Dementia

Question 1

dementia is now known as ___________

Answer 1

major neurocognitive disorder

Question 2

def major neurocognitive disorder

Answer 2

sig decline in at least 1 domain of cognition from the pt’s baseline AND persistent + progressive over time AND decrease ability to perform instrumental activities of daily living and activities of daily living

Question 3

dementia mimics

Answer 3

Head trauma
Delirium
Depression
Normal Pressure Hydrocephalus
Lyme disease
Toxic metals
Malnutrition
Cancer or paraneoplastic syndrome
Kidney or liver disease → accumulation of toxins

Question 4

reversible causes of dementia?

Answer 4

• alcohol
• medications
• heavy metal toxcitity
• hepatic or renal failure
• B12 deficiency
• metabolic: glucose, cortisol, increase Ca, and thyroid dysfunction
• normal pressure hydrocephalus
• depression
• tumour

Question 5

etiological causes of dementia?

Answer 5

• MC: Alzheimer
• 2nd: vascular ➔ HTN
• frontotemporal lobar degeneration
• lewy body
• parkinson disease
• HIV
• huntington disease
• prion
• substance/meds
• trauma

Question 6

general pathophys of major neurocognitive disorder

Answer 6

MC there is an accumulation of native proteins in the brain which results in deposits and subsequent neuronal degeneration

Question 7

proteins involved with Alzheimer

Answer 7

tau tangles and amyloid plaques

Question 8

proteins involved in lewy body dementia

Answer 8

lewy bodies ➔ alpha-synuclein

Question 9

protein involved in Huntington disease

Answer 9

huntingtin protein

Question 10

RF for major neurocognitive disorder

Answer 10

Family hx / genetics (Alzheimer)
↑ age (Alzheimer)
Low SES and education
Comorbidities for CVD (vascular)

Question 11

Main s/s of Alzheimer

Answer 11

amnesia
aphasia: language impairment
apraxia: motor impairment
agnosia: inability to remember prev known objects

Question 12

Main s/s of lewy body dementia

Answer 12

mainly visual hallucinations ➔ rabbits
parkinsonism
disordered sleep

Question 13

Main s/s of frontotemporal dementia

Answer 13

personality changes
poor executive functions - disinhibition, decrease social awareness

memory is relatively spared

Question 14

Main s/s of Huntington’s

Answer 14

chorea
irritability and depression

Question 15

Main s/s of vascular major neurocog disorder

Answer 15

step wise decline of A s/s bc of the infarcts

Question 16

main s/s of parkinson dementia

Answer 16

parkinsonism
timeline - the dementia s/s comes years later after showing the s/s of parkinsonism

Question 17

what are 4 or a potential 7 A’s of major neurocognitive disorders

Answer 17

• Amnesia
• Aphasia: language impairment
• Apraxia: inability to perform motor activities
• Agnosia: inability to recog prev known objects
• Altered perception and personality
• Anosognosia: unaware of what they don’t know
• Apathy

Question 18

what does sundowning mean?

Answer 18

context of major neurocog disorder

worsening of symptoms once the sun goes down

Question 19

what testing can you do for major neurocognitive disorder? (3)

Answer 19

• mini cog: 3 words immediate, clock-drawing, and 3 word delayed recall
• mini-mental state exam (MMSE)
• Montreal cognitive assessment (MoCA)

Question 20

how to tx major neurocognitive disorder to stop cognitive decline?

Answer 20

acetylcholinesterase inhibitors and NMDA antagonists

Question 21

how to manage major neurocog disorder s/s?

Answer 21

• consider antipsychotics for agitation and behavioural problems
• consider SSRI for depression
• consider trazodone for sleep disturbances

nonpharma
- redirection
- explore triggers and modify
- day centers or overnight centres

patient safety considerations
- ministry of transport
- social work and OT
- caregivers
- fall safety/prevention
- provide environmental cues and structure
- ensure power of attorney nad legal will is put in place before decline