Clin: Dementia - Hon Flashcards
decline in memory and a least ONE other cognitive function (aphasia, agnosia, or a decline in executive function
- this decline impairs social or occupational functioning in comparison with previous functioning in comparison with previous functioning
dementia
what are the 4 MCC of dementia?
- Alzheimer’s (80% of cases)
- Diffuse Lewy body disease
- Parkinson’s
- frontotemporal lobar degeneration
What are the 3 most common examples of frontotemporal lobar degeneration that Hon listed?
- frontotemporal dementia (Pick’s disease)
- progressive nonfluent aphasia
- semantic dementia
what are examples of vascular causes of dementia?
- multiple infarction
- single stroke
- Binswanger’s disease (d/t HTN)
- vasculitis
- SAH
what are examples of infectious causes of dementia?
- fungal meningitis
- syphilis
- AIDS dementia
- CJD
- post-herpes simplex encephalitis (can cause significant dementia)
what are examples of psychiatric causes of dementia?
- depression
- alcohol abuse
- drug-related disorder
- personality disorder
- anxiety disorder
what are examples of toxic/metabolic causes of dementia?
- vit B12 def
- thyroid def
- system failure: liver, renal, cardiac, respiratory
- heavy metals
- toxins (glue sniffing)
what are examples of traumatic causes of dementia?
- subdural hematoma
- closed head injury
- open head injury
- chronic traumatic encephalopathy (CTE, aka Pugilistic brain injury)
- anoxic brain injury
what are examples of tumors that can cause dementia?
- astrocytoma/glioblastoma
- lymphoma
- metastatic tumor
what is the most important factor in evaluation of pt with dementia?
history!
- essential that hx be obtained not only from pt but from FAMILY/caregiver, etc
- pt will often deny they have a problem
what are important questions to ask in the history?
- short term memory problems
- time course (rapid or slow progression)
- functioning (work, finances)
- safety (driving, cooking)
- hx of head injury, toxin exposure, infection
- family hx of dementia
what should be part of your exam?
- standardized short mental state test (folstein mini-mental status exam or montreal cognitive assessment)
- look for CV risk factors
- full neuro exam
what labs should be drawn?
- CBC
- chemistry panel
- sedimentation rate
- thyroid function
- B12
- CT or MRI
- EEG
- lumbar puncture
- CXR
- drug screen/heavy metal screen
- HIV screen
deficits in 2+ areas of cognition
- progressive worsening of memory and other cognitive function (aphasia, apraxia, agnosia)
- no disturbance of consciousness
- onset b/w 40-90, most often after 65
- absence of systemic disorders or other brain diseases
Alzheimer’s disease
- impaired activities of daily living
- altered patterns of behavior
- family hx of similar disorders
- normal L.P.
- EEG: normal or mild generalized slowing
- progressive atrophy on MRI/CT
when would you commonly see neurofibrillary tangles?
Alzeimers
- look like tadpoles or flames!
what is the tx of AD?
- slow the progression of disease
- AChE-I’s (donepizil, rivastigmine, galantamine)
- NDMA antag (memantine)
- memory complaint
- tested abnormal memory for age, but does not meet dcriteria for dementia (normal cognitive function, normal activities of daily living)
- probably a precursor to AD
mild cognitive impairment
- pts w/MCI at 5x more likely to develop AD
what may slow the progression to Alzherimers?
tx with AChE-I
DEMENTIA with:
- cerebrovascular disease defined by presence of focal signs on neuro exam (hemiparesis, lower facial weakness, babinski sign)
- evidence of relevant cerebrovascular disease on brain imaging, including multiple large-vessel infarct or a single strategically situated infarct, as well as multiple basal ganglia and white matter lesions
vascular dementia
NOTE: look for a relation between cognitive problems and vascular event (onset of dementia w/in 3 months of having stroke, etc)
what cause of dementia did Hon point out as being a much earlier onset than the rest?
frontotemporal degeneration progresses much earlier and more aggressively than other causes (AD, PD, HD)
- dementia
- parkinsonian symptoms (generally bradykinesia & rigidity w/OUT tremor**)
- prominent psychotic symptoms (visual illusions/hallucinations)
- extreme sensitivity to antipsychotic agents
diffuse lewy body disease
- lewy bodies are everywhere! not just in basal ganglia
- often progresses more rapidly than AD
- 81% of patients w/diffuse Lewy body disease have unexplained periods of markedly increased confusion that last days-weeks and closely mimic delirium**
diffuse Lewy body disease
- will come into ER, do a full workup and not find anything wrong. a few days later they are back to normal, but a couple months later they have a similar episode
what are common features of Lewy body disease?
- dysautonomia
- psychotic sx (more common and occur earlier than AD)
- visual hallucinations (animals or children), that are not often bothersome to the patient
what should you beward of in patients with Lewy body disease?
- *most pts experience severe, life-threatening adverse rxns if treated with anti-psychotic agents**
- if the hallucinations don’t bother them, don’t treat them!
- if they must be treated, use newer agents (quetiapine, olanzapine)
