Dementia Flashcards
1
Q
should we screen for dementia?
A
- The USPSTF concludes that the current evidence is insufficient to asses the balance and benefits and harms of screening for cognitive impairment in older adults
- Remain alert to early signs or symptoms of cognitive impairment and evaluate as appropriate
2
Q
- takes longer to learn and recall new information
- occasional trouble with word finding
- trouble remembering names of new acquaintances
- still able to maintain daily activities
A
Normal aging
3
Q
Warning signs of dementia
A
- memory loss that disrupts daily life
- challenges in planning or solving problems
- difficulty with time or place
- trouble understanding visual images or spatial relationships
- new problems with words in speaking or writing
- misplacing things and losing ability to retrace steps
- decreased or poor judgement
- withdrawal from work or social activities
- changes in mood or personality
4
Q
- three word registration
- clock draw
- three word recall
Abnormal screen
- total score < 3 (validated)
- total score < 4 (more sensitive)
A
Mini-Cog
5
Q
best studied exam for dementia
A
Mini-Mental Status Exam (MMSE)
6
Q
- Now requires training
- better for detecting mild cognitive impairment
- useful for patients with high education levels
A
Montreal cognitive assessment (MOCA)
7
Q
- Easy to administer
- Less well studied
- includes animal fluency test
A
St. Louis University Status examination
8
Q
- cognitive impairment based on history and objective testing
- not causing significatn functional impairment
- decline in cognition from baseline
A
Mild cognitive impairment
9
Q
- cognitive impairment based on history and objective testing
- causing significant functional impairment
- decline in cognition and function from baseline
- not explained by delirium or major psychiatric disoder
A
dementia
10
Q
management of mild cognitive impairment?
A
- Deprescribing
- no benefit of dementia medications for MCI
- exercise
- enjoyable lesiure activities
- mental stimulation
- monitoring for progression
11
Q
- Most common type of dementia (60-80%)
- gradual onset, slowly progressive
- prominent memory deficits; apathy and depression can be early symptoms
- later symptoms: impaired communication, disorientation, poor judgement, behavior change, diffculty speaking, swallowing, walking
- pathology: beta-amyloid protein (plaques) outside neurons, protein tau (tangles) inside neurons–> death of neurons
- mixed pathology is common
A
Alzheimer’s dementia
12
Q
- abnormal neurlogic exam
- abrupt change in cognition
- stepwise progression
- evidence of stroke on neuroimaging
- onset of dementia < 3 months follwoing stroke
- impaired judgement can be an early symptom
- 5-10% of dementia cases
- commonly mixed with alzheimer’s pathology
A
Vascular dementia
13
Q
- fluctuating attention and concentration
- sleep difficulties; REM sleep behavior disorder
- recurrent well-formed visual hallucinations
- parkinsonism, frequent falls
- visuospatial impairment
- severe reaction to antipsychotics
- memory may be intact
- 5% of dementia cases
- pathology: Lewy bodies- clumps of alpha synuclein protein in neurons
A
Dementia Lewy Bodies
14
Q
parkinson’s vs dementia with lewy bodies
A
parkinson’s disease dementia
- motor symptoms preceded cognitive symptoms by 6-8 years
Dementia with Lewy bodies
- tremor/ motor symptoms start within a year of cognitive symptoms
15
Q
- Early onset (60% age 45-60)
- behavioral variant: personality and behvavior changes (disinhibition, apathy, loss of empathy, compulsive/ritualistic behaviors, excessive/inappropriate eating & drinking, deficits in executive function
- primary progressive aphasia: language impairment - gradual loss of ability to speak, read, write, and understand
- spared memory and visuospatial skills early on
- associated with movement disorders, including amyotrophic lateral sclerosis (ALS)
- Pathology: frontal and temporal lobes become atrophied
A
Frontotemporal Degeneration (FTD)
