Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Neurology Module > Dementia > Flashcards

Dementia Flashcards

1
Q

Types of Dementia

A 
Alzheimers
Multi-infarct dementia
Dementia with Lewy Bodies
Frontotemporal Lobar Degeneration
NPH
Medications
Vitamin B12 deficiency
Alcohol related dementia and Wenicke’s encephalopathy
Progressive supranuclear palsy
Other causes of dementia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Acutely disturbed state of mind that occurs in fever or intoxication or other disorders and is characterized by restlessness, delusions, and incoherence of speech and thought

A

Delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Chronic or persistent disorder of the mental process caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning.

A

Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Onset of Delirium

A

Acute

Subacute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Onset of Dementia

A

Insidious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Duration of Delirium

A

Days-weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Duration of Dementia

A

Months-years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Course of Delirium

A

Fluctuating

Reversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Course of Dementia

A

Progressive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Level of Consciousness in Delirium

A

Altered/variable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Level of Consciousness in Dementia

A

NL - Unless of Severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Attention in Delirium

A

Impaired

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Attention in Dementia

A

Initially Intact

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Psychomotor in Delirium

A

Variable - usually slow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Psychomotor in Dementia

A

+/- Normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sleep in Delirium

A

Disrupted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Sleep in Dementia

A

Less disruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Predominant Symptoms of Delirium

A

Hyperactivity- irritation, combativeness
Hypoactivity- sedation, lethargy (more common in the elderly)
Mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes/Risk Factors of Delirium

A 
Age >60
Prior brain injury (vascular or traumatic)
Insomnia, sleep deprivation
Decreased visual and/or auditory function
Hospitalization
Polypharmacy
Poor nutritional status
Renal/hepatic failure
Alcoholism
Infection

Pneumonia, UTI, meningitis/encephalitis

CV: hypoxia, CHF, dehydration, MI

Metabolic: hypo/hyperthyroidism, hypercalcemia (or other electrolyte imbalances), thiamine deficiency (Wernicke’s encephalopathy)

Neuro: CVA, seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Drugs to be avoided in the elderly

A

The Beer’s List for Potentially Inappropriate Medication Use in Older Adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Beers List - Sedating Antihistamines

A

diphenhydramine

promethazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Beers List - Benzodiazepines for anxiety or insomnia

A

May be appropriate in some settings (Seizure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why are TCAs on the Beers list?

A

Hypotension

Sedation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Beers List antibiotics

