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NMSP Exam 2 > [CLMD] Dementia [Hon] > Flashcards

[CLMD] Dementia [Hon] Flashcards

1
Q

What is the DSM-IV definition of Dementia?

A

“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”

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2
Q

What is the prevalence of dementia in patients over the age of:

65?

85?

A

More than 10% = 65yo

More than 30% = 85yo

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3
Q

What is the most common DEGENERATIVE cause of dementia?

A

Alzhemier’s Disease

(80%)

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4
Q

What is the second most common DEGENERATIVE cause of dementia?

A

Lewy body disease

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5
Q

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)

A
  • Parkinson’s disease
  • Frontotemporal lobar degeneration
  • Progressive supranuclear palsy
  • Corticobasal degeneration
  • Multiple systems atrophy
  • Huntington’s disease
  • Olivopontocerebellar degeneration
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6
Q

Overall, what are the (8) categories of causes of dementia?

A

Degenerative

Vascular

Infectious

Psychiatric

Toxic/metabolic

Traumatic

Tumors

Other

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7
Q

What are examples of vascular causes of dementia?

A

Multiple infarction

Single stroke

Binswanger’s disease

Vasculitis

Subarachnoid hemorrhage

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8
Q

What are examples of infectious causes of dementia?

A

Fungal meningitis

Syphilis

AIDS dementia

Creutzfeldt-Jakob disease

Post-herpes simplex encephalitis

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9
Q

What are examples of psychiatric causes of dementia?

A

Depression

Alcohol use

Drug-related disorder

Personality disorder

Anxiety disorder

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10
Q

What are examples of toxic/metabolic causes of dementia?

A

Vitamin B12 deficiency

Thyroid deficiency

System failure: liver, renal, cardiac, respiratory

Heavy metals

Toxins

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11
Q

What are examples of traumatic causes of dementia?

A

Subdural hematoma

Closed head injury

Open head injury

Chronic Traumatic Encephalopathy (CTE)

Anoxic brain injury

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12
Q

What are examples of tumor causes of dementia?

A

Astrocytoma/glioblastoma

Lymphoma

Metastatic tumor

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13
Q

What are examples of OTHER causes of dementia?

A

Symptomatic hydrocephalus

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14
Q

What is argueably the most important aspect of an evaluation of a patient with dementia?

A

HISTORY

*Preferably obtained from the patient AND from spouse or other family members, caregivers, etc*

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15
Q

What may you want to consider if you are interviewing both the patient with dementia and a family member about the patient’s history?

A

Separate interviews

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16
Q

What are specific subjects to ask about in the history of a dementia patient?

A

PATIENT DIFFICULTIES

  • Memory?
  • Progression?
  • Functioning of pt?
  • Safety? (guns in house?)
  • Head injury?
  • Family hx of dementia?
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17
Q

What is the standardized examination to perform on a dementia patient?

A

Mini-Mental State Examination

18
Q

What laboratory studies are recommended in all cases of dementia?

A

CBC

Chemistry panel

Sed rate

Thyroid function studies

B12 level

RPR

CT or MRI of the head

19
Q

What are the selective tests recommended for:

  • Creutzfeldt-Jakob, Encephalitis
  • Cancer, infection, vasculitis, NPH
A

EEG = Creutzfeldt-Jakob, Encephalitis

LUMBAR puncture = Cancer, infection, vasculitis, NPH

20
Q

What is the criteria for clinical diagnosis of Alzheimers disease?

A

Deficits in 2 or more areas of cognition

Progressive worsening of memory and other cognitive function

No disturbance in consciousness

(Dementia established via MMSE)

21
Q

What are examples of laboratory supportive findings for Alzheimer’s disease?

A

Normal lumbar puncture

EEG: normal/mild generalized slowing

Progressive atrophy documented by MRI or CT brain

22
Q

What is the main goal of treatment for Alzheimer’s disease?

A

Slow the progression of the disease

23
Q

What is the primary category of drug used to treat alzheimers?

A

Acetylcholinesterase Inhibitors

24
Q

What are the (3) primary acetylcholinesterase inhibitors used to treat Alzheimer’s disease?

A

Donepizil

Rivastigmine

Galantamine

25
Q

What is an additional category of drug that has shown some efficacy in treating Alzheimer’s disease?

A

NMDA receptor antagonist - Memantine

26
Q

What is a mild cognitive impairment (MCI)?

A

Memory complaint; typically noted by the patient

Tested abnormal memory for age, yet does NOT meet the criteria for dementia

27
Q

How do you manage a patient with mild cognitive impairment?

A

MCI is probably a precursor to Alzheimer’s disease

Patients with MCI are 5x more likely to develop AD

Therefore: Treat with AchEI medications

28
Q

What is the primary finding for probable vascular dementia?

A

Focal signs on neuro exam

(Hemiparesis, lower facial weakness, babinski sign, sensory deficit, hemianopia etc)

29
Q

What is the tetrad of symptoms of diffuse lewy body disease?

A
  • Dementia
  • Parkinsonian symptoms
  • Promnent psychotic symptoms (hallucinations)
  • Extreme sensitivity to antipsychotic agents
30
Q

Compare diffuse lewy body disease to alzheimer’s disease

A

Diffuse lewy body disease:

  • progresses more rapidly than AD
  • symptoms generally vary a great deal more day to day than AD
31
Q

Most patients with diffuse lewy body disease experience severe, potentially life-threatening adverse reactions if treated with _______________

A

Most patients with diffuse lewy body disease experience severe, potentially life-threatening adverse reactions if treated with ANTIPSYCHOTIC AGENTS

32
Q

Lewy bodies are located in the __________ for parkinsons disease

A

Lewy bodies are located in the Basal ganglia for parkinsons disease

33
Q

What are the features of frontotemporal degeneration?

A

Slow progressive deterioration of:

Social skills

Changes in personality

Impairment of intellect, memory and language

34
Q

What is the triad of normal pressure hydrocephalus?

A

Dementia

Gait disturbance

Urinary incontinence

35
Q

What is the most likely feature of normal pressure hydrocephalus to be reversed with shunting?

A

GAIT

36
Q

What does CADASIL disease stand for?

A

Cerebral autosomal dominant subcortical infarcts and leukoencephalopathy

37
Q

Age of onset for CADASIL?

A

40-50 yo

38
Q

What is the pathophys of CADASIL’s Disease?

A

Hereditary stroke disorder

(Progressive degeneration of smooth muscle cells in blood vessels)

39
Q

How does CADASIL’s disease typically manifest?

A

“Migraine” headaches

TIAs

Strokes

40
Q
A

NMSP Exam 2 (16 decks)

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