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x Neurology 200 > Chapter 12: Dementia > Flashcards

Chapter 12: Dementia Flashcards

1
Q

What faculties of the mind maybe impaired in Dementia?

A

Memory, orientation, visuospatial perception, language, and higher executive functions (planning, organizing, and sequencing)

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2
Q

First thing to go in dementia

A

Short-term memory

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3
Q

Do you use EEG in diagnosing Dementia

A

Not ordered routinely, do it if there is evidence of fluctuations in cognitive status that could represent seizures.

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4
Q

Pathology of Alzheimer’s

A

Neurofibrillary tangles and senile plaques in the cerebral neocortex and hippocampus.
Brain atrophy: loss of neurons in cortex and gliosis

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5
Q

Risk factors for AD

A

Age, female sex, family history, history of severe head trauma, Down’s

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6
Q

Genetic risk factors for AD

A

ApoE4, amyloid precursor protein (APP), presnilin 1 and 2.

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7
Q

Natural history of AD

A

Starts off with small things like getting lost, forgetting where you placed your keys, and social withdrawal…worsens to the loss of the ability to speak, understand, think , and make decisions.

Personality changes, aggressive behavior, paranoid thoughts and delusions.

Death in 5-10 years.

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8
Q

Lab test for AD

A

There is none, only brain biopsy (autopsy)

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9
Q

MRI studies of AD

A

Reduced hippocampus, amygdala, and thalamus.

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10
Q

What are Neurofibrillary tangles

A

Intracellular accumulation of phosphorylated tau protein

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11
Q

What are Senile Plaques

A

Extracellular deposits of amyloid surrounded by dystrophic axons

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12
Q

Treatment

A

Treat/Prevent associated symptoms
Prevent/delay progression: ACEIs like donepezil or rivastigmine, Memantine (NMDAR ant.)
Prophylaxis: None, maybe Vit. E, NSAIDs, estrogen

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13
Q

AD makes up what percent of all dementias

A

50-70% of all dementias

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14
Q

Vascular dementia types

A
  1. Macrovascular: large infarcts
  2. Microvascular: subcortical ischemia associated with cerebral small vessel disease (lacunes or deep white matter changes on MRI).
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15
Q

Vascular dementia risk factors

A

HTN, DM, age, embolism sources, extensive large artery atherosclerosis.

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16
Q

Diagnosis criteria for vascular dementia

A

Dementia + 2 or more of the following: focal neurologic signs on physical exam; onset that was abrupt, stepwise, or stroke-related; or brain imaging study showing multiple strokes, lacunes, or extensive deep white matter changes.

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17
Q

Who is at high risk for vascular dementia

A

HTN and Diabetics

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18
Q

Vascular dementia treatment

A

Same as for preventing strokeq

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19
Q

Binswanger disease

A

Associated with vascular dementia. Subcortical leukoencophalopathy.

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20
Q

Dementia with Lewy Bodies prevalance

A

Now thought to be the 2nd most common cause of dementia after AD (by many)

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21
Q

Dementia with Lewy Bodies clinical picture

A

Parkinsonian dementia syndrome with visual hallucinations

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22
Q

Dementia with Lewy Bodies major features

A

Cognitive impairment (severe problems of visuospatial perception and visual memory), marked fluctuations of alertness, prominent visual hallucinations (up to 80%) and delusions, extrapyramidal symptoms, and extraordinary sensitivity to neuroleptics

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23
Q

Lewy body is..

A

An eosinophilic intracellular inclusion of alpha synuclein.

24
Q

Dementia with Lewy Bodies: where are the Lewy Bodies

A

Found in cortical neurons, not in substantia nigra like in PD

25
Q

Dementia with Lewy Bodies pathology

A

Lewy Bodies, may see NFTs and senile plaques

26
Q

Dementia with Lewy Bodies tx

A

Low dose atypicals like Risperdal and Clozapine to treat behavior symptoms

27
Q

Dementia with Lewy Bodies prognosis

A

Death after 10-15 years

28
Q

Progressive Supranuclear Palsy

A

Subcortical dementia with prominent extrapyramidal features.

29
Q

Progressive Supranuclear Palsy major clinical findings

A

Palsy of vertical gaze, abnormal gait, frequent falls

30
Q

Progressive Supranuclear Palsy prognosis

A

Death in 6-10 years

31
Q

Progressive Supranuclear Palsy all the clinical findings

A

Supranuclear ocular palsy (failure of vertical gaze)
Dysarthria; dysphagia; extrapyramidal rigidity, gait ataxia, and dementia.
Falls and gait abnormalities early on, dementia early or late.

32
Q

Progressive Supranuclear Palsy Pathology

A

Atrophy of dorsal midbrain, globus pallidus, and subthalamic nucleus.

33
Q

Huntington Disease

A

Triad: Chorea, dementia, and personality and behavioral changes (OCD)

34
Q

Huntington Disease prognosis

A

Death in 10-20 years

35
Q

Huntington Disease and suicide

A

Suicide is not rare in at-risk and early onset HD patients

36
Q

Huntington Disease natural history

A

Ages 35-45

37
Q

Huntington Disease pathology

A

Caudate atrophy and putamen and loss of neurons in cerebral cortex

38
Q

Huntington Disease cause

A

Aut. dom. CAG repeats on Chr. 4 (>40 repeats)

39
Q

Huntington Disease tx

A

DA antagonists (neuroleptics). Get genetic counseling for relatives.

40
Q

Parkinson Disease dementia

A

Subcortical dementia in 30% of PD patients

41
Q

Frontotemporal Dementia

A

Anterior lobal atrophy. Patients present with cognitive and behavioral deficits other than memory loss first.

42
Q

Pick disease, primary progressive aphasia, and semantic dementia

A

All different kinds of FTD

43
Q

Pick Disease

A

Personality change, speech disturbance, inattentiveness, and sometime extrapyramidal signs.

44
Q

What are pick Bodies

A

Argyrophilic round intraneuronal incusions

45
Q

Pick dz pathology

A

Pick bodies, abnormal tau in neurons and glial cells. No senile plaques.

46
Q

Prion-related diseases

A

Cruetzfeldt-Jakob, Fatal familial insomnia, Gerstmann-Straussler-Scheinker syndrome

47
Q

Prior disease pathology

A

Spongy degeneration, neuronal loss, gliosis, and astrocytic proliferation

48
Q

CJD signs

A

Rapidly progressive dementia with pyramidal signs, myoclonus, cerebellar or extrapyramidal signs, and periodic sharp waves on EEG

49
Q

CJD on MRI

A

DWI shows evolving cortical and basal ganglionic abnormalities.

50
Q

CJD lab test

A

CSF protein 14-3-3 presence is sensitive and specific for CJD

51
Q

CJD prognosis

A

Death within a year

52
Q

HIV-associated Dementia Complex

A

Memory problems, problems concentrating, poor attention

53
Q

HIV-associated Dementia Complex MRI

A

MRI shows cortical and subcortical atrophy

54
Q

HIV-associated Dementia Complex tx

A

AZT, selegiline, memantine

55
Q

Metabolic causes of dementia

A

Vitamin B12 may cause a progressive dementing illness.

56
Q

Vitamin B12 deficiency

A

Will see spinal cord signs (subacute combined degeneration), neuropathy (paresthesias in the hands and feet, sensory ataxia, visual loss, orthostasis) and memory loss.
Anemia, sore tongue

57
Q

Vitamin B12 deficiency tx

A

B12 relacement

x Neurology 200 (25 decks)

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