Alzheimer's and other Dementias Flashcards
What is dementia?
Gradual decline of a previous high level of intellectual functioning of sufficient severity to interfere with social or occupational activities or both
What are two conditions that may coexist with dementia or be difficult to distinguish from dementia?
- Depression
- Delerium
Pathophysiology Facts of AD (4)
- Brain weight decreased 20%
- Significant cortical atrophy
- Neuronal loss and loss of synapses
- Senile (amyloid) plaques and neurofibrillary tangles
AD Patterns on PET (5)
- 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
How does AD affect Hormones? (3)
- Decreases Ach
- Compromised cholinergic pathways in cerebral cortex and basal forebrain
- Imbalance in serotonin, GABA, substance P, NE & somatostatin
Types of AD (4)
- 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
Assessment of AD (3)
- Progressive but symptoms can remain steady for years
- Progression varies d/t treatment, environment, other conditions
- Social skills are usually preserved
Memory Mild/Moderate/Severe
Mild: forgets important events, difficulty focusing
Mod: recent/remote impairment, new material lost
Sev: Fragments of memory remain, untestable
Language Mild/Moderate/Severe
Mild: Difficulty naming persons/objects
Mod: Impaired comprehensiveness of speech
Severe: repeats words with increased speed/volume
Orientation Mild/Moderate/Severe
Mild: Lost in familiar places
Mod: disoriented to time and place
Severe: oriented to person only
Judgement/Problem Solving Mil/Mod/Sev
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
Behavior Mild/Mod/Sev
Mild: irritable, indifferent, hesitant
Mod: indifferent, delusional
Sev: agitated, difficulty participating in groups
Personal Hygiene Mild/Mod/Sev
Mild: needs occasional prompting
Mod: requires assistance
Sev: requires much help, incontinent
Gait Mild/Mod/Sev
Mild: normal
Mod: normal
Sev: flexed
Abnormal Movements Mild/Mod/Sev
Mild: none
Mod: none
Sev: myoclonus
Diagnostic Testing for Memory loss
Quantify and objectify with standardized tests
Diagnostic Testing for Orientation
Memory-concentratio test (mini mental status test)
Diagnostic Test for Time and Change
- 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
Diagnostic Test Facts (3)
- 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
Neuropsychological Testing for AD (5)
- identifies dementia
- monitors dz progression
- differentiates between different dementias
- administered at regular intervals
- Frontal release signs are often present in moderate to severe alzheimers
Differential Diagnosis for AD (3)
- 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
Delerium Presentation (6)
- Difficulty concentrating
- Inattention
- Restlessness and irritability
- Poor appetite
- Insomnia
- Tremulousness
Delerium Causes (3)
- Deficiency of metabolic substrate like glucose
- Disruption of internal environment, dehydration
- Presence of a toxin like uremia or ketosis
Delerium Tx (3)
- 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
Depression Presentation (7)
- Sleep disturbances
- Appetite/Wt. changes
- Psychomotor retardation
- Fatigue
- Loss of libido
- Guilt/low self esteem
- Suicidal ideation
Prevention Tx of AD (3)
- Reduced in postmenopausal women treated with hormone replacement therapy
- Indomethacin and Vit. E used
- Activities throughout life that challenge the mind
Goals of Tx for AD (3)
- Arrest progression
- Tx associated symptoms
- Tx long term consequences of AD like anxiety, anger, frustration, etc.
Pharmacological Therapy for AD (2)
- Tacrine (Tetrahydroaminoacridine): attempts to replace Ach that has been lost
- Donepezil (Aricept): same mechanism, no liver tox
Non-Pharmacological Therapy for AD (3)
- Enviornmental support
- Sleep Hygiene practices
- Wandering
Tx of Agitated Dementia
- Tx with neuroleptics for:
Hallucinations, jealousy, paranoid ideation, etc..
Lewy Body Dementia (5)
- Progressive
- *Prominent Hallucinations!!
- Movement disorders (parkinsonism)
- Fluctuating attention
- o/w looks like AD
Frontal Lobe Dementia (4)
- 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
Vascular Dementia (4)
- Cause: chronic decreased blood flow to the brain (stroke)
- Usually from “silent strokes”
- Slow or sudden onset
- May have deficits related to stroke
Vascular Dementia Diagnosis (3)
- Neurcognitive testing
- Usually have another vascular dz
- MRI showing vascular dz or stroke in the brain
Subcortical Dementia (5)
- Affects the diencephalon
- Affects motivation, mood, timing, arousal
- Depression can be prominent
- Clumsy, apathy or irritable
- Diagnosis made by neuropsychiatric testing and imaging
Subcortical Dementia Tx
- No medical cure
- Tx symptoms
- Control hypertension/hypotension
Primary Progressive Aphasia (5)
- Rare, impairs language capabilities
- Trouble expressing thoughts, finding words
- Onset usually after 65
- slowly progressive
- May become mute, unable to understand language
What are the risk factors for primary progressive aphasia? (2)
- learning disabilities like dyslexia
- genetic
Primary progressive aphasia Diagnosis/Cause/Tx
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
Caregiver Education (5)
- Formal/informal education
- Support groups
- Support system
- Adult day care
- Monitor for signs of abuse (both ways)
Signs of Abuse
- 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
