Degenerative Dz JB Flashcards
What are the 5 cognitive domains?
- Memory
- Language
- Visual-Perceptual-Spatial
- Executive Function
- Social Function/behavior
What is the criteria for delirium?
- acute change or fluctuating course of mental status
- inattention
- either
- Altered level of consciousness
- disorganized thinking
positive antibodies to neuronal cell-surface or intracellular antigens such as VGKC or NMDA would make you think of…
that presents with ssx of…
limbic encephalitis
altered sensorium, rapid cognitive decline, altered mood/personality, and hx of autoimmunity likely
What is a special consideration for pts with limbic encephalitis?
a/w certain cancers - ovarian teratoma, small cell lung cancer, adenocarcinoma of breast, testicular cancer, lymphoma, etc
an LP of a pt with limbic encephalitis might show…
- increased protein
- elevated IgG index
- oligoclonal bands present
What is caused by a ‘deviant protein’ called a ‘proteinaceous infectious particle’?
prion disease - Jakob-Creutzfeldt Disease
How does Jakob-Cruetzfeldt Dz present?
rapidly progressive dementia with behavioral abnormalities, ataxia and eventually myoclonus, visual/cerebellar dysfunction
What does MRI and EEG show on Jakob-Creutzfeldt Disease, classically?
cortical ribboning
triphasic perioidic sharp wave complexes
What are the 5 criteria for dementia?
- interfere with the ability to function daily
- decline from prior levels
- not explained otherwise
- dx from H&P and objective cognitive assessment
- impairment of at least 2 cognitive domains (memory doesn’t have to be one)
pre-dementia/ mild cognitive impairment is different from dementia in that…
daily function is preserved
it is impairment in one or more cognitive domains
What is the MC mild cognitive impairment?
amnestic MCI, prodromal state of Alzheimer Disease
Not all MCI is early Alzheimer Disease. What else could it be?
depression
What is the most preventable cause of dementia?
vascular cognitive impairment
What criteria is needed with dx of vascular cognitive impairment?
- imaging evidence
- temporal relationship between vascular event and onset of cognitive deficits
- no hx of gradually progressive cognitive deficits before or after stroke to suggest another cognitive disorder
A major form of VCI is from multiple infarcts. These pts have a … course
step-wise course
small strokes in the basal ganglia and white matter or single stroke in thalamic region likely to impair cognition would be…
lacunar infarcts and single strategic infarcts
In most cases, nonstroke vascular cognitive impairment is caused by subcortical ischemic cerebral small vessels disease called…
Binswanger Disease
Clinical exam of Binswanger Disease would show…
gait disturbances, executive dysfunction, evidence of small strokes (hyperreflexia), apathy/depression
A major form of VCI is CADASIL (stands for….)
This is a genetic small vessel disease with vessel smooth muscle …. accumulation
ssx are…
Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy
NOTCH3
migraines, multiple strokes, and dementia
unrelated to atherosclerosis, this major form of VCI is caused by vascualy beta-amyloid deposition in the cerebral cortex and leptomeninges, this causes the vessels to…
cerebral amyloid angiopathy (CAA)
become fragile and can rupture leading to intracranial bleeding (superficial/lobar)
What is the MC neurodegenerative disorder?
When is it usually first symptomatic?
Alzheimer Disease
symptomat after age 65
What are the three steps of pathophys behind AD?
- Tau hyperphosphorylation causing interneuronal neurofibrillary tangles
- overproduction or impaired clearance of beta-amyloid causing neuritic plaques
- mesial temporal begins global atrophy
What are some risk factors for AD?
- age
- one or more APOE4 alleles
- family hx
- low edu/occupational attainment
- TBIs
- poor CR fitness in mid and late life
- midlife adiposity
- Afib
- stroke
- impaired insulin signaling
What is the tx of AD?
no FDA approved rx
lack of evidence for AChE inhibitors
aerobic exercise may be effective at reducing the rate of conversion
donepezil and rivastigmine have shown modest effects in trials
memantine is FAD approved for moderate tos evere AD
