Dementia

Question 1

Alzheimer’s dementia - epidemiology

Answer 1

*estimated to be 60-70% of ALL dementias (most common type of dementia)
*2/3 are women
*increased rates in older black americans and older hispanics

Question 2

types of dementia

Answer 2

*Alzheimer’s disease (AD)
*Vascular dementia
*Lewy body dementia
*Parkinson’s dementia
*FTLD

Question 3

activities of daily living

Answer 3

*transferring
*toileting
*bathing
*hygiene/grooming
*dressing
*feeding oneself

Question 4

instrumental activities of daily living

Answer 4

*determine whether patient is independent, dependent, or requires assistance
-money management
-telephoning
-housework
-transportation
-medication management
-shopping
-meal preparation

Question 5

diagnostic criteria for AD

Answer 5

*established by clinical exam & cognitive testing (collateral history is critical)
*deficits in memory & at 1 other cognitive domain
*progressive worsening of cognition
*no disturbance of consciousness
*FUNCTIONALLY impaired (instrumental activities of daily living)
*absence of other brain disease

Question 6

Alzheimer’s Disease - Stage I

Answer 6

MEMORY DISTURBANCE
*poor judgement, carelessness in work habits and household chores
*disorientation in space & time, get lost in familiar surroundings
*apathy, irritability, suspicion
*mild anomia
*sx exacerbated by challenges (surgery, illness, travel, etc)

Question 7

Alzheimer’s Disease - Stage 2

Answer 7

APHASIA
*anomia, paraphasia, comprehension impaired
*apraxia, acalculia, apathy worsens
*restlessness/pacing, incontinence

Question 8

Alzheimer’s Disease - Stage 3

Answer 8

ALL INTELLECTUAL FXNS AFFECTED
*worsening language function
*motor disturbances (rigidity, flexed posture)
*incontinence of urine and feces

Question 8

important risk factors for Alzheimer’s Disease

Answer 8

*age (1/9 for 65+; nearly 1/3 for 85+)
*gender (women > men)
*head trauma
*depression
*excessive alcohol use (>14 drinks/week)
*diabetes
*sedentary lifestyle?

Question 9

genetics of Alzheimer’s Disease

Answer 9

90% sporadic

Question 10

early Alzheimer’s Disease

Answer 10

*cardinal symptom: impaired learning of new info
*verbal memory tests = most sensitive (decreased delayed)

Question 11

mild cognitive impairment

Answer 11

*mild impairment (-1 to -1.5 SD) in cognition relative to premorbid levels
*PRESERVED IADLs (instrumental ADLs)
*prognosis: majority progress to AD within 6 years

Question 12

vascular dementia

Answer 12

*step-wise progression:
1. evidence of cerebrovascular disease on neuro-imaging
2. decline in cognitive function in 2+ domains
3. compromise in daily functioning NOT explicable by deficits from stroke
*small vessel disease most common, often producing:
-executive fxn deficit
-reduced verbal fluency
-motor slowing
-depression, irritability, or apathy often present

Question 13

lewy body dementia

Answer 13

*core symptoms:
-fluctuations in cognition: attention, alertness, orientation
-visual hallucinations (vivid, well-formed)
-parkinsonism (bradykinesia/rigidity)
*suggestive sx: REM sleep problems, adverse rxns to levadopa
*supportive features: falls, syncope, autonomic dysfunction

Question 14

Parkinson’s vs. Lewy Body Dementia

Answer 14

*parkinson’s dx when motor sx precede cognitive sx by 1 yr
*Lewy Body disease dx when cognitive sx precede or occur together with motor sx