Clinical Approach to Dementia Flashcards
What is the incidence of dementia in patients over 65 y/o and 85 y/o?
> 65 y/o: 10%
> 85 y/o: 30%
How is a degenerative cause of dementia determined?
Only at autopsy
What 3 diseases have features of frontotemporal lobar degeneration?
Frontotemporal dementia (Pick’s disease)
Progressive nonfluent aphasia
Semantic dementia
What are 3 areas you should be done in the exam of a patient with possible dementia?
Standardized short mental state test (Folstein Mini-mental exam, MOCA); may ask about current events, etc.
Evaluation of CV risk factors (HTN, bruits, arrhythmias, murmurs, etc.).
Full neurologic exam.
What is the criteria for a clinical diagnosis of Alzheimer’s disease? (6)
Dementia established by means of clinical examination and documented with the Mini-Mental State Examination or similar examination and confirmed with neuropsychological tests.
Deficits in 2 or more areas of cognition.
Progressive worsening of memory and other cognitive function.
No disturbance of consciousness
Onset between the ages of 40 & 90 yr, most often after 65.
Absence of systemic disorders or other brain diseases that in and of themselves could account for the progressive deficits in memory and cognition.
What clinical findings support a diagnosis of AD?
Progressive deterioration of cognitive functions.
Impaired activities of daily living.
Family history.
Normal L.P.
EEG is normal or mild slowing
Progressive brain atrophy seen in MRI or CT
What 2 MOAs can be used to slow progression of AD?
What other agents might be helpful?
AChE inhibitors
- Donepizil
- Rivastigmine
- Galantamine
NMDA receptor antagonists
-Memantine (indicated for moderate to severe dementia of probable AD)
Consider: Complex B, lipid-lowering agent, aspirin.
What is mild cognitive impairment?
What is the likely progression?
What kind of treatment has shown efficacy?
A memory complaint often noticed by the patient. There is an abnormal memory for their age, but it does not meet the criteria or dementia (normal cognitive function, normal activities of daily living).
It is likely a precursor to AD.
AChE inhibitors
What is the diagnostic criteria for probable vascular dementia? (3)
Dementia defined similarly to the DSM-V:
- Cerebrovascular disease defined by the presence of focal signs on neurologic examination, such as hemiparesis, lower facial weakness, Babinski sign, sensory deficit, hemianopia, consistent with stroke.
- Evidence of relevant cerebrovascular disease at brain imaging including multiple large-vessel infarcts
or a single strategically situated infarct (angular gyrus, thalamus, basal forebrain, or posterior or anterior cerebral artery territories), as well as multiple basal ganglia and white matter lesions and white matter
lacunes or extensive periventricular white matter lesions, or combination thereof. - A relation between cognitive problems and vascular events manifested or inferred by the presence of one or more of the following:
• Onset of dementia within 3 months after a recognized stroke
• Abrupt deterioration in cognitive functions OR
• Fluctuating, step-wise progression of cognitive deficits.
What is the tetrad of symptoms of (diffuse) Lewy body disease?
They are extremely sensitive to what?
Dementia
Parkinsonian symptoms (bradykinesia and rigity w/o tremor)
Prominent psychotic symptoms
-symptoms vary a lot from day to day.
**extreme sensitivity to antipsychotic agents!
Which progresses quicker: LBD or AD?
LBD
What is the location of Lewy bodies in Parkinson’s disease vs. LBD?
Parkinson’s - midbrain
LBD - cortical`
Frontotemporal dementia includes several forms of dementia characterized by… (3)
What ages are most common?
How long does it progress?
Slowly deteriorating social skills, personality changes and impairment of intellect, memory and language.
40-60 y/o
2-10 years; there is no cure.
What are symptoms of NPH?
What is the treatment?
Dementia, gait disturbance and urinary incontinence.
Can be reversible with ventriculoperitoneal shunting (gait disturbance is most likely to be reversed with the shunting).
CADASIL disease onset:
What gene is defective? What is the result?
How does it manifest most commonly?
No treatment exists, but what can be helpful?
Age 40-50 y/o
NOTCH3 on chr. 19 - progressive degeneration of SM cells in blood vessels.
Migraine headaches and TIAs/strokes; MRI will show areas of ischemia.
Antiplatelet agents can help lower risk of clotting.
