1. Dementia

Question 1

DSM-5 Definition of Dementia

Answer 1

1. ↓ in memory and at least 1 other cognitive function (aphasia, apraxia, agnosia or a decline in an executive function (planning, organizing, sequencing, or abstracting).
2. Impair social/occupational functioning compared to PREVIOUS functioning.
3. Does not occur exclusively during dementia
4. Not due to another psych illness

Question 2

Aphasia

Answer 2

loss of ability to understand or express speech, caused by brain damage.

Question 3

Agnosia

Answer 3

cant interpret sensations ==> recognize things, typically as a result of brain damage.

Question 4

Apraxia

Answer 4

inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement

Question 5

What is the MCC of dementia? and 2nd?

Answer 5

• 1. Alzheimers
• 2. Diffuse Lewy Body Dementia

Question 6

How do we determine is a patient has dementia?

Answer 6

Autopsy

Question 7

What is the most important part in the evaluation of a patient with dementia?

Answer 7

History: take a separate hx from the patient AND their loved ones because the patient will often deny that they have a problem and the family may not want to speak in front of patient.

Question 8

What difficulties may a patient with dementia have?

Answer 8

• 1. Short term memory problems
• 2. Time course
• 3. Functioning
• 4. Safety (driving, cooking, weapons in home)
• 5. HO of head injury, toxin exposures, infection, psych problems
• 6. FHx of dementia

Question 9

How is an exam conducted for a patient with dementia?

Answer 9

• 1. Standardized short mental state test: Mini-Mental State Exam or MOCA (Montreal Cognitive Assessment) and ask about news event.
• 2. Look for CV RF (HTN, bruits, arrhythmia, murmurs)
• 3. Full neuro exam

Question 10

Lab in a patient with ALL patients with dementia

Answer 10

1. CBC with chem panel
2. Sed rate
3. Thyroid function labs
4. B12
5. RPR
6. CT/MRI of head

Question 11

What lab test would you run if you suspect a patient has Creutzfeldt-Jakob, encephalitis or seizures?

Answer 11

EEG

Question 12

What lab test would you run if you suspect a patient has CA, infection, vasculitis, or NPH?

Answer 12

Lumbar puncture

Question 13

Alzheimers Disease Clinical Diagnosis

Answer 13

1. Dementia that is established by Mini-Mental State Exam or similar test and confirmed with neuropscyh testing.
2. Deficits in 2 or more areas of cognition
3. Progressive worsening
4. No changes in consciousness.
5. Onset between 40-90, most often after 65YO
6. No other systemic disorders or brain diseases that could cause progressive deficits

Question 14

If between 2 and 3 years, the patient has not seen a decline in memory or cognitive functioning, can they have Alzheimers?

Answer 14

No: have to have progressive decline

Question 15

If a patient is constantly sleepy, do they have Alzheimers?

Answer 15

No: there is no changes in consciouness

Question 16

What will LP, EEG and MRI/CT show in a person with Alzheimers?

Answer 16

1. NL LP
2. EEG: NL or mild generalized slowing
3. MRI/CT: progressive atrophy

Question 17

Treatment of Alzheimers

Answer 17

Main goal: slow progression

1. ACh-I: Donepazil, Rivastigmine, Galantamine
2. NMDA-ANT: Memantine (moderate - severe dementia of probably Alz)
3. B complex, lipid-lowering drugs, ASA

Question 18

Patient comes in with short-term memory problems.

What is their dx?

Answer 18

Mild Cognitive Impairment (MCI):

1. Memory complaint, often noted by patient, that is abnormal for their age and doesnt meet criteria for dementia but has NL cognitive functioning and NL activities of daily living.

Question 19

What is a probably precursor to Alzheimers?

Answer 19

Mild Cognitive Impairment: 5x more likely to develop Alzheimers.

