Alzheimers disease Flashcards
AD =
Progressive brain dz with:
Memory loss
Problems with thinking and behavior
Severe enough to affect work, lifelong hobbies, and social life
Dementia =
Acquired decline in memory and at least one other cognitive fxn:
Language
Visual-Spatial
Executive
Areas of Brain Affected by AD
Cortex - thinking, planning, remembering
Hippocampus - formation of memories
Other dementias
Mild Cognitive Impairment (MCI) Vascular Dementia Mixed Dementia Dementia of Lewy Body (DLB) Parkinson's Disease Dementia (PDD) Frontotemporal Dementia (FTD) Creutzfeltd-Jakob Disease (CJD) Normal Pressure Hydrocephalus (NPH) Huntington's Dz (HD) Wernicke-Korsakoff Syndrome
Risk Factors
Age Family Hx Genetic - apolipoprotein E-e4 (APOE-e4) ---50% who test + for APOE-e4 go on to have dementia Head injury or recent fall CV disease
Warning signs
Memory loss that affects job skills Difficulty performing familiar tasks Problems with language Disorientation to time and place Poor or decreased judgment Problems with abstract thinking Misplacing things Changes in mood or behavior Changes in personality Loss of initiative
Progression
Progressive
Status
Stepwise
Fluctuating
Questions for Family
Have you noticed observable decline in the patient’s ability to: remember things that happened recently? use the telephone? travel? handle finances? take care of personal hygiene?
AD8 Screen
- Problems with judgments?
- - Bad financial decisions, inappropriate gifts, can’t handle household emergencies - Reduced interest in hobbies/activities?
- Repeats questions, stories, statements?
- Trouble learning how to use a tool, appliance, gadget?
- Forgets correct month and year?
- Difficulty handling complicated financial affairs?
- Difficulty remembering appointments?
- Consistent problems with thinking and/or memory?
2 or more items = dementia
PMH
Look for cardiovascular risk factors:
HTN, TIA, CVA, hyperlipidemia, DM, smoking
Other causes of memory impairment:
Depression, delirium, thyroid disease, alcohol use, drug adverse effects, vision & hearing loss, Vit B deficiencies
Parkinson’s disease
Head injury
Important Family and Social Hx
Family history: first degree members with dementia and age of onset Social history: Alcohol Substance abuse Education Occupation Retirement related to memory concerns?
Ask pt
Do you have any concerns about forgetfulness or your memory?
How often do you have trouble remembering things?
Very often, often, sometimes, rarely, never
How is your memory compared to 10 years ago?
Much worse, a little worse, the same, a little better, much better
ROS
Mood Sleep Appetite Swallow Balance/ gait/ falls Incontinence Hallucinations
Mini Mental Status Exam (MMSE)
Orientation: 10 points Registration: 3 points Attention & calculation: 5 points Recall: 3 points Language: 9 points Identifying 2 objects, repeating a sentence, reading a sentence, following a 3 stage command, writing a sentence, and copying an image
Score 23-24/30 = Dementia
Clock Drawing Test
Ask pt to draw a clock with all of the numbers
Then ask pt to draw 11:10
Scoring: normal vs. abnormal
Use as visual analog to for improvement or deterioration over time
Mini-Cog test
Give pt 3 words to remember: Table, Apple, Penny
Do Clock Drawing Test
What are the 3 words I asked you to remember?
Scoring:
3 item recall = no dementia
1-2 item recall and CDT normal = no dementia
1-2 item recall and CDT abnrml = dementia
0 item recall = dementia
Other screening tools:
Animals in 1 minute
Trail making
Name as many animals as you can in one minute
18/min = normal
Trail making:
Alternate #s and letters: A-1, B-2, C-3…
2 or more errors in 13 = problem with executive fxn
Executive fxn = working memory, problem solving, sequencing, resisting distraction
PE
Cranial nerves Motor strength Tremor/myoclonus Reflexes Babinski Sensory – pinprick Finger to nose -coordination Praxis BP supine and standing CHF PVD Heart rate A fib Carotid bruits
Praxis
Physical planning
Show me how you cut a piece of bread, hammer in a nail, comb your hair
Abnormal = using hand as object instead of pantomiming
Gait
Short steps Shuffle Lack of arm swing Flexed/stooped posture Turns en bloc (many small steps to turn) Wide-based Poor tandem
Labs
CBC CMP B12 TSH RPR (if history indicates) UA (if suspect confusion related to UTI)
Consider MRI/CT if:
Under age 60 Recent head trauma/seizure Questions about vascular or mixed dementia NPH Hx of cancer or bleeding disorder Atypical presentation Sudden onset or rapid progression Focal neurological signs
DSM-IV Diagnostic Criteria
Memory impairment (impaired ability to learn new information or to recall previously learned information) and
1 or more cognitive disturbances
Aphasia - language
Apraxia – ability to carry out motor activities
Agnosia – can’t recognize or identify objects
Executive function - planning, organizing, sequencing, abstracting
DSM-IV
Cause significant impairment in social or occupational function
Represents a decline in previous level of function
Gradual onset and continuing decline
