Approach to Dementia Flashcards
what are the degenerative causes of dementia?
Alzheimers Lewy body disease Parkinsons Frontotemporal lobar degeneration Progressive supranuclear palsy Corticobasal degeneration Multiple system atrophy Huntingtons Olivopontocerebellar degeneration
what are the vascular causes of dementia?
multiple infarctions single stroke binswanger's disease vasculitis subarachnoid hemorrhage
what are the infectious causes of dementia?
fungal meningitis syphilis AIDS CJD post-herpetic encephalitis
what are the psych causes of dementia?
depression alcohol abuse drug-related disorder personality disorder anxiety disorder
what are the toxic/metabolic causes of dementia?
Vit B12 deficiency thyroid deficiency system failure heavy metals toxins
what are the traumatic causes of dementia?
subdural hematoma closed head injury open head injury chronic traumatic encephalopathy anoxic brain injury
what is important when getting a history on a patient with possible dementia?
interviewing both the patient and a family member/caregiver
what is a standard PE for a patient with possible dementia?
standardized short mental state test
assess CV risks
full neuro exam
what labs should you order to r/o dementia?
CBC CMP sed rate thyroid function B12 levels RPR LP HIV testing drug screen heavy metal screen
what imaging should you order to r/o dementia?
CT or MRI
EEG
CXR
PET scan
what are the criteria for diagnosing Alzheimers disease?
established by mini-mental state exam
deficits in 2 or more areas of cognition
progressive worsening of memory and other cognitive functioning
no disturbance of consciousness
absence of systemic disorders or other brain diseases
what findings would support an Alzheimers diagnosis?
progressive deterioration of aphasia, apraxia or agnosia impaired activities of daily living family hx of dementia normal LP normal EEG progressive atrophy on MRI or CT
what is the definition of mild cognitive impairment (MCI)?
tested abnormal memory for age but does not meet the criteria for dementia
- normal general cognitive function
- normal daily activities
what is the relationship between MCI and Alzheimers?
patients with MCI are 5x more likely to develop Alzheimers
what is the relationship between stroke and dementia?
strokes tend to cause dementia within 3 months
can also result in abrupt deterioration in cognitive functions or fluctuating cognitive deficits
what is the tetrad of diffuse lewy body disease?
dementia
parkinsonian symptoms
psychotic symptoms
extreme sensitivity to antipsychotic agents
what is the pattern of LBD compared to Alzheimers?
often progresses more rapidly
symptoms vary more than sx of alzheimers
psych sx are much more common
what should you absolutely not give someone with LBD?
anti-psychotics!!
can result in a potentially life-threatening reaction
compare and contrast Parkinsons vs LBD
Parkinsons: Midbrain lewy bodies dementia occurs late in illness resting tremor hallucinations in response to drugs
LBD: cortical lewy bodies dementia occurs early in illness no resting tremor autonomic dysfunction hallucinations without drugs
what is frontotemporal degeneration?
umbrella term for multiple forms of dementia characterized by deterioration in social skills and changes in personality
includes impairment of intellect, memory, and language
what are the core symptoms of FTD?
loss of memory
lack of spontaneity
difficulty concentrating
disturbances of speech
what can be seen on CT/MRI in FTD?
frontal and temporal atrophy
what is the triad of normal pressure hydrocephalus?
wacky
wobbly
wet
how does CADASIL contribute to developing dementia?
multiple areas of ischemia causing subcortical dementia