A

Nitrofurantoin

Causes Pulmonary Toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
CV drugs on the Beer's List
Alpha blockers (doxazosin, terazosin, prazosin, clonidine) Antiarrhythmics- amiodarone (rate control more beneficial than rhythm control) Digoxin (toxicity) Spironolactone (hyperkalemia)
26
Why are antipsychotics on the Beer's List?
Increased risk of stroke
27
Express caution with diabetic medications with:
SSI | Longer acting sulfonylureas - glyburide
28
Meoclopramide in elderly can cause
extrapyramidal effects
29
Long-term NSAIDs in elderly can have
increased risk of GI bleeding
30
Muscle relaxants in teh elderly?
Avoid
31
Most common type of dementia in the elderly
Alzheimer's Dementia
32
Presentation of Dementia
``` New information is difficult to learn and retain Complex tasks difficult to perform Unable to solve simple problems Getting lost in familiar surroundings Difficulty expressing oneself Irritable or aggressive behavior ```
33
Prevalence of Dementia
Age >65 10% | Age > 90 50%
34
Types of Dementia
Cortical - Alzheimer's metabolic Subcortical - vascular dementia Mixed - Parkson's, Lewy body
35
Cortical (Alzheimer's metabolic) dementia has:
Short term memory loss Aphasia Apraxia- inability to perform purposeful movement; inabilit to use objects properly (not due to sensory/motor deficits)
36
Subcortical (Vascular Dementia) has
Motor slowing | Mood disturbances
37
Mixed Dementia includes:
Parkinson's Disease, Lewy Bodies
38
Risk factors for dementia
``` Age >65 yo Female Family hx Low education level Head trauma Long standing htn/MI ```
39
Alzheimer's Genetic Link
Apolipoprotein E (ApoE)
40
How many subtypes of ApoE exist?
3 subtypes
41
What is associated with alzheimers?
E4 Mechanism? Increased amyloid deposition?
42
Chromosome linkage for early onset dementia:
21 14 1
43
Abnormal cleavage of protein leads to formation of βamyloid protein which deposits in blood vessels and activates glutamate
Amyloid Plaques
44
Helical filaments (tau proteins) stabilizers in cells/neurons; when hyperphosphylated, form tangles; hippocampus, medial temporal lobe, frontal lobe, parietotemporal area
Neurofibrillary Tangles
45
Pathophysiology of Alzheimers
Amyloid Plaques Neurofibrillary tangles Death of cholinergic neurons – decreased Ach (involved with memory) Death of serotoninergic neurons- decreased serotonin Death of adrenergic neurons- decreased norepinephrine +/- Inflammation
46
"Deaths" associated with Alzheimers
Death of cholinergic neurons – decreased Ach (involved with memory) Death of serotoninergic neurons- decreased serotonin Death of adrenergic neurons- decreased norepinephrine +/- Inflammation
47
DMS Criteria for Alzheimers (294.1)
The development of multiple cognitive deficits manifested by both: Memory impairment (impaired ability to learn new information or to recall previously learned information). One (or more) of the following cognitive disturbances: - Aphasia (language disturbance) - Apraxia (impaired ability to carry out motor activities despite intact motor function) - Agnosia (failure to recognize or identify objects despite intact sensory function) - Disturbance in executive functioning (ie. Planning, organizing, sequencing, abstracting) The cognitive deficits in A1 and A2 each cause significant impairment in social or occupational functioning and represent a significant decline from a previous level of functioning The course is characterized by gradual onset and continuing cognitive decline
48
Diagnosis of Alzheimers
Diagnosis of exclusion! CT/MRI- cortical atrophy; volume loss medial temporal lobe PET scans- hypometabolism
49
Treatment of Alzheimer's Disease
Cholinesterase Inhibitors Donepezil (Aricept) 5mg daily x 4-6 weeks; 10mg daily Rivastigmine (Exelon) - Pill or patch Galantamine (Reminyl, Razadyne) - 4mg BID, titrate Q4 wks to 24mg daily NMDA Receptor Antagonist - N-methyl-d-aspartate - Glutamate overstimulation of NMDA receptors allows increased calcium influx - Memantine (Namenda) 10mg BID
50
Goal of pharmacotherapy in Alzheimer's
Slow progression of Disease
51
Cholinesterase Inhibitors and NMDA Receptor Antagonists have
Similar Efficacy | GI side effects
52
Prognosis for Alzheimers
11.8 years
53
Cholinesterase Inhibitors for Alzheimers
Donepezil (Aricept) 5mg daily x 4-6 weeks; 10mg daily Rivastigmine (Exelon) - Pill or patch Galantamine (Reminyl, Razadyne) - 4mg BID, titrate Q4 wks to 24mg daily
54
