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Neurology > Alzheimer's and other Dementias > Flashcards

Alzheimer's and other Dementias Flashcards

1
Q

What is dementia?

A

Gradual decline of a previous high level of intellectual functioning of sufficient severity to interfere with social or occupational activities or both

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2
Q

What are two conditions that may coexist with dementia or be difficult to distinguish from dementia?

A
  • Depression

- Delerium

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3
Q

Pathophysiology Facts of AD (4)

A
  • Brain weight decreased 20%
  • Significant cortical atrophy
  • Neuronal loss and loss of synapses
  • Senile (amyloid) plaques and neurofibrillary tangles
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4
Q

AD Patterns on PET (5)

A
  • Hypometablosim in posterior parietal lobe
  • Extends to temporal and occipital lobes
  • Seen in the frontal lobe if advanced
  • PET can detect hypo metabolism before S/S even occur
  • AD differs from other dementias on PET
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5
Q

How does AD affect Hormones? (3)

A
  • Decreases Ach
  • Compromised cholinergic pathways in cerebral cortex and basal forebrain
  • Imbalance in serotonin, GABA, substance P, NE & somatostatin
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6
Q

Types of AD (4)

A
  • Familial 5-10%, develops at an earlier age, 30-50
  • Sporadic also seems to have genetic susceptibility
  • Genetic testing is suggestive
  • Do neuropsychological testing prior to genetic testing
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7
Q

Assessment of AD (3)

A
  • Progressive but symptoms can remain steady for years
  • Progression varies d/t treatment, environment, other conditions
  • Social skills are usually preserved
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8
Q

Memory Mild/Moderate/Severe

A

Mild: forgets important events, difficulty focusing
Mod: recent/remote impairment, new material lost
Sev: Fragments of memory remain, untestable

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9
Q

Language Mild/Moderate/Severe

A

Mild: Difficulty naming persons/objects
Mod: Impaired comprehensiveness of speech
Severe: repeats words with increased speed/volume

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10
Q

Orientation Mild/Moderate/Severe

A

Mild: Lost in familiar places
Mod: disoriented to time and place
Severe: oriented to person only

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11
Q

Judgement/Problem Solving Mil/Mod/Sev

A

Mild: Difficulty with complex problems and meanings
Mod: Social judgement impaired, difficulty with similarities and differences, not good with problems
Sev: Unable to attempt problem solving

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12
Q

Behavior Mild/Mod/Sev

A

Mild: irritable, indifferent, hesitant
Mod: indifferent, delusional
Sev: agitated, difficulty participating in groups

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13
Q

Personal Hygiene Mild/Mod/Sev

A

Mild: needs occasional prompting
Mod: requires assistance
Sev: requires much help, incontinent

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14
Q

Gait Mild/Mod/Sev

A

Mild: normal
Mod: normal
Sev: flexed

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15
Q

Abnormal Movements Mild/Mod/Sev

A

Mild: none
Mod: none
Sev: myoclonus

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16
Q

Diagnostic Testing for Memory loss

A

Quantify and objectify with standardized tests

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17
Q

Diagnostic Testing for Orientation

A

Memory-concentratio test (mini mental status test)

18
Q

Diagnostic Test for Time and Change

A
  • Set clock to 11:10, respond in 60s, 2 tries
  • Make change from 3 quarters, 7 dimes, 7 nickels, 120s to respond, 2 tries
  • Incorrect responses on either or both indicate dementia
19
Q

Diagnostic Test Facts (3)

A
  • No longer a diagnosis of exclusion
  • There is criteria in the DSM IV
  • Acquired, persistent impairment of intellectual functioning in memory and at least one of the following: language, visuospatial skills, emotion or personality, abstraction, calculation, judgement or problem solving
20
Q

Neuropsychological Testing for AD (5)

A
  • identifies dementia
  • monitors dz progression
  • differentiates between different dementias
  • administered at regular intervals
  • Frontal release signs are often present in moderate to severe alzheimers
21
Q

Differential Diagnosis for AD (3)

A
  • consider other causes for symptoms
  • depression often coexists at early stages of AD
  • Acute delirium can be a serious medical condition requiring referral and hospitalization
22
Q

