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Medicine II: Neurology > Dementia > Flashcards

Dementia Flashcards

1
Q

What is the relationship between depression and dementia?

A

depression can mimic AD and other dementias
depression can be a harbinger of dementia
depression can be a symptom of dementia

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2
Q

What is normal pressure hydrocephalus?

A

problem with reabsorbtion of CSF fluid

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3
Q

Who is at a greater risk for normal pressure hydrocephalus?

A

those with a history of meningitis or subdural hemorrhage

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4
Q

What are the classic characteristics of normal pressure hydrocephalus?

A

gait apraxia
urinary incontinence
confusion

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5
Q

What are the MRI findings of normal pressure hydrocephalus?

A

ventriculomegaly out of proportion to any sulcal atrophy, subependymal leakage

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6
Q

What is the treatment for normal pressure hydrocephalus?

A

placement of a ventriculoperitoneal shunt

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7
Q

What is the prognosis of normal pressure hydrocephalus?

A

presence of triad, short duration, significant improvement after large volume LP (110-120cc (40 per day))

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8
Q

What is mild cognitive impairment?

A

cognitive complaint and dysfunction of exam but preserved function with no other etiology

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9
Q

What is amnestic mild cognitive impairment?

A

MCI with a memory component

GREATER risk of developing PD (10-15%)

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10
Q

What is the relationship between MCI in pts younger than 55 and dementia?

A

MCI in patients younger than 55 have NO EVIDENCE of a conversion to dementia

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11
Q

What is the most common dementia in ages 60 and over?

A

AD

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12
Q

What is the percentage of the population who is over 80 with AD?

A

50%

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13
Q

What is the first and worst sign of AD?

A

MEMORY

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14
Q

What are other characteristics of AD?

A

should have two or more cognitive domains involved
animal fluency > letter fluency
some functional impairment
amyloid plaques

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15
Q

What does the MRI show with AD?

A

atrophy, particular in the hippocampal regions

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16
Q

What are the risk factors for AD?

A 
AGE
low education
uncontrolled DM
FHx
APOE genotype
Mutations (chromosomes 21, 14, 1)
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17
Q

Is there a correlation between down syndrome and AD?

A

yeas almost all pts with down syndrome have AD by 50 yo

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18
Q

How do we stage and follow AD?

A

MMSE and MoCa

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19
Q

What are the MMSE scores?

A 
>20 = mild
10-20 = moderate
<10 = severe
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20
Q

T/F: AD is misdiagnosed in higher educated pts and under-diagnosed in undereducated.

A

false other way around

21
Q

What is multiple infarct dementia?

A

Step wise deterioration and focal signs and symptoms

strokes on MRI

22
Q

What is subcortical dementia?

A 
gradual and/or stepwise deterioration
no memory problem
letter fluency > animal
MoCA < MMSE
Lacunes and/or white matter changes on MRI
23
Q

What are the four horsemen of neurological Apocalypse?

A

smoking
DM
HTN
hypercholestremia

24
Q

What is an addition risk factor for multi-infarct dementia?

A

a fib

25
Q

What is mixed AD/VD?

A

they share a common risk factor (DM), these symptoms co occur; need to treat both!

26
Q

What is Lewy Body dementia?

A

same pathology as parkinsons, but in the cortex

less problems with memory, more with executive function

27
Q

What are the symptoms of LBD?

A

*early halucinations, rigidity, falls and fluctuating loss of consiousness

NEED to have visuospatial dysfunction

28
Q

What is Parkinsons Disease Dementia?

A

subtle cog problems, memory is less of a problem

low letter fluency and MoCA

29
Q

What are the types of parkinsonian syndromes?

A

progressive supranuclear palsy

corticobasal degeneration

30
Q

What are the symptoms of progressive supranuclear palsy?

A

gaze palsy especially on downward gaze
early parkinsonism, especially falls and rigidity, less so tremor.

more subcortical abnormalities

31
Q

What are the symptoms of corticobasal degeneration?

A 
unilateral ideomotorapraxia, agraphesthesia, astereognosis
alien hand syndrome
myoclonic jerks
some parkinsonism
GAIT is often preserved until late
32
Q

What are the types of frontotemporal lobe degenerations?

A

frontotemporal dementia
progressive non-fluent aphasia
semantic dementia

33
Q

How do frontatemporal lobe degenerations compare with PD?

A

earlier onset (40s)

34
Q

What are the characteristics of frontotemporal dementia?

A

early odd and innappropriate behavior, food cravings, poor judgement, loss of insight and empathy
may test perfectly normal

35
Q

What does the MRI show in pts with frontotemporal lobe dementia?

A

atrophy in the right frontal and temporal lobes

36
Q

What are the characteristics of progressive non-fluent aphasia?

A

pt has a loss of luency and language expression early

MRI may show increased atrophy in left frontal and temporal lobes

37
Q

What are the characteristics of semantic dementia?

A

language is fluent but patient loses the meaning of things, may lose empathy
some memory problems
MRI may show increased atrophy in bilateral anterior temporal lobes

38
Q

When do we check for dementia?

A

complaints of chronic memory loss of changes in thinking or behavior
if there is a strong FHx of dementia

39
Q

What is the MoCA?

A

Montreal cognitive assessment (takes 10 min)
30 point scale, 26 or above is normal
add a point if not a HS grad

40
Q

What is the typical onset of AD?

A

gradual and slowly getting worse

41
Q

What are symptoms of AD?

A

forgetting things
changes in language expression or comprehension
weakness, numbness, vision loss on one side of body
early halucinations
early slowing down, gait changes, fall, tremor
urinary incontinence
paranoia
poor judgement
disinhibitted behavior
strange new food cravings

42
Q

What do we also screen for with AD?

A

depression

43
Q

What is the association of sleep studies with CPAP?

A

if pt has symptoms suggestive of obstructive sleep apnea, will help control vascular risk and may help with mild cog symptoms

44
Q

What are non medical treatments for dementia?

A

exercise and intellectual stimulation

45
Q

Treatments for dementia:

A

acetylcholinesterase inhibitors (gradually titrate)
donepezil- mild, moderate, severe dementia
rivastigmine- mild to moderate AD & PD
galantamine- mild to moderate AD

46
Q

What is the main side effect of acytlcholinesterase inhibitors?

A

GI problems, also can have bradycardia, sleep disturbances and muscle cramps

47
Q

What are things to think about when using rivastigmine and galantamine?

A

rivastigmine- only the last month is therapeutic

galantamine- dont use in MCI, adverse effects

48
Q

What are other treatments for dementia?

A

memantine (weak NMDA antagonist)- moderate to severe AD

Ergoloid mesylates (sympathetic metabolic enhancer)- idiopathic cog decline in elderly
SE= bradycardia, feeling of runny nose

Medicine II: Neurology (12 decks)

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