NMDA-Receptor Antagonists for Alzheimers
N-methyl-d-aspartate Glutamate overstimulation of NMDA receptors allows increased calcium influx Memantine (Namenda) 10mg BID
55
Risk factors for multi-infarct dementia
``` Diabetes CAD Htn CVA Smoking Men>women ```
56
Treatment of multi infarct dementia
Manage risk factors | Alzheimers meds not effective
57
Pathonemonic for Dementia with Lewy Bodies
Visual Hallucinations!! Can have auditory or olfactory
58
Characteristics of Dementia with Lewy Bodies
Shares characteristics of Alzheimers and Parkinson’s Visual hallucinations (auditory, olfactory) Fluctuations in alertness and attention Periods of staring into space Affects men more than women
59
Pathophysiology of Dementia with Lewy Bodies
Lewy bodies- protein deposits in nerve cells Develop plaques and tangles (AD) Movement disorders- Parkinsonian sxs
60
Treatment of Dementia with Lewy Bodies
Same meds as Alzheimers Parkinsonian sxs- meds for Parkinson’s +/- anti-psychotics
61
Prognosis for Dementia with Lewy Bodies
Death ~5-7 years after diagnosis
62
Frontotermporal Lobar Degeneration AKA
Pick's Disease
63
Frontotermporal Lobar Degeneration onset
40-70
64
Frontotermporal Lobar Degeneration risk factors
Family History
65
What is found in structures of "Picks Disease"?
Named “Pick’s disease” for abnormal protein-filled structures found on pathology
66
Frontotermporal Lobar Degeneration presentation
``` Inappropriate behaviors and actions Decreased empathy Lack of judgement/inhibitions Apathy Repetitive compulsive behaviors Lack of hygiene Speech and language disorders +/- Movement disorders Lack of awareness of behavioral changes ```
67
Classifications of Frontotermporal Lobar Degeneration
Behavioral Variant FTD Semantic Dementia Progressive nonfluent aphasia
68
Behavioral variant FTD presents as
Decline in social skills, behaviors, emotional lability Poor hygiene Compulsive behaviors
69
Semantic Dementia presentation
Effortless speech that lacks meaning | Failure to recognize faces of famous people
70
Progressive nonfluent aphasia
Stuttering, poor grammar, difficulty with word finding, decreased comprehension
71
Treatment of Frontotemporal Lobar Degeneration
SSRIs- behavioral issues +/- antipsychotics +/- (experimental) Alzheimers meds- cholinesterase inhibitors
72
Prognosis for Frontotemproal Lobar Degeneration
8.7 years duration
73
Pathophysiology of NPH
Communicating hydropcephalus” No obstructive mass Decreased CSF absorption due to scarring/fibrosis of the arachnoid villae Ventricles become distended and compress the preiventricular tissues/vessels- ischemia
74
Causes of NPH
Idiopathic | Contributing factors: head injury, SAH, meningitis
75
NPH Triad
Gait Instability Urinary Incontinence Dementia Wobbly - Wet- Wacky Can't think, can't walk, can't pee
76
Testing for NPH
MRI | Lumbar Puncture
77
NPH - MRI will show
Ventriculomegaly Cerebral parenchyma preserved Medial hippocampus and temporal regions preseverved
78
NPH - Lumbar Puncture Results
Pressure at upper limits of normal Not needed for diagnosis but often will remove CSF and monitor response to see if shunting will be beneficial
79
NPH Treatment
Shunt system to drain spinal fluid from ventricles into abdomen.
80
Medications causing Dementia
``` Beer’s List (review) Intoxication/Withdrawal Opioids Benzodiazepine Corticosteroids Metoclopramide (Reglan) Antihistamines TCAs ```
81
Vitamin B12 Deficiency is caused by
``` Pernicious anemia (lack of intrinsic factor) Surgery Crohn’s, celiac Long term use of PPIs Autoimmune conditions: Graves, SLE ```
82
Signs and Symptoms of Vitamin B12 deficiency
``` Weakness Sore tongue Easy bruising, bleeding gums Pallor Paresthesias Mood changes Dementia/memory loss ```
83
Short term memory loss | Lack of thiamine (B1)
Wernicke-Korsakoff Syndrome | "wet brain"
84
Impaired planning, apathy (mimics depression)
Alcohol related dementia
85
Other neuro effects caused by EtOH
peripheral neuropathy, cerebellar ataxia, depression, psychosis
86
Questions to ask to determine severity of dementia:
When was the last time their thinking and memory was completely normal? Is there any time you thought they may have had a stroke? Do they repeat, misplace, forget names, rely more on calendars/notes? Who is in charge of meds? Finances? Word finding difficulty? Get lost driving? Do you feel comfortable leaving them home alone? Overnight? Weekend? Week? Can they perform ADLs? Are they depressed? Anxious? Agitated? Restless? Do they have hallucinations? Sleep? Incontinence? Hx head trauma?
