6.2 - Subcortical Dementias Flashcards
What are the 7 Hallmarks of Subcortical Dementias?
Bradyphrenia
Memory and learning disturbances
Frontal executive syndromes
Motor disturbances in gait and speech
Psychiatric disturbances
More rapid progression than cognitive dysfunction in PPA
Uncommon to see isolated aphasia, apraxia and agnosia
Where are Lesions seen in Subcortical Dementias?
3
Basal ganglia
Brainstem
Cerebellum
What is Bradyphrenia?
Slowing of cognition
What Psychiatric Disturbances may be seen in Subcortical Dementias?
(6)
Apathy
Irritability
Depression
Psychosis
Mania
Hallucinations
What is the Clinical Profiles of Subcortical Dementia?
There is not one specific clinical profile
What do Clinical Profiles of Subcortical Dementias depend on?
Underlying disease
Disease severity
Stage of disease
What is Corticobasal Degeneration characterized by?
Cell loss and atrophy primarily in the cerebral cortex and the basal ganglia.
There are an estimated ____-____ people in United States with Corticobasal Degeneration, but only ___-___ are diagnosed.
2000-3000
500-750
Is there a known cause of Corticobasal Degeneration?
No
Is there a cure for Corticobasal Degeneration?
No
When do the Initial
symptoms of Corticobasal Degeneration begin?
Around 60
What are the Initial Symptoms of Corticobasal Degeneration?
3
Sudden problems controlling certain limbs
Loss of balance and co-ordination
Slowness and reduced mobility
What 5 symptoms are seen as Corticobasal Degeneration progresses?
Symptoms become more wide-ranging
Muscle spasms and stiffness
Dementia
Dysphagia
Expressive language + comprehension issues
What 3 Language Issues are seen in Corticobasal Degeneration?
Phonologic + spelling impairments even in
nonaphasic patients
Visuospatial + constructional impairment
Frontal impairments
___% of individuals with Parkinson’s Disease develop signs of dementia.
50%
Average dementia prevalence approximately ___%.
35%
In those with Parkinson’s Disease, Cognitive Deficits emerge with ___________.
Disease progression
What Cognitive Deficits may be seen as Parkinson’s Disease progresses?
(3)
Memory
Problem solving
Abstract reasoning
Can Parkinson’s Disease co-occur with Alzheimer’s Disease?
Yes
What causes Parkinson’s Disease?
Disruption of Basal Ganglia-Frontal Circuits
What happens when the Basal Ganglia-Frontal Circuits are disrupted?
(4)
Executive function deficits
Bradyphrenia
Visuospatial disturbances
Depression
What Symptoms may be seen in Parkinson’s Disease?
3
Speech deficits
Linguistic deficits
Depression
What kinds of Speech Deficitsmay be seen in Parkinson’s Disease?
Hypokinetic dysarthria
What kinds of Linguistic Deficits may be seen in Parkinson’s Disease?
(4)
Language processing (due to subcortical damage)
Complex language processing
Verbal fluency
Both spoken + written language
How often does Depression affect those with Parkinson’s Disease?
(2)
Incidence up to 50%
May or may not be abnormal reaction to the disease process
How do those with Parkinson’s Disease respond to Drug Therapy in the EARLY Stage?
Some improvement in executive function and memory
How do those with ESTABLISHED Parkinson’s Disease respond to Drug Therapy?
Therapy improves speed of response but not other cognitive areas
What may be caused by increased medications for motor difficulties in Parkinson’s Patients?
Cognitive deterioration
How do the EARLY STAGES of Alzheimer’s Disease and Parkinson’s Disease differ?
AD = insidious cognitive decline, but no motor impairment
PD = Motor impairment, but no cognitive decline
How do the LATE STAGES of Alzheimer’s Disease and Parkinson’s Disease differ?
AD = Bradykinetic Gait + Tremor
PD = Bradyphrenia + Memory Disfunction
How does the CLASSIFICATION of Alzheimer’s Disease and Parkinson’s Disease differ
AD = Cortical
PD = Subcortical
How does the NEUROPATHOLOGY of Alzheimer’s Disease and Parkinson’s Disease differ?
(2)
Both =
Depletion of cholinergic neurons in nucleus basalis of Mynert
Hypoperfusion (frontal, temporal, parietal)
What is Huntington’s Disease associated with?
2
Cortical degeneration
Basal Ganglia degeneration
What kind of decline is seen in Huntington’s Disease?
Progressive cognitive and behavioral
What kinds of deficits are seen early in Huntington’s Disease?
Memory
What kinds of Speech Deficits are seen in Huntington’s Disease?
