042015 dementia Flashcards by jenny Guo

mental status change that is chronic suggests

dementia
other neurodegen diseases
psychiatric disease

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mild cognitive impairment

more than normal aging, but can still get things done

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dementia-history-things to ask for?

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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differential diagnosis for dementia

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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mini cognitive test

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

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lab work up for suspected dementia

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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normal for Montreal cognitive assess test

equal or over 26

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DSM 5 dementia criteria

-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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cognitive domains

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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diagnosis of dementia

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

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most common forms of dementia in US

AD
vascular
Lewy body dementia

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small hippocampal volume, atrophy

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onset of vascular dementia

sudden and gradual

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

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domains for Lewy body dementia

memory
visuospatial
hallucinations

fluctuating

also-motor: parkinsonism

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white matter lesions

vascular dementia

amyloid plaques

extracellular accumulations of Abeta proteins

neurofibrillary tangles

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

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

agents used for AD to tx cognitive issues

cholinesterase inhibitors

NMDA noncompetitive antagonist

agents used for AD to tx behavioral symptoms

cholinesterase inhibitors, NMDA antagonists (some efficacy)

atypical antipsychotics

mood stabilizers

antidepressants

cholinesterase inhibitors-list them

donepezil
rivastigmine
galantamine

centrally acting, but not selective for CNS

name NMDA channel blocker for tx AD

memantine (prevents Ca flux)

antipsychotics for tx AD

risperidone
olanzapine
quetiapine

are atypical antipsychotics

side effects of antipsychotics

parkinsonism
sedation
falls

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

mood stabilizers for tx AD

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

avoid what drugs in AD?

those that aggravate cognitive impairment: anticholinergics benzodiazepines sedatives

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

delirium

when would you consider brain imaging?

sudden onset problem-tumor? stroke?

second most common cause of degenerative dementia

dementia with Lewy bodies

Lewy body dementia features

dementia often presenting symptom early in course: attention, visuospatial, executive fxn, getting lost later in course: memory impaired

three core clinical features of Lewy body dementia

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)

suggestive features of Lewy body dementia

- 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

imaging for Lewy body dementia

MRI-generalized atrophy | SPECT/PET-decreased perfusion in occipital lobes

Lewy bodies

round, eosinophilic intracytoplasmic inclusions in nuclei of neurons alpha synuclein is major component

neuropathology of Lewy body dementia

Lewy bodies amyloid plaques often, NFTs rare

FTD imaging

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