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OMS - 2 Neuro Final > Alzheimer's Disease > Flashcards

Alzheimer's Disease Flashcards

1
Q

How many people currently have Alzheimer’s disease? Population affected the most?

A
  • About 6 million (1 out of every 8 people)
  • Women account for 2/3

(6 leading cause of death)

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2
Q

Delirium signs and symptoms (4)

A
  1. Impaired consciousness & attention
  2. Acute onset
  3. Fluctuating cognitive function (hours or days)
  4. Alterations in sleep

(Often confused for dementia. Different, but often occur together. Look for underlying cause.)

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3
Q

Define dementia

A

Acquired syndrome of decline in memory and other cognitive functions that affect daily life of an alert patient.

(neurodegenerative)

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4
Q

Dementia is ______ and ______.

A
  • Progressive
  • disabling

(neurodegenerative)

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5
Q

6 examples of typical expected decline with cognition during the aging process (these are not signs of dementia).

A
  1. Speed of processing and nonverbal intelligence
  2. Learning and recall ability
  3. Multitasking
  4. Additional time needed to complete executive tasks
  5. Reaction Time increases
  6. Tip-of-the-tongue phenomenon
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6
Q

What’s the DSM V criteria for evidence of significant cognitive decline from previous level of performance (dementia)?

A
  1. Complex attention
  2. Executive function
  3. Language
  4. Learning / memory
  5. Motor perception
  6. Social cognition

(one or more)

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7
Q

Cognitive deficits that interfere with independence in everyday activities (2 categories).

A
  • ADLs: dress, shower, toilet
  • iADLs: instrumental activities; things you would do on your own or with help (ex: Transportation, cleaning, finances)

(cognitive deficits are not related to delirium and are not explained by a mental disorder i.e. schizophrenia, ADD)

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8
Q

What are the three major risk factors for dementia?

(Alzheimer’s disease, Frontotemporal, Lewy Body Dementia and vascular dementia)

A
  1. Age
  2. Family history (1st degree relative)
  3. Down syndrome
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9
Q

In addition to age, family history and down syndrome what is the genetic risk factor for development of dementia?

A
  • APP
  • PS1 & 2
  • APOE4 allele
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10
Q

What are some possible (not definitive) preventative measures for dementia?

A
  1. NSAIDs
  2. Antioxidants
  3. Level of education and cognition required for work
  4. Exercise
  5. Statins
  6. APOE2*** allele (APOE_4_ allele is a ***risk factor)
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11
Q

What is the most common gene that is related to late onset Alzheimer’s disease?

A

APOE4 gene, chromo. 19

(3 different alleles types 2/3/4, APOE2 = protective)

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12
Q

What is the genetic predisposition for early onset Alzheimer’s disease (before 60 y.o.)?

A
  • APP
  • PS1 & PS2 (presenilin)

(APOE4 is a risk factor for Late AD)

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13
Q

When evaluating a patient for the different types of dementia, what are important pieces of information to gather from a family member?

A
  1. Onset
  2. Family history of dementia
  3. Injuries or Falls
  4. Substance abuse
  5. History of depression
  6. Weakness
  7. Gait changes
  8. Medications
  9. Behavior
  10. Functionality and ADLs & iADLs
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14
Q

Which tests are included in the mental status exam for the different types of Alzheimer’s (5)?

A
  1. MOCA (Montreal Cog)
  2. Mini COG
  3. MSSE (mini mental state)
  4. SLUMs (St. Louis U. Mental Status)
  5. Depression Scale (always needed to r/o a MDD)
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15
Q

How would you evaluate a patient for different types of dementia with a Mini Cog exam?

A

Repeat and remember a chain of words→ draw a clock→ repeat words

(give 3 minutes in between)

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16
Q

How do you score a Mini Cog exam?

A
  • One point for each recalled word (up to 3)
  • Two points for normal clock drawing (0 for ab)

(0-2 points = positive for dementia)

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17
Q

Which items are included on the mini mental state exam (5)?

A
  1. Orientation
  2. Registration
  3. Attention & Calculation
  4. Recall
  5. Language

(unique to MMSE)

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18
Q

Which items are included on the MoCA exam (8)

A
    1. Visuospatial/executive
  2. Naming
  3. Memory
  4. Abstraction
  5. Attention
  6. Language
  7. Delayed Recall

(her fav; must have at least 8th grade edu. Unique to MoCA)

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19
Q

What is included in the lab workup for a patient with possible dementia (5)?

A
  1. CBC/CMP (electrolytes, Kidney fx, LFTs, glucose)
  2. TSH
  3. Vitamin B12
  4. Spinal tap: looking at beta amyloid & tau in CSF
  5. STI: RPR (shyphillis) & HIV in selective population

(ab amyloid would be low; tau high)

20
Q

Which imaging would you order for a patient with possible dementia?

A
  1. MRI (lesions)
  2. FDG-PET: AD or frontotemporal dementia
  3. CT: r/o vascular events

(MRI if young or abrupt, the others are only used in research at the moment)

21
Q

Which type of dementia is have sudden onset?

A

Vascular Dementia

(the other types are typically gradual, may also be stepwise or build over time, a lot of the time it is mixed)

22
Q

What is a clinical features that Alzheimer Disease, Lewy Body Dementia, Vascular Dementia & Frontotemporal Dementia all have in common?