Delerium Presentation (6)

A
  • Difficulty concentrating
  • Inattention
  • Restlessness and irritability
  • Poor appetite
  • Insomnia
  • Tremulousness
23
Q

Delerium Causes (3)

A
  • Deficiency of metabolic substrate like glucose
  • Disruption of internal environment, dehydration
  • Presence of a toxin like uremia or ketosis
24
Q

Delerium Tx (3)

A
  • Treat underlying condition swiftly
  • CBC, lytes, ABG, ammonia, renal function, liver function, coags, drug & box screen, EKG, LP, UA
  • HIV titer, syphilis serology, serum and urinary copper levels
25
Q

Depression Presentation (7)

A
  • Sleep disturbances
  • Appetite/Wt. changes
  • Psychomotor retardation
  • Fatigue
  • Loss of libido
  • Guilt/low self esteem
  • Suicidal ideation
26
Q

Prevention Tx of AD (3)

A
  • Reduced in postmenopausal women treated with hormone replacement therapy
  • Indomethacin and Vit. E used
  • Activities throughout life that challenge the mind
27
Q

Goals of Tx for AD (3)

A
  • Arrest progression
  • Tx associated symptoms
  • Tx long term consequences of AD like anxiety, anger, frustration, etc.
28
Q

Pharmacological Therapy for AD (2)

A
  • Tacrine (Tetrahydroaminoacridine): attempts to replace Ach that has been lost
  • Donepezil (Aricept): same mechanism, no liver tox
29
Q

Non-Pharmacological Therapy for AD (3)

A
  • Enviornmental support
  • Sleep Hygiene practices
  • Wandering
30
Q

Tx of Agitated Dementia

A
  • Tx with neuroleptics for:

Hallucinations, jealousy, paranoid ideation, etc..

31
Q

Lewy Body Dementia (5)

A
  • Progressive
  • *Prominent Hallucinations!!
  • Movement disorders (parkinsonism)
  • Fluctuating attention
  • o/w looks like AD
32
Q

Frontal Lobe Dementia (4)

A
  • Atrophy of frontal and temporal lobe
  • Personality changes: socially inappropriate, impulsive or emotionally withdrawn, early on!
  • Occurs at a younger age (40-70)
  • Often misdiagnosed
33
Q

Vascular Dementia (4)

A
  • Cause: chronic decreased blood flow to the brain (stroke)
  • Usually from “silent strokes”
  • Slow or sudden onset
  • May have deficits related to stroke
34
Q

Vascular Dementia Diagnosis (3)

A
  • Neurcognitive testing
  • Usually have another vascular dz
  • MRI showing vascular dz or stroke in the brain
35
Q

Subcortical Dementia (5)

A
  • Affects the diencephalon
  • Affects motivation, mood, timing, arousal
  • Depression can be prominent
  • Clumsy, apathy or irritable
  • Diagnosis made by neuropsychiatric testing and imaging
36
Q

Subcortical Dementia Tx

A
  • No medical cure
  • Tx symptoms
  • Control hypertension/hypotension
37
Q

Primary Progressive Aphasia (5)

A
  • Rare, impairs language capabilities
  • Trouble expressing thoughts, finding words
  • Onset usually after 65
  • slowly progressive
  • May become mute, unable to understand language
38
Q

What are the risk factors for primary progressive aphasia? (2)

A
  • learning disabilities like dyslexia

- genetic

39
Q

Primary progressive aphasia Diagnosis/Cause/Tx

A

Cause: atrophy of frontal and temporal lobes, usually on the left side
Diagnosis: neuropsych exam, genetic testing, MRI or PET
Tx: no med available, SLP may help

40
Q

Caregiver Education (5)

A
  • Formal/informal education
  • Support groups
  • Support system
  • Adult day care
  • Monitor for signs of abuse (both ways)
41
Q

Signs of Abuse

A
  • Bruises on the face, shoulders, arms
  • Bruises in different stages of healing
  • Cigarette and rope burns
  • Lacerations or human bites
  • Fractures in different stages of healing
  • Cringing back when touched, nervous, fearful

Neurology (12 decks)

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