Cognitive disorders

Question 1

What is dementia

Answer 1

An acquired, generalized and usually progressive impairment of cognitive function with preserved level of consciousness (Clinical Neurology)

•A general term for loss of memory and other mental abilities severe enough to interfere with daily life (Alzheimer’s Association)

Dementia is not a specific disease. It is a descriptive term for a collection of symptoms

Question 2

Diagnosis criteria for dimentia

Answer 2

Doctors diagnose dementia only if two or more brain functions - such as memory and language skills – are significantly impaired without loss of consciousness

Question 3

Mnemonic for Neurologic Disease Etiology

Answer 3

V=vascular or vasculitis

I=infectious

T=trauma or toxin

A=autoimmune

M=metabolic

I=inflammatory

N=neoplastic (paraneoplastic)

S=seizure

C=congenital

D=degenerative

Additional etiologies to consider:

• Normal Pressure Hydrocephalus (NPH)
• Medications

Question 4

Alzheimer’s pathology, clinical progression, meds

Answer 4

Path:

Neuritic (senile) plaques (Aβ)

Neurofibrillary tangles (tau)

Neuronal loss (Cerebral cortex and hippocampus)

Progress: Short-term memory

Meds:

Glutamate antagonist

Acetylcholinesterase inhibitor

Question 5

Vascular dimentia pathology, clinical progression, meds

Answer 5

Path: Multiple infarcts (cortical, hippocampus or thalamus, lacunar, ICH)

Hypertension (HTN)

Progress: Acute onset

Stepwise progression

Meds:

Manage HTN

Mixed: Alzheimer + Vascular

Question 6

Frontotemporal dimentia pathology, clinical progression, meds

Answer 6

Path:

Frontal and temporal lobe atrophy

Tangles and Pick bodies (tau)

Progress:

Behavior

Language Fasciculations

Meds: SSRI

Question 7

Lewy Body dimentia pathology, clinical progression, meds

Answer 7

Path:

α-synuclein Lewy bodies in the brainstem and cerebral cortex

Progress: TRAP tremors, rigidity, akinesia, posture

Visual hallucinations REM sleep behavior

Antiparkinsonian

Meds: Mixed: Alzheimer + LBD

Question 8

Creutzfeldt-Jakob Disease pathology, clinical progression, meds

Answer 8

Path:

Proteinaceous infectious particle (Prion)

Variable cortical and subcortcal degeneration

Genetic or Acquired

Progress: RAPIDLY progressing

Memory

Myoclonus

Psychiatric symptoms

Question 9

Huntington Disease pathology, clinical progression, meds

Answer 9

Path:

Inherited (AD)

Atrophy of the caudate nucleus, putamen and cerebral cortex

Progress: Chorea

Impaired executive function & memory

Psychiatric symptoms

Neuroleptic agents

Dopamine depleters

Benzodiazepines.

Question 10

Diagnostic tests for dimentia

Answer 10

Question 11

Best way to differentiate types of dimentia

Answer 11

Determine the time of onset and rate of progression of symptoms