A

normal lab findings

23
Q

Clinical features of Alzheimer disease

A
  1. Memory impairment with difficulty in learning new information
  2. Rarely has motor issues but can lead to apraxia
  3. Confusion, agitation, paranoia, loss of memory
  4. Difficulty w/ADL/iADLs
24
Q

Which two types of dementia have Global atrophy on Imaging?

A
  1. Alzheimer disease (also has small hippocampal vol.)
  2. Lewy Body dementia
25
Q

Clinical features of Lewy Body dementia (6)

A
  1. Motor changes followed by memory loss
  2. Hallucinations (visual)
  3. Parkinsonian-like
  4. Fluctuations of confusion
  5. ANS malfunction
  6. REM sleep disorder

(sensitive to neuroleptic drugs)

26
Q

Clinical features of vascular dementia include ______ deficits (2).

A
  1. Motor deficits
  2. cognition deficits (depend on ischemia)

(step-wise decline w/platues until the next infarct)

27
Q

Image findings for vascular dementia

A

Cortical or subcortical damage on an MRI

28
Q

Frontotemporal dementia has a loss of ______ and is correlated with _____.

A
  • Executive function (disinhibition, apathy, behavior change)
  • ALS

(usually no motor deficits)

29
Q

Image findings for frontotemporal dementia

A

Atrophy of the frontal and temporal lobes

(order FDG-PET scan - uptake of glucose)

30
Q

Pathology of Alzheimer disease

A

Abnormal beta amyloid Aβ protein processing leading to amyloid plaques (extracellular) → Inflammation, neuronal degeneration, and apoptosis→Neurofibrillary tangles (intracellular phosphorylated tau protein)→Decreased glucose metabolism in brain

31
Q

Pathology of Lewy Body formation and Parkinson with dementia

A

alpha-synuclein

(2nd most common neurocognitive diz)

32
Q

AchE inhibitors are commonly used to treat which types of dementia?

A
  1. Lewy Body
  2. Alzheimer
  3. Vascular (only if mixed w/AD)

(not frontotemporal! it could make it worse!)

33
Q

Which AchE inhibitor is used to treat Alzheimer, Lewy Body and vascular dementia?

A
  1. Donepezil
  2. Galantamine
  3. Rivastigmine

(do not use for frontotemporal, it may make it worse)

34
Q

In addition to AchE inhibitors, what medication might be prescribed for Alzheimer disease?

A

NMDA Antagonist

(prevents excitotoxicity)

35
Q

Pharmacologic treatment of Lewy Body dementia (4)

A
  1. AchE Inhibitors
  2. Antipsychotics
  3. Levodopa Carbidopa
  4. SSRIs

(same for vascular dementia, with the addition of BP control, antiplatelet, DM & cholesterol control)

36
Q

What is the pharmalogic treatment for frontotemporal dementia?

A
  1. Antidepressants
  2. Antipsychotics

(do NOT give AchE inhibitors, it may make it worse)

37
Q

Korsakoff Syndrome symptoms

A
  • Anterograde and retrograde memory loss
  • Apathy
  • Confabulation
  • Long-term memory is preserved

(late neuropsychiatric manifestation of Wernicke’s encephalopathy)

38
Q

The vast majority of treatment for dementia is NON-PHARMACOLOGIC (7)

A
  1. Enhance quality of life
  2. Maximize functional performance
  3. Improve cognition, mood, behavior
  4. Caregivers
  5. Safety modifications
  6. Regular appointments
  7. Education for family
39
Q

Mild Cognitive Impairment

A
  • This is a prodromal form of dementia and a HUGE risk factor in developing AD
  • Some memory loss, but very functional & non-demented

(test memory every year)

40
Q

Criteria for Mild Cognitive Impairment (4)

A
  1. Change in cognition
  2. Impairment in one or more cognitive domains
  3. Preservation of independence in functional abilities
  4. Non-demented

(high risk for developing AD)

41
Q

How do AchE inhibitors help dementia?

A

Slow breakdown of acetylcholine → modest delay in cognitive decline

42
Q

Side effects of AchE inhibitors

A

Side effects: GI side effects common (diarrhea), syncope, falls

43
Q

New treatment for dementia. How does it work?

A
  • Aducanumab
  • Monoclonal antibodies against amyloid beta

(must catch them before memory loss to be effective)

44
Q

Memantine (Namenda) MOA

A

reduces glutamate-mediated excitotoxicity (neuroprotective)

(moderate-severe only. side effect: constipation)

45
Q

Vascular Dementia tx (7)

A
  1. stop smoking
  2. blood pressure control
  3. cholesterol control
  4. anti-platelet tx
  5. diabetes control
  6. exercise
  7. healthy diet

(the only demential you can stop)

46
Q

Lewy Body tx (4)

A
  1. AchE inhibitor: memory & hallucinations
  2. Quetiapine if hallucinations not treated
  3. SSRI: depression is common
  4. levodopa/carbidopa: motor fxn

(levodopa/carbidopa may exacerbate psychiatric sx)

OMS - 2 Neuro Final (36 decks)

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