Question 20

Treatment for Mild Cognitive Impairment

Answer 20

AChEI to slow progression to Alzheimers

Question 21

Vascular Dementia Dx Criteria

Answer 21

1. Dementia dx by DM-5
2. Cerebrovascular disease => focal neurological deficits on neuro exam (hemiparesis, lower facial weakness, Babinski sign, sensory deficit, hemianopia consistent with a stroke AND
3. Evidence of cerebrovascular disease on imaging: multiple large vessel infarcts, single situated infarct (angular gyrus, thalamus, basal forebrain or posterior/anteiror cerebral artery area), as well as many BG and white matter lesions and white matter lacunes or extensive periventricular white matter lesions or a combo.
4. A relation between cognitive problems and vascular event, seen by 1 or more of the following
   
   1. Dementia occur within 3 months of a stroke
   2. Abrupt deterioration of cognitive functions
   3. Fluctuating, stepwise progression of cognitive deficits.

Question 22

Step-wise progression is a clue for what type of dementia?

Answer 22

Vascular

Question 23

Tetrad of Sx for Diffuse LB Dementia

Answer 23

1. Dementia
2. Parkinson like symptoms (bradykinesia and rigidity; NO tremor)
3. Psychotic sx (visual illuions/hallucinations)
4. VERY sensetive to antipsychotic drugs: avoid but if needed, give a newer drug (quetiapine or olanzapine)

Question 24

Differentiate a patient with LB dementia and Parkinsons

Answer 24

• LB dementia: LB in cortex, slow, stiff but no shaking (bradykinesia and rigid)
• Parkinsons: LB in BG, slow, stiff and shaky (bradykinesia, rigid, tremor)

Question 25

Which type of dementia is extremely sensitive to antipsychotic meds, and should not be given due to potentially life-threatening adverse rxns?

Answer 25

Lewy body disease (dementia)

Question 26

How do the hallucinations seen with Parkisons Disease differ from that of Lewy body disease?

Answer 26

• In PD the hallucinations are usually caused by the antiparkinsonian drugs! (like Levadopa)
• In Lewy body disease the hallucinations are an actual feature of the disease (but we do NOT treat with antipsychotics!): generally animals or children

Question 27

How does LB Disease differ from Alzheimers?

Answer 27

LB

• Progresses faster
• Psychotic sx are more common and appear earlier than Alz
• Symptoms vary more day to day, than Alzheimers
• Almost every patient has unexplained period of confusion that last days => weeks and look like delirium. So, most are often diagnosed bc they are admitted several times for unexplained confuion
• Pys

Question 28

Difference between Parkinsons and Diffuse Lewy Body Dementia

1. LB?
2. _____ dementia occurs when?
3. Resting tremor?
4. Hallucinations?

Answer 28

1. Diffuse LB dementia:
   
   1. Cortical LB
   2. Cortical dementia occurs early
   3. No
   4. Common, w/o drugs
2. Parkinsons:
   
   1. Midbrain LB
   2. Executive dementia occurs late
   3. Yes
   4. Hallucinations only d/t drugs

Question 29

What is Frontotemporal Degeneration?

Answer 29

• Many forms of dementia characterized by atropgy of frontal/temporal lobes => slowly progressive deterioration of social skills and changes in personality + impairment in [intellect, memory and language]

Question 30

Frontotemporal Degeneration

Common Symptoms:

Answer 30

1. Loss of memory
2. Lack of spontaneity
3. Diff thinking/concentrating
4. Speech problems
5. Other: emotional dullness, loss of moral judement and progressive dementia

Question 31

Frontotemporal Degeneration

1. Common Age:
2. Treatment:
3. Progression:

Answer 31

1. 40 - 60 YO
2. No cure
3. 2 - 10 years

Question 32

What are reversible causes of dementia?

Answer 32

1. Normal pressure hydrocephalus
2. Some patients w pseudodementia

Question 33

Triad of NPH

Answer 33

“Wet, wild & wacky”

1. Dementia
2. Gait disturbance
3. Urinary incontinence

Question 34

Treatment of NPH

Answer 34

Potentially reversible w ventriculoperitoneal shunting (gait disturbance is most likely to be reversed.