Chapter 8 Pt 3 Flashcards
abnormal screening tests for mild and major NCDs indicates what
further testing, preferably FORMAL NEUROPSYCHOLOGICAL TESTING
what is done on the Mini-Mental Status Exam
1 Orientation (awareness)
- what is the date
- where are we
2. registration - name 3 objects and repeat them
3. attention - serial 7s or spell “world” backwards
4. recall (recent memory) - name the 3 objects above 5 minutes later
5. language - naming: name a pen and a clock
- repetition: say “no ifs, ands, or buts”
- verbal comprehension: read the statement written on a piece of paper, and do what it says “close your eyes”
- writing: write a sentence
- visuospatial skills: draw two intersecting pentagons
what is the most common underlying etiology of major NCDs (dementia)
Alzheimer’s Disease
what are the clinical manifestations of Alzheimer’s disease
GRADUAl PROGRESSIVE DECLINE in cognitive functions
primary domains affected are MEMORY, LEARNING, and LANGUAGE
personality changes, mood swings, and paranoia are very common
motor and sensory symptoms are absent until late int he course
on average, death within 10 years
how is Alzheimer’s diagnosed
can’t be definitive until POSTMORTEM
diagnosis of POSSIBLE NCD due to Alzheimers is made based on presence of:
- insidious onset
- gradual progression-imapriment in one (mild NCD) or more (major NCD) cognitive domains
approximately 1% of AD results from an autosomal DOMINANT single gene mutation in
amyloid precursor protein
presenilin 1
presenilin 2
E4 varient of Apolipoprotein gene is also risk factor for early onset
what is found in the brain of Alzheimers patients and what other disease are they found in
SENILE PLAQUES (beta amyloid) NEUROFIBRILLARY TANGLES (tau)
also seen in DOWN SYNDROME and even NORMAL AGING
what is the only way to definitively diagnose Alzheimer’s
postmortem pathological examination of brain
adults with down syndrome are at increased risk of what disease in midlife
Alzheimers
what is the treatment of Alzheimer’s
no cure or truly effective treatment CHOLINESTERASE INHIBITORS (donepezil, rivastigmine, and galantamine) may SLOW CLINICAL DETERIORATION by 6-12 months in up to 50% of patients w/ mild-moderate
NMDA ANTAGONSIT memantine may prove modest benefit in pt with moderate-severe
antipsychotics are often used to treat agitation and aggression in AD, how should this be done
LOW DOSES due to INCREASED MORTALITY
MONITOR CLOSELY for side effects
any treatment plan for AD must include
CAREGIVER SUPPORT
antipsychotics have what black box warning regarding dementia
increased risk of death
a lesion to the frontal lobe can manifest with a spectrum of symptoms including what
personality changes disinhibition inappropriate behavior aggression apathy amotivation parnoia
what is the second most common single cause of major NCD after Alzheimer’s
Vascular Disease
accounts for approximately 20% of major NCDs
evidence of vascular disease is found in what percentage of all major NCDs
50%
most commonly comorbid with AD pathology (NCD due to multiple pathologies
cognitive decline due to vascular disease occurs as a result of at least one of which of the following mechanisms
large vessel strokes, usually cortical
small vessel strokes (lacunar infarcts) to subcortical structures
microvascular disease affecting the periventricular white matter
what are risk factors for vascular dementia
hypetension diabetes smoking obesity hyperlipidemia atrial fibrillation old age
what is clinical manifestation of vascular dementia
STEPWISE deterioration
may present with acute onset followed by partial improvement
may have insidious onset with gradual decline similar to AD
COMPLEX ATTENTION and EXECUTIVE FUNCTION are the cognitive domains typically affected by SMALL VESSEL disease
how is vascular dementia confirmed
neuroimaging with findings that correlate with clinical picture
what is treatment for vascular dementia
no cure or truly effective treatment
manage risk factors with a goal of preventing future strokes
symptomatic treatment similar to AD
