients get:

  • CBC (hemoglobin sufficient?)
  • electrolytes
  • creatinine
  • glucose
  • TSH
  • vit B12

selected cases:

  • HIV serology
  • RPR
  • heavy metal screen
  • LFTs
  • MMA (methylmalonic acid)
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7
Q

normal for Montreal cognitive assess test

A

equal or over 26

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8
Q

DSM 5 dementia criteria

A

-concern of pt, relative/friend, clinician that there’s decline in cognitive fxn
AND
standardized neuropsych testing result

  • interference w daily activities
  • not a delirium
  • not explained by other mental disorder (major depressive disorder, schizophrenia)
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9
Q

cognitive domains

A 
complex attention (driving)
executive fxn
learning and memory
language (producing and understanding)
perceptual motor (waving goodbye)
social cognition (recognizing emotions, what's appropriate)
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10
Q

diagnosis of dementia

A

more than 2 cognitive domains affected
impaired fxn (bathing, dressing)
evidence of progression
no alternative diagnosis

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11
Q

most common forms of dementia in US

A

AD
vascular
Lewy body dementia

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12
Q

small hippocampal volume, atrophy

A

AD

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13
Q

onset of vascular dementia

A

sudden and gradual

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14
Q

small hippocampal volume, atrophy (widening of sulci, atrophy of gyri)

A

AD

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15
Q

domains for Lewy body dementia

A

memory
visuospatial
hallucinations

fluctuating

also-motor: parkinsonism

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16
Q

white matter lesions

A

vascular dementia

17
Q

amyloid plaques

A

extracellular accumulations of Abeta proteins

18
Q

neurofibrillary tangles

A

intraneuronal accumulation of abnormally phosphorylated tau (a normal microtubule associated protein)

not specific for AD (also tau aggregates in frontotemporal degeneration)

19
Q

agents used for AD to tx cognitive issues

A

cholinesterase inhibitors

NMDA noncompetitive antagonist

20
Q

agents used for AD to tx behavioral symptoms

A

cholinesterase inhibitors, NMDA antagonists (some efficacy)

atypical antipsychotics

mood stabilizers

antidepressants

21
Q

cholinesterase inhibitors-list them

A

donepezil
rivastigmine
galantamine

centrally acting, but not selective for CNS

22
Q

name NMDA channel blocker for tx AD

A

memantine (prevents Ca flux)

23
Q

antipsychotics for tx AD

A

risperidone
olanzapine
quetiapine

are atypical antipsychotics

24
Q

side effects of antipsychotics

A

parkinsonism
sedation
falls

black box warning: higher risk for stroke and overall mortality (1.6 fold increase)

25
Q

mood stabilizers for tx AD

A

carbamazepine
lithium

benzodiazepines (for acute agitation)
haloperidol (for acute aggression)

26
Q

avoid what drugs in AD?

A

those that aggravate cognitive impairment:
anticholinergics
benzodiazepines
sedatives

27
Q

what’s a must not miss diagnosis when suspecting dementia?

A

delirium

28
Q

when would you consider brain imaging?

A

sudden onset problem-tumor? stroke?

29
Q

second most common cause of degenerative dementia

A

dementia with Lewy bodies

30
Q

Lewy body dementia features

A

dementia often presenting symptom

early in course: attention, visuospatial, executive fxn, getting lost

later in course: memory impaired

31
Q

three core clinical features of Lewy body dementia

A

fluctuation in alertness (in btwn episodes, functing may be normal)

visual hallucinations (often precede motor symptoms)-not bothersome to pt

parkinsonism (tremor less common than PD)

32
Q

suggestive features of Lewy body dementia

A
  • repeat falls
  • neuroleptic (antipsychotic) sensitivity
  • REM sleep disorder
  • syncope or loss of consciousness
  • orthostasis-carotid sinus sensitivity
  • autonomic dysfxn (urinary incontinence/retention, impotence)
  • audiotry hallucinations, delusions
  • depression
33
Q

imaging for Lewy body dementia

A

MRI-generalized atrophy

SPECT/PET-decreased perfusion in occipital lobes

34
Q

Lewy bodies

A

round, eosinophilic intracytoplasmic inclusions in nuclei of neurons

alpha synuclein is major component

35
Q

neuropathology of Lewy body dementia

A

Lewy bodies

amyloid plaques often, NFTs rare

36
Q

FTD imaging

A

MRI: frontal, temporal atrophy
PET: decreased metabolism in these areas

Symptoms (18 decks)

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