Hyperkinetic dysarthria
What kinds of Linguistic Deficits are seen in Huntington’s Disease?
(5)
Impairment in comprehension of prosody
Simplified syntax
Press of speech
Word finding difficulties
Reduced verbal fluency
What is the Pathology of Progressive Supranuclear Palsy?
3
Reticular formation
Thalamus
Hypothalamus
When is Death expected in patients with Progressive Supranuclear Palsy?
Within 6 years
When does Dementia appear in Progressive Supranuclear Palsy?
In middle-late stages of the disease
Progressive Supranuclear Palsy occurs in ___-___ per 100,00.
1.0 - 3.1
What are the 8 Characteristics of Progressive Supranuclear Palsy?
Gaze palsy
Pseudobulbar palsy
Dysarthria
Dysphagia
Dystonic rigidity of the neck and upper trunk
Slowed movements
Frequent falling
Poor visual function
What kinds of difficulty can be caused by Poor Visual Function in Progressive Supranuclear Palsy?
Reading
Feeding
Performing other eye-hand tasks
What difficulty can be caused by the Impaired or Inability to maintain Eye Contact in Progressive Supranuclear Palsy?
It gives the impression patient is uninterested
What is the Cognitive-Behavioral Profile of Progressive Supranuclear Palsy?
(4)
Forgetfulness
Slow mental abilities
Emotional and personality changes
Impaired ability to manipulate knowledge
What kinds of Speech Deficits are seen in Progressive Supranuclear Palsy?
(2)
Palilalia
Mutism common in late stages
What kinds of Linguistic Deficits are seen in Progressive Supranuclear Palsy?
(3)
Mild word finding difficulties
Reading and writing deficits (due to gaze palsy)
Well formed sentences with simple syntax
What is the onset of Corticobasal Degeneration?
What is the course?
Gradual onset
Slow progression
What is the onset of Parkinson’s Disease?
What is the course?
Sporadic
Gradual
What is the onset of Huntington’s Disease?
What is the course?
Gradual onset
Progressive
What is the onset of Progressive Supranuclear Palsy?
What is the course?
Gradual onset
Rapid progression if untreated
What are 4 Other Dementias?
Mixed Dementias (Multi-Infarct)
HIV-associated cognitive impairment
Dementia associated with alcoholism
Dementia occurring from Normal Pressure Hydrocephalus
What are 3 types of Mixed/Multi-Infarct Dementias?
Lacunar state
Multiple cortical Infarcts
Binswanger’s disease
What causes Lacunar State dementia?
1+4
Multiple infarcts in the…
- Basal Ganglia - Thalamus - Midbrain - Brainstem
What causes Multiple Cortical Infarcts?
Occlusion of cortical arteries
What causes Binswanger’s disease?
2
Rare disease
Multiple infarcts in white matter; severe HTN
What is seen in HIV-Associated Cognitive Impairment?
3
Abnormality of one cognitive domain
Underperformance on 2 or more domains
Minor cognitive/motor disorder which affects everyday functioning to at least a mild degree
What is seen in HIV Dementia?
Marked cognitive impairment
What are 2 types of Dementia associated with Alcoholism?
Wernicke-Korsakoff Syndrome
Wernicke’s encephalopathy
What is seen in Wernicke-Korsakoff Syndrome?
Amnesia vs dementia due to chronic alcoholism
What is seen in Wernicke’s Encephalopathy?
Thaimine deficiency due to chronic alcholism
Chronic alcohol abuse and associated head trauma can lead to ______.
Dementia
Why are there Communication Issues in Dementia associated with Alcoholism?
Due to reductions in memory
Why is there Dysarthria in Dementia associated with Alcoholism?
Due to damage to neurotransmitter and subcortical systems
What 2 conditions are often seen in Normal Pressure Hydrocephalus?
Dementia
Urinary incontinence
What Dementia symptoms are seen in Normal Pressure Hydrocephalus?
(5)
Slowing of mental functions
Impaired memory
Attentional deficits
Aphasia?
Gait disturbance
What Other Disorders are associated with Dementia?
Pseudodementia
Delirium
What are 4 symptoms of Pseudodementia?
Clinical depression
Identifiable onset w/rapid symptom development
Minimal effort to perform tests
Highly variable test performance
What can be caused by the Clinical Depression in Pseudodementia?
(4)
Cognitive impairment
Loss of appetite
Difficulty sleeping
Social withdrawal
What is Delirium?
A transient, confusional state
What can cause Delirium?
4
Medications
Infections
Metabolic disorders
Surgery; anesthesia
