25 Delirium & Dementia Flashcards
Describe alzheimers
loss of cerebral cortical neruons, neuritic plaques of B-amyloid, and neurofibrillary tangles
What is hallmark cognitive change in AD?
memory decline
In alzheimer’s does parietal lobe have more tangles or plaques?
more plagues than tangles
What genes are involved in early onset, autosomal dominant Alzheimers? What percentage of disease patients is this responsible for?
chromosomes 21, 14 and 1 mutations on amyloid precurso protein (APP), presenilin 1 and 2 (aka AD1, AD3 and AD4). Only 5-10% of all alzheimers pateints
What gene is associated with late onset, sporadic alzheimers? What percentage of disease patients is sporadic responsible for? What percentage of sporadic is the gene mutation responsible for?
chromosome 19 abnormality (AD2) that codes for APOE4. Sporadic accounts for 90-95% of all alzheimers patients. APOE4 is present in 50% of those cases
What happens to neurotransmitter levels in alzheimer’s? What nucleus is involved in the pathology?
nucleus basalis is atrophied, then it no longer sends Acetylcholine to neocortex. (provides heavy innervation to neocortex
What enzyme inhibitor drug can be given to help aleviate symptoms of alzheimers?
AchE inhibitors to increase neuronal neocortex activity. also butrylcholinesterase (BuChE) inhibitors to do the same thing.
What is contraindicated treatment for lewy body dementia?
neuroleptic drugs that may be prescribed for hallucinations (extremely sensitive to it and react)
What is the hallmark histology of FTDs?
neurofibrillary tangles and/or Pick bodies comprised of ubiquitin and hyper-phosphorylated tau protein. (tauopathies)
What are presenting symptoms of FTD?
prominent personality and behavioral changes with LESS prominent memory loss early in course. Loss of pwerosnlal awareness, socal comportment, disnhibition, impulsive, distracted, orality,
Prominent primitive or frontal reflexes.
Patient has loss of judgment, disinhibition, social and sexual misconduct and loss of language, but memory is still workable. Diagnosis? What chromosome mutation is a common cause?
Pick’s disease caused by chromosome 17 mutation involving tau protein gene.
Cognitive defects out of proportion to memory loss
What does atrophy pattern of Pick’s disease look like?
frontal and temporal atrophy, with parietal lobe spared
What will temporal lobe atrophy cause?
fluent (semantic) aphasia and emotional flatness/apathy
What is the minimum acceptable score on Folstein mini-mental status exam? (score that doesn’t raise concern)
scores < 27 / 30
Exam has you name date/time, name and remember 3 objects, serial subrtractions, say “no ifs, ands or buts”, write a sentance, etc.
What lab workups should be ordered for dementia?
neuropsych battery, chem profile (liver, renal, PTH), thyroid, folate B1,6, and 12, RPR or VDRL for neurosyphilis, lumbar punture, head CT/MRI, PET, APOE4, and AD1,3,4 genes.
