(25) Dementia and delerium Flashcards
Defn of dementia vs delerium
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
is consciousness impaired in dementia
No
**but it is in delerium
is there an attention deficit in dementia/
NO
**but there usualtly is in delerium
how is autonomic function affected in delerium? dementia?
hyperactive in delerium and normal in dementia
how does the onset of depression compare to dementia?
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
most common cause of dementia
alzheimers
What is the 3 hallmark pathologies assc with alzheimers
- B amyloid deposits
- neurofibrillary tangles
- loss of cortical neurons
major diagnostic critera for alzheimers
dementia/memory loss + deficits in one or more areas of cognition (speech, vision, hearing, executive dysfunction)
is consciousness disturbed in alzheimers
no
What is seen on CT or MRI in a pt with dementia
atrophy of the cortex (it may also be normal…)
-parietal, dorsal frontal temporal
does alzheimers cause personality changes?
yes, eventually
pathogenesis of alzheimers
accumulation of B amyloid in neurons leading to neurofibrillairy tangles. these set of immune reaction/inflammation –> neuronal death by apoptosis
The hallmark cognitive change assc with alzheimers is memory loss that is characterized by a _______ problem, meaning
storage problem, meaning info cannot be recalled with a cue
What is a neuritic plaque?
dystropic synapses caused by tau aggregates which are surrounded by B-amyloid
What are neurofibitllary tangles?
hyper -P tau protiens inclusions in pyramidal cells
Where are neuritic plaques preferentially found? tangles?
plaques = parietal and temporal
tangles = temporal
genetics assc with early onset alzheimers
chrom 21: Amyloid Precursor Protein (APP) (AD1)
-tracks with down syndrome
chrom 14: Presenilin 1 (AD3)
chrom 1: Presenilin 2 (AD4)
Most common gene assc with late onset/sporadic alzheimers (aka “risk factor gene”)
chrom 19 for ApoE4 (AD2)
**usually have 1 or 2 copies of it
Rank ApoE genotypes from most likely to get AD to least likely
4/4 > 3/4 > 2/4 or 3/3 > 2/3
What NT levels are significantly affected in AD and how do we use this to treat the Dz
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
What are lewry bodies? Where are they found?
eosinophillic inclusion bodies comprised of alpha-synuclein and ubiquitin
SNc of pts with parkinsons and neocortex in DLB
hallucinations, delusions, and cognitive dysfunction + lewry bodies
dementia with lewry bodies
how is DLB differentated from parkinsons
onset of dementia
what are Pick bodies? what are they seen in?
aggregates of hyper-P tau protein and ubiquitin
seen in frontotemporal dementias
what does the physical examination of a person with FTD relveal
prominent primitive or frontal reflexes
genetic alterations assc with Pick’s Dz (varient of FTD)
mut chrom 17 for tau protein
age of onset for Pick’s
40s = earlier than AD
FTDs are assc with progressive loss of ___ out of proportion to the degree of anterograde amnesia
language
anerograde = inability to form new memories
what areas of cortex are atropied in FTD vs AD
FTD = frontal and temporal
AD = parietal and superior temporal
2nd most common cuase od dementia after AD
vascular dementia
pathophys of vascular dementia
multiple infarctions (assc with untreated or poorly controlled HTN or DM)
