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NMSP Exam 2 > Clin: Dementia - Hon > Flashcards

Clin: Dementia - Hon Flashcards

1
Q

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

A

dementia

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2
Q

what are the 4 MCC of dementia?

A
  1. Alzheimer’s (80% of cases)
  2. Diffuse Lewy body disease
  3. Parkinson’s
  4. frontotemporal lobar degeneration
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3
Q

What are the 3 most common examples of frontotemporal lobar degeneration that Hon listed?

A
  • frontotemporal dementia (Pick’s disease)
  • progressive nonfluent aphasia
  • semantic dementia
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4
Q

what are examples of vascular causes of dementia?

A
  • multiple infarction
  • single stroke
  • Binswanger’s disease (d/t HTN)
  • vasculitis
  • SAH
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5
Q

what are examples of infectious causes of dementia?

A
  • fungal meningitis
  • syphilis
  • AIDS dementia
  • CJD
  • post-herpes simplex encephalitis (can cause significant dementia)
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6
Q

what are examples of psychiatric causes of dementia?

A
  • depression
  • alcohol abuse
  • drug-related disorder
  • personality disorder
  • anxiety disorder
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7
Q

what are examples of toxic/metabolic causes of dementia?

A
  • vit B12 def
  • thyroid def
  • system failure: liver, renal, cardiac, respiratory
  • heavy metals
  • toxins (glue sniffing)
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8
Q

what are examples of traumatic causes of dementia?

A
  • subdural hematoma
  • closed head injury
  • open head injury
  • chronic traumatic encephalopathy (CTE, aka Pugilistic brain injury)
  • anoxic brain injury
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9
Q

what are examples of tumors that can cause dementia?

A
  • astrocytoma/glioblastoma
  • lymphoma
  • metastatic tumor
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10
Q

what is the most important factor in evaluation of pt with dementia?

A

history!

  • essential that hx be obtained not only from pt but from FAMILY/caregiver, etc
  • pt will often deny they have a problem
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11
Q

what are important questions to ask in the history?

A
  • 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
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12
Q

what should be part of your exam?

A
  • standardized short mental state test (folstein mini-mental status exam or montreal cognitive assessment)
  • look for CV risk factors
  • full neuro exam
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13
Q

what labs should be drawn?

A
  • CBC
  • chemistry panel
  • sedimentation rate
  • thyroid function
  • B12
  • CT or MRI
  • EEG
  • lumbar puncture
  • CXR
  • drug screen/heavy metal screen
  • HIV screen
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14
Q

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
A

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
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15
Q

when would you commonly see neurofibrillary tangles?

A

Alzeimers

- look like tadpoles or flames!

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16
Q

what is the tx of AD?

A
  • slow the progression of disease
  • AChE-I’s (donepizil, rivastigmine, galantamine)
  • NDMA antag (memantine)
17
Q
  • 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
A

mild cognitive impairment

- pts w/MCI at 5x more likely to develop AD

18
Q

what may slow the progression to Alzherimers?

A

tx with AChE-I

19
Q

DEMENTIA with:

  1. cerebrovascular disease defined by presence of focal signs on neuro exam (hemiparesis, lower facial weakness, babinski sign)
  2. 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
A

vascular dementia

NOTE: look for a relation between cognitive problems and vascular event (onset of dementia w/in 3 months of having stroke, etc)

20
Q

what cause of dementia did Hon point out as being a much earlier onset than the rest?

A

frontotemporal degeneration progresses much earlier and more aggressively than other causes (AD, PD, HD)

21
Q
  • dementia
  • parkinsonian symptoms (generally bradykinesia & rigidity w/OUT tremor**)
  • prominent psychotic symptoms (visual illusions/hallucinations)
  • extreme sensitivity to antipsychotic agents
A

diffuse lewy body disease

- lewy bodies are everywhere! not just in basal ganglia

22
Q
  • 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**
A

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

23
Q

what are common features of Lewy body disease?

A
  • dysautonomia
  • psychotic sx (more common and occur earlier than AD)
  • visual hallucinations (animals or children), that are not often bothersome to the patient
24
Q

what should you beward of in patients with Lewy body disease?

A
  • *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)
25
Q

what disease:

  • midbrain Lewy bodies (basal ganglia)
  • executive dementia, occurring LATE in illness
  • resting tremor
  • autonomic dysfunction (sometimes)
  • hallucinations only in response to antiparkinsonian drugs
A

Parkinson’s

26
Q

what disease:

  • cortical Lewy bodies (everywhere!)
  • cortical dementia, occuring EARLY in illness
  • NO tremor
  • PROMINENT autonomic dysfinction
  • hallucinations common in absence of antiparkinsonian drugs
A

Diffuse Lewy body disease

27
Q

this dx includes several forms of dementia, characterized by a slowly progressive deterioration of social skills and changes in personality, along with impairment of intellect, memory, and language

A

frontotemporal degeneration

  • usually affects ppl beween 40-60
  • atrophy of frontal and temporal lobes
  • no cure, length of progression 2-10 years
28
Q
  • dementia
  • gait disturbance
  • urinary incontinence
A

normal pressure hydrocephalus

- POTENTIALLY reversible w/ventriculoperitoneal shunting (GAIT disturbance the most likely to be reversed)

29
Q
  • onset age 40-50
  • hereditary stroke disorder, causing progressive degeneration of smooth muscle cells in blood vessels
  • defect of NOTCH3 gene on xsome 19
  • manifests as migraines and TIA’s or strokes
  • MRI shows multiple areas of ischemia from years prior to onset
  • eventually progresses to subcortical dementia
A

cerebral autosomal dominant subcortical infarcts and leukoencephalopathy
- no tx exists, but anti-platelet agents can minimize risk factors

NMSP Exam 2 (13 decks)

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