Behavior and Dementia Flashcards
Dementia
Impairment of 2/5 : Memory, Emotion, Visual/spatial, Executive language
Mild Cognitive Impairment
Impairment that does not meet the criteria for dementia because there is no impairment in function. - Risk factor for developing Alzheimer’s disease
Episodic Memory
memory of person experiences. Primarily affected in AD
Semantic Memory
memory of facts :
Declarative memory
semantic + episodic memory
Procedural memory
memory of how to do things. Less affected in AD.
Alzheimer’s Disease
Pts p/w atrophy of the mesial temporal lobe primarily (hippocampi) leading to diffuse brain atrophy over time.
Tx for alzheimer’s
- Cholinesterase inhibitors : galantamine, donepezil (aricept).
- NMDA receptor antagonist: Memantine ( Namenda)
- They do not delay natural history just help symptoms .
What protein mutated in familial Alzheimer’s disease? ( younger than 60)
Amyloid precursor.
-Pathologically there are cortical neuritic plaques and neuronal loss in cerebral cortex.
What abnormality is likely to be associated with the underlying disease process of AD?
- Presence of the e4 allele of apolipoprotein E.
Alzheimer’s disease is inevitable in which disease ?
Down syndrome
Difference between delirium and AD
Delirium has fluctuations in level of arousal
Evaluation of a patient with dementia
- Look for reversible causes
- Electrolyte panels ( Na/glucose)
- renal function ( uremia)
- hepatic function (encephalopathy)
- TSH, serologic tests for syphilis, B12, UA ( UTI can cause delirium), tox screen HIV
- Imaging
- Meds: antiochole, benzos, and opiates.
- pseudodementia
- Lumbar puncture and eeg only when there are red flag : these included early onset or rapidly progressing dementia, immunocompromised pt, focal neurological findings, sign of systemic illness
- dementia is distinguished from delirium by its lack of fluctuating course
Lewy body dementia
- central feature: progressive cognitive decline, combined with :
- pronouced fluctuation in alertness and attention ( differs from parkinsons because this isnt found in PD)
- prominent visual hallucinations
- Parkinsonism such as rigidity and braykinesia. Patients are hypersensitive to antopsychotics;
- Sleep disturbance and orthostatic hypotension.
Charles Bonnet syndrome
Pts are mentally healthy, with often significant visual loss,
- typical hallucinations include small animals and people: they understand that the hallucinations are not real and are not typically bothered by it.
Frontal lobe damage
- Apathy, abulia, mutism
- poor judgement and inappropriate social behavior can occur with damage to frontal lobe but memory and general intelligence is often intact
Frontotemporal Degeneration ( Pick’s disease)
- P/w different patterns of behavior
- disinhibition: pt display inappropriate social behavior, lack of social tact , lack of empathy, distractibility loss of insight into behaviors of oneself and others. and increased interest in sex. agitation
- Apathy: neglect of personal hygiene, repetitive or compulsive behavior and decreased energy and motivation
- Language disturbance: patient develop global language difficulties termed primary progressive aphasia.
- Occurs at younger age less than 65 and has more rapid progression than other dementias. memory is often relatively unaffected
requip
Dopamine agonist used to treat parkinson’s : side effect is increased impulsivity such as gambling or hypersexual behavior
Wernicke-korsakoff syndrome
Caused by a lack of thiamine/Vitamin B1
Triad of : Gait ataxia, encephalopathy (confabulation, dementia), and eye movement abnormalities (nystagmus)
- chronic alcoholics who received IV glucose in ER or in ICU patients or post gastric bypass.
Ganser’s syndrome
- syndrome of approximate answers.
- Seen in prisoners may represent attempt to manipulate legal situation.
- form of malingering
Vascular dementia
- Step-wise fashion: with focal neuro deficit
- Risk factors; HTN, DM, smoking lipids
- can present after a strategically placed lesion to hippocampus, medial thalamus or caudate.
- often in conjunction with other dementing processes eg AD
Normal pressure hydrocephalus
- Triad: Magnetic gait, dementia, urinary urgency/frequency.
