Dementia Flashcards
Pseudodementia time course
Cognitive deficits typically manifest after mood symptoms. Sudden onset.
Pseudodementia is strongly associated with:
major depressive disorder
Pseudodementia is strongly associated with:
major depressive disorder
Distinctive clinical features of pseudodementia
- Patients able to recall onset of Sx
- Mostly depressed mood
- Patient gives short answers
- Cognition usually improves after effective antidepressant therapy
Pathological findings in pseudodementia
Structural or metabolic abnormalities that are associated with depression e.g. lesions of the limbic system.
Alzheimer’s disease time course
Slowly progressive over 8-10 years
Distinctive clinical features of Alzheimer’s disease
- Episodic impairment of memory.
- Characteristic order of language impairment (naming → comprehension → fluency)
Diagnosis of Alzheimer’s disease is made:
clinically
MRI findings in Alzheimer’s disease
Diffuse cortical atrophy and hippocampal atrophy.
CSF findings in Alzheimer’s disease
Decreased beta amyloid, increased phosphorylated tau
Pathological findings in Alzheimer’s disease
Neuritic plaques (amyloid beta peptides, mainly accumulating extracellularly)
Neurofibrillary tangles (abnormally phosphorylated tau protein, which accumulates intracellularly).
Vascular dementia time course
May present with abrupt cognitive decline and stepwise deterioration.
Distinctive clinical features of vascular dementia
Asymmetric or focal deficits (e.g. hemiparesis)
CT/MRI findings in vascular dementia
Multiple cortical and lacunar infarcts, white matter lesions
Lewy body dementia time course
Steady decline, usually over 8-10 years but more rapid progression is possible
Distinctive clinical features of lewy body dementia
Visual hallucinations and Parkinsonian motor disorders, attention impairment.
MRI features of lewy body dementia
Diffuse mild cortical atrophy, atrophy of substantia innominata and mesopontine grey matter
SPECT findings in lewy body dementia
Decreased occipital perfusion/metabolism.
Pathological features of lewy body dementia
Lewy bodies (intracellular aggregations of mainly a-Synuclein)
Risk factors for Alzheimer disease
Age > 60, cerebrovascular disease, Down’s syndrome, smoking, family history
Early-onset familial Alzheimer’s disease is inherited:
in an autosomal dominant pattern.
MOA of anticholinesterases
Decrease breakdown of Ach reducing the apparent deficiency of cholinergic neurotransmitter activity in AD.
Anticholinesterase precautions and contraindications
GI/ureteric obstruction, active PUD, pregnancy
Adverse effects of anticholinesterases
Vivid dreams, depression, increased sweating
What are the three drugs used for AD in the anticholinesterase class?
Donepezil
Galantamine
Rivastigmine
