[CLMD] Dementia [Hon] Flashcards
What is the DSM-IV definition of Dementia?
“A decline in memory and at least one other cognitive function”
(…Aphasia, apraxia, agnosia or a decline in an executive function such as planning, organizing, sequencing or abstracting)
“This decline impaires social or occupational functioning in comparison with previous functioning”
What is the prevalence of dementia in patients over the age of:
65?
85?
More than 10% = 65yo
More than 30% = 85yo
What is the most common DEGENERATIVE cause of dementia?
Alzhemier’s Disease
(80%)
What is the second most common DEGENERATIVE cause of dementia?
Lewy body disease
What are the remaining 7 DEGENERATIVE potential causes of dementia?
(don’t worry you don’t need to know all of them, just be familiar with the names)
- Parkinson’s disease
- Frontotemporal lobar degeneration
- Progressive supranuclear palsy
- Corticobasal degeneration
- Multiple systems atrophy
- Huntington’s disease
- Olivopontocerebellar degeneration
Overall, what are the (8) categories of causes of dementia?
Degenerative
Vascular
Infectious
Psychiatric
Toxic/metabolic
Traumatic
Tumors
Other
What are examples of vascular causes of dementia?
Multiple infarction
Single stroke
Binswanger’s disease
Vasculitis
Subarachnoid hemorrhage
What are examples of infectious causes of dementia?
Fungal meningitis
Syphilis
AIDS dementia
Creutzfeldt-Jakob disease
Post-herpes simplex encephalitis
What are examples of psychiatric causes of dementia?
Depression
Alcohol use
Drug-related disorder
Personality disorder
Anxiety disorder
What are examples of toxic/metabolic causes of dementia?
Vitamin B12 deficiency
Thyroid deficiency
System failure: liver, renal, cardiac, respiratory
Heavy metals
Toxins
What are examples of traumatic causes of dementia?
Subdural hematoma
Closed head injury
Open head injury
Chronic Traumatic Encephalopathy (CTE)
Anoxic brain injury
What are examples of tumor causes of dementia?
Astrocytoma/glioblastoma
Lymphoma
Metastatic tumor
What are examples of OTHER causes of dementia?
Symptomatic hydrocephalus
What is argueably the most important aspect of an evaluation of a patient with dementia?
HISTORY
*Preferably obtained from the patient AND from spouse or other family members, caregivers, etc*
What may you want to consider if you are interviewing both the patient with dementia and a family member about the patient’s history?
Separate interviews
What are specific subjects to ask about in the history of a dementia patient?
PATIENT DIFFICULTIES
- Memory?
- Progression?
- Functioning of pt?
- Safety? (guns in house?)
- Head injury?
- Family hx of dementia?
What is the standardized examination to perform on a dementia patient?
Mini-Mental State Examination
What laboratory studies are recommended in all cases of dementia?
CBC
Chemistry panel
Sed rate
Thyroid function studies
B12 level
RPR
CT or MRI of the head
What are the selective tests recommended for:
- Creutzfeldt-Jakob, Encephalitis
- Cancer, infection, vasculitis, NPH
EEG = Creutzfeldt-Jakob, Encephalitis
LUMBAR puncture = Cancer, infection, vasculitis, NPH
What is the criteria for clinical diagnosis of Alzheimers disease?
Deficits in 2 or more areas of cognition
Progressive worsening of memory and other cognitive function
No disturbance in consciousness
(Dementia established via MMSE)
What are examples of laboratory supportive findings for Alzheimer’s disease?
Normal lumbar puncture
EEG: normal/mild generalized slowing
Progressive atrophy documented by MRI or CT brain
What is the main goal of treatment for Alzheimer’s disease?
Slow the progression of the disease
What is the primary category of drug used to treat alzheimers?
Acetylcholinesterase Inhibitors
What are the (3) primary acetylcholinesterase inhibitors used to treat Alzheimer’s disease?
Donepizil
Rivastigmine
Galantamine
What is an additional category of drug that has shown some efficacy in treating Alzheimer’s disease?
NMDA receptor antagonist - Memantine
What is a mild cognitive impairment (MCI)?
Memory complaint; typically noted by the patient
Tested abnormal memory for age, yet does NOT meet the criteria for dementia
How do you manage a patient with mild cognitive impairment?
MCI is probably a precursor to Alzheimer’s disease
Patients with MCI are 5x more likely to develop AD
Therefore: Treat with AchEI medications
What is the primary finding for probable vascular dementia?
Focal signs on neuro exam
(Hemiparesis, lower facial weakness, babinski sign, sensory deficit, hemianopia etc)
What is the tetrad of symptoms of diffuse lewy body disease?
- Dementia
- Parkinsonian symptoms
- Promnent psychotic symptoms (hallucinations)
- Extreme sensitivity to antipsychotic agents
Compare diffuse lewy body disease to alzheimer’s disease
Diffuse lewy body disease:
- progresses more rapidly than AD
- symptoms generally vary a great deal more day to day than AD
Most patients with diffuse lewy body disease experience severe, potentially life-threatening adverse reactions if treated with _______________
Most patients with diffuse lewy body disease experience severe, potentially life-threatening adverse reactions if treated with ANTIPSYCHOTIC AGENTS
Lewy bodies are located in the __________ for parkinsons disease
Lewy bodies are located in the Basal ganglia for parkinsons disease
What are the features of frontotemporal degeneration?
Slow progressive deterioration of:
Social skills
Changes in personality
Impairment of intellect, memory and language
What is the triad of normal pressure hydrocephalus?
Dementia
Gait disturbance
Urinary incontinence
What is the most likely feature of normal pressure hydrocephalus to be reversed with shunting?
GAIT
What does CADASIL disease stand for?
Cerebral autosomal dominant subcortical infarcts and leukoencephalopathy
Age of onset for CADASIL?
40-50 yo
What is the pathophys of CADASIL’s Disease?
Hereditary stroke disorder
(Progressive degeneration of smooth muscle cells in blood vessels)
How does CADASIL’s disease typically manifest?
“Migraine” headaches
TIAs
Strokes
