Clin med 2: Dementia

Question 1

Step-wise progression is a clue for what type of dementia?

Answer 1

Vascular dementia

Question 2

3 main symptoms of Lewy Body Disease?

Answer 2

1) Dementia
2) Parkinsonian sx’s (generally bradykinesia and rigidity w/o tremor)
3) Prominent psychotic sx’s (usually visual illusions/hallucinations)

Question 3

Which type of dementia is extremely sensitive to antipsychotic meds, and should not be given due to potentially life-threatening adverse rxns?

Answer 3

Lewy body disease (dementia)

Question 4

How do the hallucinations seen with PD differ from that of Lewy body disease?

Answer 4

• In PD the hallucinations are usually caused by the antiparkinsonian drugs! (like Levadopa)
• In Lewy body disease the hallucinations are an actual feature of the disease (but we do NOT treat with antipsychotics!)

Question 5

How does FTD differ in presentation from Alzheimer’s?

Answer 5

Changes in behavior typically precede cognitive dysfunction

Question 6

How can normal pressure hydrocephalus be treated and is it reversible?

Answer 6

POTENTIALLY reversible with ventriculoperitoneal shunting (gait disturbance is most likely to be reversed w/ shunting)

Question 7

What type of psychosis is associated with Alzheimer’s Disease?

When does it present?

Answer 7

• Presents late in the disease (in comparison to Lewy Body disease where it presents early on)
• Psychosis is usually related to them thinking family is stealing from them, spouse is cheating on them or trying to put them in a nursing home.. Often directed at the people closest to them.

Question 8

What are the 2 flavors of Vascular Dementia?

Answer 8

1) Step-wise progression of deficits, due to mulitiple infarcts over time
2) One massive stroke that is strategically placed i.e., the left hemisphere knocking out language and understanding centers. The patient is now demented.

Question 9

Which lab studies are selectively recommended for diagnosing causes of dementia?

Answer 9

• EEG (Creutzfeldt-Jakob, encephalitis - characteristic findings)
• LP (CA, infections, vasculitis, NPH)
• CXR
• HIV testing!!!!

Question 10

What is the criteria for diagnosing Alzheimer’s Disease?

Answer 10

• Deficits in 2 or more areas of cognition
• Progressive worsening of memory and other cognitive function