Clinical Approach to Dementia (Hon) Flashcards
What is the definition of dementia?
A decline in memory and at least one other cognitive function or a decline in an executive function
What are some infectious causes of dementia?
1) Fungal meningitis
2) Syphilis
3) AIDS
4) CJD
5) Post-herpes simplex encephalitis
What are some toxic/metabolic causes of dementia?
1) Vitamin B12 deficiency
2) Thyroid deficiency
3) Heavy metals
What is the criteria for clinical diagnosis of Alzheimer’s disease?
1) Deficits in 2 or more areas of cognition
2) Progressive worsening of memory and other cognitive function
3) No disturbance of consciousness
4) Onset most often after 65
What is found on CT or MRI of the brain with Alzheimer’s?
Progressive atrophy
What is the main goal of the treatment of Alzheimer’s?
To slow the progression of the disease
What class of drugs are used in the treatment of Alzheimer’s?
1) Acetylcholinesterase inhibitors
2) NMDA receptor antagonist
Donepezil, rivastigmine, and galantamine are from what drug class?
Memantine is from what drug class?
1) Acetylcholinesterase inhibitors
2) NMDA receptor antagonist
What is most likely a precursor to Alzheimer’s disease?
Mild Cognitive Impairment
What is Mild Cognitive Impairment?
Memory complaint abnormal for age
What should be given to a patient with mild cognitive impairment in order to slow progression to Alzheimer’s?
AChE inhibitor
What is the criteria for probable vascular dementia?
1) Presence of focal signs such as hemiparesis, lower facial weakness, Babinski sign, etc.
2) Evidence of relevant cerebrovascular disease on brain imaging including infarcts, multiple basal ganglia and white matter lesions
A diagnosis of vascular dementia can be made when there is a relation between cognitive problems and vascular events manifested or inferred by the presence of one or more of the following:
1) Onset of dementia within 3 months after a recognized stroke
2) Deterioration in cognitive functions (either abrupt or progressive)
What are some vascular causes of dementia?
1) Multiple infarction
2) Stroke
3) Binswanger’s disease
4) Vasculitis
5) Subarachnoid hemorrhage
What symptoms are seen with Diffuse Lewy Body disease?
1) Dementia
2) Parkinsonian symptoms (bradykinesia and rigidity)
3) Prominent psychotic symptoms (generally visual hallucinations)
Lewy Body Disease patients can experience severe, potentially life-threatening adverse reactions if treated with?
Antipsychotic agents
Up to 81% of Lewy Body Disease patients have unexplained periods of?
Increased confusion that last days to weeks and closely mimic delirium
What often presents early in Lewy Body Disease patients?
Bradykinesia, rigidity and falls
How do Lewy Body Disease patients respond to levodopa?
Poor
When do psychotic symptoms commonly present in Lewy Body Disease patients?
In Alzheimer’s disease patients?
1) Earlier in disease course
2) Later in disease course
What is the most common psychotic symptom of Lewy Body Disease?
Visual hallucinations generally of animals or children
Where are the Lewy bodies found with Parkinson’s disease?
In Lewy Body disease?
1) Midbrain
2) Diffuse
Executive dementia sometimes occurs when with Parkinson’s disease?
Cortical dementia always occurs when in Lewy Body disease?
1) Late in illness
2) Early
What symptom is usually only present with Parkinson’s disease and mostly absent in Lewy Body disease?
Resting tremor