- Dx: continuous lumbar drain is most sensitive and specific
Tx for NPH
- VP shunt : leads to a risk of subdural hematoma
- Ideal candidate for surg has evidence of ventriculomegaly +: one these: 1) presence of clearly identified etiology, gait difficulties more than cognitive, substantial improvement after CSF removal, lack of atrophy and white matter lesion onimaging
Transient global amnesia
Complete and reversible anterograde and retrograde memory loss lasting up to 24 hrs.
- Occurs in the context of emotional event or sexual activity.
- might be migraine phenomenon
- rarely occurs but must rule out vascular disease, epilepsy. no tx.
Limbic encephalitis
- Psychosis and memory loss
- Seizures.
- Hyperintesity of the mesial temporal lobe and frontal lobes b/l
- CSF: anti-hu antibodies
- Can be a paraneoplastic process in females associated with ovarian tumors
CJD
- prion disease
- rapid onset change in mental status and myoclonus
- sx: dementia, behavioral abnormalities : concentration, memory apathy depression
- LP: 14-3-3 and phosphorylated tau
Damage to b/l hippocampi would cause what?
- Inability to make new memories
Kluver-busy
- caused by damage to b/l amygdala : Hypersexuality, placidity: diminished fear response
- hyperphagia/ hyperorality: overeating
Visual agnosia: difficulty recognizing familiar faces
Wereneke’s Aphasia
- receptive aphasia: able to speak with proper grammar but phrases are nonsensical, unable to repeat
- due to damage of superior temporal gyrus
Broca’s ( motor) aphasia
- expressive aphasia
- can understand speech but cannot speak fluently and are unable to repeat
- damage to the inferior frontal gyrus
Conduction aphasia
- due to damage to arcuate fasciculus
- inability to repeat
Prosody
- The rhythmicity of speech usually in the non-dominant hemisphere.
- can be due to damage to the inferior frontal or superior temporal gyri in the non dominant hemisphere.
Pure word deafness
- caused by b/l damage to posterior superior temporal lobes: primary auditory cortex
- manifests as inability to comprehend meaning of speech but still being able to hear sounds, speak, read and write
Akinetic mutism
- damage to cingulate gyrus b/l-
- Pts can speak but chooses to do so only under extreme duress.
Alexia without agraphia
- Damage to left occipital lobe, splenium of corpus callosum
- Can be caused by infarction of the posterior cerebral artery
Transcortical motor aphasia
Broca’s aphasia with intact repetition
Transcortical sensory aphasia
Wernicke’s with intact repetitioin
Global aphasia
- Both broca and wernike’s
Anomic aphasia
- trouble naming objects
Neologism
- Made up words
Semantic paraphasia
- Substituted word is related to the intended word
Phenomic paraphasia
syllables out of sequence
Gerstmann’s syndrome
- lesions in dominant parietal lobe ( angular gyrus
- Acalculia, agraphia, left/right confusion, finger agnosia
Apraxia
a disorder of skilled movement not caused by weakness, akinesia, deafferentation, abnormal tone or posture, movement disorders intellectual deterioration poor comprehension or uncooperativeness.
Neglect
Neglect of one half of patient’s world,
due to lesion in the non dominant parietal lobe
prospagnosia
- inability to recognize faces
- damage to fusiform gyrus of temporal lobe
Astereoagnosia
- inability to recognize objects when placed in her hand : localized to parietal lobe: primary somatosensory cortex.
Anton’s syndrome
denial of blindness due to damage in b/l occipital lobes.
Balint’s Syndrome
- Due to damage to both posterior parietal lobes
- Optic apraxia: incoordination of hand and eye movement
- occulomotor apraxia: inability to voluntarily guide eye movements
- Simultanagnosia: inability to perceive more than one object at a time in one’s visual field
Posterior reversible encephalopathy syndrome (PRES)
- A consequence of severe uncontrolled HTN especially if it is of rapid increase.
- In women it is common in preeclampsia
- P/w: seizures, visual disturbances, headaches and mental status changes
Synesthesia
When activation of one sensor pathway leads to the involuntary activation of another
Kleine-Levin syndrome
Sleeping Beauty:
- Increased sleeping
- Hyperphagia
- Hypersexuality
Pseudobulbar palsy
- characterized by uncontrolled episodes of crying or laughing
- tx: dextromethorphan/quinidine
Alien hand syndrome
Associated with dementia occurs in corticobasal degeneration
- can be consequence of surgery where corpus collosum is severed
- hands have minds of their own
