Chapter 8 Pt 4 Flashcards
what are the CORE clinical features of lewy body dementia
progressive cognitive decline
WAXING and WANING of cognition, especially in the areas of ATTENTION and ALERTNESS
VISUAL HALLUINATIONS- usually VIVID, COLORFUL, WELL-FORMED IMAGES of ANIMALS or PEOPLE
Development of EXTRAPYRAMIDAL SIGNS at least 1 year AFTER COGNITIVE DECLINE becomes evident
what are SUGGESTIVE features of lewy body dementia
REM SLEEP BEHAVIOR DISORDER
ANTIPSYCHOTIC SENSITIVITY
how is lewy body dementia diagnosed
definitely- autopys
POSSIBLE NCD with lewy body: only one core feature or ≥ 1 suggestive feature
PROBABLY NCD with LEwy bodies: ≥2 core features OR 1 core feature and ≥ suggestive feature
how is lewy body dementia treated
CHOLINESTERASE INHIBITORS for cognitive ad behvioral symoms
QUETIPINE and CLOZAPINE for psychotic symptoms (lowest effective dose for shortest time possible)
Levodopa-Carbidoa for parkinsonism (not as effective as in idiopathic Parkinsonism, may exacerbate REM sleep disorder)
melatonin and/or clonazepam for REM sleep behavior disorder
what is frontotemporal degeneration
a diverse group of clinical and pathological disorders that typically present between the ages of 45-65
what are the clinical manifestations of frontotemporal degeneration
cognitive defects in ATTENTION, ABSTRACTION, PLANNING, and PROBLEM SOLVING
what are the clinical manifestations of the behavioral variant of frontotemporal degeneration
DISINHIBITED verbal, physical, or sexual behavior
overeating or oral exploration of inanimate objects
lack of emotional warmth, empathy, or sympathy
apathy or inertia
perseveration, repetitive speech, rituals, or obsessions
decline in SOCIAL COGNITION and/or EXECUTIVE ABILITIES
what are the clinical manifestations of the language variant frontotemporal degeneration
difficulties with SPEECH and COMPREHENSION
what is relatively spared in frontotemporal degeneration
learning/memory and perceptual-motor function
what is seen patholgocially in frontotemoral degeneration
marked atrophy of frontal and temporal lobes
how is frontotemporal degeneration diagnosed
can’t be done till AUTOPSY
FTD is PROBABLE if frontotemporal atrophy is evident on structural imaging or hyperactivity is visualized on functional imaging in context of the characteristic clinical signs
how is frontotemporal degeneration treated
symptom-focused serotonergic mediations (SSRIs, trazodone) may help reduce disinhibition, anxiety, impulsivity, repetitive behaviors, and eating disorders
what is the most common infectious agent known to cause cognitive impairment
HIV
25% of people with HIV meet mild NCD criteria and <5% meet major NCD criteria
what are tis factors for HIV dementia
severe immunosuppression
high viral loads in CSF
advanced HIV infection
what are the clinical manifestations of HIV dementia
variable presentation depending on the parts of the brain affected
decline may be observed in executive functioning, attention, working memory, psychomotor activity
psychiatric and neuromotor symptoms may be present
how is HIV dementia diagnosed
mild or major NCD attributable to confirmed HIV infection
what is treatment for HIV dementia
HAART improves cognition in some patinets
psychostimulants target fatigue, apathy, and psychomotor retardation
what is Huntington’s Disease
CAG repeats in HUNTINGTIN (HTT) protein on chromosome 4
autosomal DOMINANT
what are the clinical manifestations of Huntington;s
MOTOR, COGNITIVE, and PSYCHIATRIC symptoms
average age of onset is 40
cognitive decline and behavioral changes can precede onset of motor signs by up to 15 years
EXECUTIVE FUCNTION is the primary cognitive domain affected
what psychiatric manifestations are seen in Huntingtons
depression apathy irritability obsessions impulsivity INCREASED RATE OF SUICIDE
what movement disorders are seen in Huntington’s
CHOREA (jerky, dance-like movements)
BRADYKINESIA
How is Huntignton’s diagnosed
extrapyramidal movement disorder in an individual with either a FAMILY HISTORY of HD or GENETIC TESTING that confirms an increased number of CAG repairs in the HTT gene
mild or major NCD due to HD may be diagnosed prior to onset of motor signs if an individual is determined to be at risk based on family history or genetic testing
how is Huntington’s disease treated
symptom-directed therapy
TETRABENAZINE or ATYPICAL (second generation0 ANTIPSYCHOTIC
