Cognitive Changes in the Elderly: Normal and Abnormal Lecture Powerpoint

Question 1

Broca’s aphasia

Answer 1

Classically localized to regions affecting the frontal lobe, characterized by nonfluency and sparse output, comprehension is relatively spared but getting words out is challenging

Question 2

Wernicke’s aphasia

Answer 2

Classically localized to lesions affecting the posterior superior temporal gyrus, markedly impaired comprehension where speech is voluminous but meaningless often described as a word salad, usually speech retains normal cadence and intonation and patient apepars completely unaware of deficit

Question 3

Wernicke-Korsakoff syndrome

Answer 3

Associated with alcoholism, but can occur in other situations such as malnutrition or dialysis, classic triad is hoemorrhagic necrosis in midline brain structure producing deficits in mentaiton (encephalopathy), oculomotor function, and gait ataxia, administer thiamine as soon as expected as untreated results in death

Question 4

Anterograde amnesia

Answer 4

The impaired ability to formulate new memories

Question 5

Retrograde amnesia

Answer 5

Loss of all memories prior to an event

Question 6

Delirium

Answer 6

Acute change (hours to days) where a patient has fluctuating levels of consciousness easily confused with psychiatric disorders most often due to primary underlying causes such as a medical condition, medication or drug withdrawal

Question 7

Delirium diagnosis (4)

Answer 7

• NOT mini mental status exam
• confusion survey
• electrolytes, creatinine, tox screen, drug levels, etc (rule out)
• neuroimaging

Question 8

Most common medical etiologies of delirium (6)

Answer 8

• infection
• fluid and electrolyte disturbance
• withdrawal
• toxicity
• metabolic disturbances
• post op states

Question 9

Sundowning

Answer 9

Distinguished condition from delirium, frequently seen poorly understood phenomenon with frequent recurrence*** characterized by change in mental status and behavior often becoming more agitated as the day ends

Question 10

Dementia vs delirium

Answer 10

Insidious vs acute, stable and progressive vs fluctuating, sensorium intact till late vs impaired, poor short term memory vs globally impaired

Question 11

When I say amyloid plaques and neurofibrilary tangles you say…

Answer 11

….alzheimer’s disease

Question 12

Pick’s disease/frontotemporal dementia

Answer 12

dementia is initially manifested by changes in personality and social behavior or language progressing over time to a more global dementia, progresses more rapidly than alzheimer’s

Question 13

Dementia with lewy bodies

Answer 13

form of dementia is characterized by the presence of abnormal aggregates of protein that develop inside nerve cells. These are identified under the microscope when histology is performed on the brain, distinctive clinical features including visual hallucinations, parkinsonism, cognitive fluctuations, and dysautonomia, differentiated from parkinson disease because cognitive decline is manifested much earlier than motor symptoms

Question 14

Vascular dementia

Answer 14

Result of brain ischemia, no understood risk factors and not fully understood, no uniform diagnostic criteria, also referred to as post stroke dementia as clinical features are consistent with vascular etiology

Question 15

Parkinson disease dementia

Answer 15

Characterized by executive function (early findings include brady and akinesia, rigidity, etc) and sees memory loss as a later finding, most with parkinson disease will go on to develop this

Question 16

Diseases that present like dementia but unlike dementia are reversible upon proper diagnosis and treatment (3) (do initial lab workup based on these!)

Answer 16

• depression
• b12 deficiency
• hypothyroidism