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