87
Important PMH for dementia diagnosis
``` Neuro: seizures, strokes, Down’s syndrome CV: CAD, seizures Endocrine: DM, thyroid GI: hepatic disease Renal: failure- dialysis Psych: anxiety/depression Oncology ```
88
Important Social History regarding dementia
EtOH Ilicit Drug Use Exposures - HIV, syphilis, TB
89
Important FH regarding dementia
``` Dementia Psychiatric illness Endocrine Cancer Cardiac ```
90
Dementia Physical Exam Findings
General appearance- facies, basic mental status, grooming Cranial nerve exam: Pupillary response, EOMs, Symmetry Presence/absence of dysarthria Motor: Tremor, Lateralized weakness/spasticity, Cogwheeling/rigidity, Atrophy/fasiculations (ALS) Sensory: Hyperreflexia- stroke/vascular dementia, Hypo- neuropathy Gait/balance
91
Dementia Initial Labs
Mini-Mental Status Exam Labs: CBC, CMP, B12, folate, TSH, UA Imaging: CT or MRI (preferrable) Second line labs or as indicated in history: ESR, Syphilis serology VDRL/RDR, Lyme titer, LP, EEG, heavy metal screening, ceruplasmin, HIV
92
Nutrition issues with Dementia
``` Avoid enteral nutrition if possible Dysphagia diet Strongly flavored foods Liquid supplements Easy access to food Preferred treats Swallowing ability ```
93
Wandering Issues with Dementia
``` Common reason for nursing home placement Increase daytime activity Sleep hygiene Visual barriers/alarms ID bracelets Safe areas ```
94
What administration of medications are an issue with dementia?
Self-Administered | 30% dementia patients still have active license
95
Driving in Dementia
Double risk for accident
96
Is depression an issue with dementia?
YES!!! Depression may go away later on in dementia.
97
Symptoms worsening toward the evening
Sun Downing
98
Alcohol Related Dementia Ages
Age 50-70 Correlates to amount of alcohol/tiem period
99
Protection effect of alcohol related dementia
4 glasses daily may protect from dementia but more can increase risk
100
Diagnosis of Alcohol Related Dementia
Similar criteria to Alzheimers WITH -Significant EtOH (35 d/wk for men; 28/wk female) x 5 years -Onset of dementia within 3 yrs of cessation More supportive: other end-organ damage, peripheral neuropathy, cerebellar degeneration
101
EtOH Dementia Treatment
EtOH cessation Thiamine replacement Experimental research- Alzheimers meds?
102
S/S Wernicke's Encephalopathy
Ataxia Confusion Opthalmoplegia Vertical and horizontal nystagmus
103
Prognosis of Wernicke's Encephalopathy
Death occurs in 20% cases Those that survive, 85% will develop Korsakoff’s disease
104
Short term memory loss | Confabulation
Korsakoff's Disease
105
Treatment Korsakoff's Disease
Improvement in 75% patients with treatment Treatment: - Thiamine 100-200mg IM or IV - Maintenance 50 mg PO daily
106
Progressive Supranuclear Palsy
Rare Related to Parkinsons and FTD
107
Risk Factors of Progressive Supranuclear Palsy
Age | Familial
108
Supranuclear Palsy Symptoms
``` Blurred vision Loss of balance Stiffness and bradykinesia similar to Parkinsons Dysphagia Dysarthria Emotional labile Apathy/depression ```
109
Progressive Supranuclear Palsy Symptoms
Masked facies “Startled appearance” Paralysis of vertical gaze Overcome with vestibulaocular reflex (VOR) Later stages- horizontal movements impaired
110
Progressive Supranuclear Palsy Treatment
Vision/speech- no treatment Movement disorders- Parkinsons SSRIs- mood +/- Alzheimer’s meds
111
Infectious Diseases that cause Dementia
Syphilis (tertiary) AIDS/HIV Infection- toxoplasmosis, Lyme disease, PML, encephalitis Prion disease- Jacob-Creuzfeldt
112
Infections that cause Dementia
Taxoplasmosis Lyme Disease PML Encephalitis
113
Other Diseases that can cause dementia
Hyper/Hypothyroidism Neoplasms Parkinson's Disease Depression
114
Rare causes of dementia
``` Wilson's Disease Paraneoplastic Syndromes Sarcoidosis SLE Whipple's Disease MS ALS-late ```
115
Evaulation of Dementia
Age Source- patient vs. family member Onset: acute, subacute, chronic, initiating event? Pace: slow vs. rapid; plateaued, fluctuating Cognitive domains involved: attention, memory, executive function, calculation Behavior: irritability, lability, social w/drawal, disinhibition Degree of disability/independence Associated symptoms: weakness, HA, fever, incontinence, falls/ataxia, depression

Neurology Module (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions