Alzheimers Disease & Dementia Flashcards
Prevalence
“Graying” population
-by 2030, there may be 70 million elderly in the US
Current prevalence rates of dementia
- 6-8% if older than 65
- 30% if older than 80
Dementia
an acquired syndrome consisting of a decline in memory and other cognitive functions
Diagnosis of Dementia
Memory impairment & one of the following
- Aphasia, APraxia (noted in transfers, tool use) or impaired executive functioning ($ management, driving)
- Deficits cause significant impairment in social or occupational functioning
Aphasia
Characterized initally by a fluent aphasia
- able to initiate & maintain a conversation
- impaired comprehension
- intact grammar and syntax - but speech is vague, tangential
- Later language can be severely impaired w/ mutism, echolalia
Aphasia During Tx
Be aware of their ability to follow directions
(provide repatition & teach back by the pt.)
If they use nonspecific phrases (“The thing”) fill in the word
Apraxia
Inability to carry out motor activities despite intact motor function
Contributes to loss of ADLS
May be a progressive decline
- keep envt. unclutered
- keep routine consistent
- keep room set up the same
Agnosia
The inability to recognize or identify objects despite intact sensory function
Typically occurs later in the course of illness
Can be visual or tactile
Envt. simplification
Hand over hand A
Picture of objects
Impaired Executive Function
Difficulty w/ planning, initiating, sequencing, monitoring or stopping complex behaviors
- occurs early to midcourse
- contributes to loss of IADL’s
Ressist A d/t parinoa & lack of awareness of decline
Dementia Subtypes : Early onset
Before 60
- less then 5% of all cases
- strong genetic link
- tends to progress more rapidly
Dementia Subtypes: Late onset
After 60
Represents a majority of cases
Features Associated w/ Dementia
Agitation, Aggression, Sleep disturbances
Apathy, Depression or Anxiety, Personality changes
Behavioral disinhibition, impaired insight, hallucinations
Delusions
Medical Assessment of Dementia
History Physical & Neurological Exam Cognitive screening test Rule out reversible causes Neuroimaging Consider the etiology Tx or referral
Potentially Reversible Dementia
Drug toxicity Metabolic disturbance Hydrocephalus Mass lesion Infectious Process Endrocine Disorder Nutritional Disease Other (COPD, CHF, Liver, Apnea
Fewer then 13% are reversible
Tx may not return pt. to baseline
Assessments for Reversible Dementia
Labwork
Neuroimaging
Alzheimer’s Disease (AD) : Overview
Insidious onset and gradual progression
Presentation usually related to primary deficits in recent memory
Incidence age-related 8% per year by 85
1/2-2/3 the cause of dementia is AD
Ultimate Dx based on pathology of plaques & tangles
Genetics of AD
In minority of cases there is an autosomal dominant inheritance linked to chromosome 1, 14, or 21.
This is associated w/ Early Onset
The presence of AD in a 1st degree relative is associated w/ a fourfold increased risk of AD
Course of AD
Insidious onset & progressive course w/ typical loss of 3 point on MMSE each year and death occuring 8-12 years after diagnosis
Course of AD : Mild
MMSE 20-24
Usually the first 2-3 years after diagnosis
Primarily memory and visual-spatial deficits
Mild difficulty w/ executive functioning
Course of AD : Moderate
MMSE 11-20
3-6 years following diagnosis
Apashia and apraxia become more pronounces
Loss of IADL and increased A w/ ADL’s
Beginning to exhibit some neuropsych Sx particularly paranoia
Course of AD : Severe
Usually 6-10 years following diagnosis
Severe language disturbances
Pronounced neuropsych manifestations including agitation, aggression
Very late in the course can see muscle ridgity, gait disturbances, incontinence, dysphagia
More bed bound pt.s, seen for positioning, transfers
Vascular Dementia : Dementia Syndromes
Second most common form of dementia after AD
One or more strokes, two or more cognitive functions affected
Abrupt onset of stepwise course - different from AD
Aka “binswanger’s disease”, “lacunar state” or “multi-infact dementia
-Difficulty w/ name recall dates, increased difficulty w/ speech, decreased endurance
Vascular Dementia : Prevelance
Increase risk population
should be reserved for pt.’s w/ evidence of stroke or imaging or physical examination
10-40% of all dementia cases
10-15% of AD cases are “mixed”
Vascular Dementia : Tx
Tx focused on risj factors
- smoking
- atrial fibrillation
- diabetes
- HTN
Dementia w/ Lewy Bodies
Lewy body = abnormal protein High incidence 7-26% Memory impairment may come after visual hallucinations, delirium, parkinsonism Sensitive to neuroleptics Decline faster than AD
