(25) Dementia and delerium

Question 1

Defn of dementia vs delerium

Answer 1

dementia: impairment of cognitive functions that interfere with occupation and social actiivites
delerium: clouding of consciousness with reduced ability to pay attention, shift focus, or respond to envrio stimuli

Question 2

is consciousness impaired in dementia

Answer 2

No

**but it is in delerium

Question 3

is there an attention deficit in dementia/

Answer 3

NO

**but there usualtly is in delerium

Question 4

how is autonomic function affected in delerium? dementia?

Answer 4

hyperactive in delerium and normal in dementia

Question 5

how does the onset of depression compare to dementia?

Answer 5

depression onset is known and dementia has a vague onset. the patients family is also aware of the changes in depression and may not in dementia

Question 6

most common cause of dementia

Answer 6

alzheimers

Question 7

What is the 3 hallmark pathologies assc with alzheimers

Answer 7

1. B amyloid deposits
2. neurofibrillary tangles
3. loss of cortical neurons

Question 8

major diagnostic critera for alzheimers

Answer 8

dementia/memory loss + deficits in one or more areas of cognition (speech, vision, hearing, executive dysfunction)

Question 9

is consciousness disturbed in alzheimers

Answer 9

no

Question 10

What is seen on CT or MRI in a pt with dementia

Answer 10

atrophy of the cortex (it may also be normal…)

-parietal, dorsal frontal temporal

Question 11

does alzheimers cause personality changes?

Answer 11

yes, eventually

Question 12

pathogenesis of alzheimers

Answer 12

accumulation of B amyloid in neurons leading to neurofibrillairy tangles. these set of immune reaction/inflammation –> neuronal death by apoptosis

Question 13

The hallmark cognitive change assc with alzheimers is memory loss that is characterized by a _______ problem, meaning

Answer 13

storage problem, meaning info cannot be recalled with a cue

Question 14

What is a neuritic plaque?

Answer 14

dystropic synapses caused by tau aggregates which are surrounded by B-amyloid

Question 15

What are neurofibitllary tangles?

Answer 15

hyper -P tau protiens inclusions in pyramidal cells

Question 16

Where are neuritic plaques preferentially found? tangles?

Answer 16

plaques = parietal and temporal

tangles = temporal

Question 17

genetics assc with early onset alzheimers

Answer 17

chrom 21: Amyloid Precursor Protein (APP) (AD1)
-tracks with down syndrome

chrom 14: Presenilin 1 (AD3)

chrom 1: Presenilin 2 (AD4)

Question 18

Most common gene assc with late onset/sporadic alzheimers (aka “risk factor gene”)

Answer 18

chrom 19 for ApoE4 (AD2)

**usually have 1 or 2 copies of it

Question 19

Rank ApoE genotypes from most likely to get AD to least likely

Answer 19

4/4 > 3/4 > 2/4 or 3/3 > 2/3

Question 20

What NT levels are significantly affected in AD and how do we use this to treat the Dz

Answer 20

Low Ach!

AD assc with atrophy of cortex which includes the nucleus basalis, where Ach is found! therefore by inc Ach we can treat symptoms of AD

use AchE inhib

Question 21

What are lewry bodies? Where are they found?

Answer 21

eosinophillic inclusion bodies comprised of alpha-synuclein and ubiquitin

SNc of pts with parkinsons and neocortex in DLB

Question 22

hallucinations, delusions, and cognitive dysfunction + lewry bodies

Answer 22

dementia with lewry bodies

Question 23

how is DLB differentated from parkinsons

Answer 23

onset of dementia

Question 24

what are Pick bodies? what are they seen in?

Answer 24

aggregates of hyper-P tau protein and ubiquitin

seen in frontotemporal dementias

Question 25

what does the physical examination of a person with FTD relveal

Answer 25

prominent primitive or frontal reflexes

Question 26

genetic alterations assc with Pick’s Dz (varient of FTD)

Answer 26

mut chrom 17 for tau protein

Question 27

age of onset for Pick’s

Answer 27

40s = earlier than AD

Question 28

FTDs are assc with progressive loss of ___ out of proportion to the degree of anterograde amnesia

Answer 28

language

anerograde = inability to form new memories

Question 29

what areas of cortex are atropied in FTD vs AD

Answer 29

FTD = frontal and temporal

AD = parietal and superior temporal

Question 30

2nd most common cuase od dementia after AD

Answer 30

vascular dementia

Question 31

pathophys of vascular dementia

Answer 31

multiple infarctions (assc with untreated or poorly controlled HTN or DM)