Dementia

Question 1

dementia vs delirium

Answer 1

-memory loss that INTERFERES with life*, awake & alert
vs
-not alert, metabolic abnormalities

Question 2

dementia dx

Answer 2

• CT –> to rule out stroke, NPH, tumors
• mini mental state exam
• thyroid function tests
• RPR
• B12 levels

-rule out reversible causes

Question 3

dementia causes

Answer 3

• PML (in AIDS pts) –> JC virus
• Lewy body dementia
• Pick’s disease
• CJD -biopsy
• B12 deficiency
• hypothyroidism

Question 4

common causes of dementia

Answer 4

• stroke

- normal pressure hydrocephalus

Question 5

Lewy body dementia px

Answer 5

• Parkinsoniasm symptoms
• hallucinations
• fluctuating cognitive impairment

Question 6

hallucination vs delusion

Answer 6

-visual or auditory stimulus that aren’t actually present
vs
-false beliefs

Question 7

Pick’s disease px

Answer 7

• frontal & temporal lobes
• lobar atrophy
• SOCIAL appropriateness loss
• memory intact

Question 8

CJD px

Answer 8

• very rapid course (<6 months b/t dx and death)
• rapidly progressive dementia
• myoclonus*

Question 9

CJD dx, tx

Answer 9

• biopsy = most accurate
• CSF –> 14-3-3 protein* = specific

-tx: none

Question 10

dementia px

• mild cognitive impairment
• Alzheimer’s
• frontotemporal
• Lewy body
• Parkinson’s
• CJD
• multi-infarct
• NPH

Answer 10

• memory loss only
• memory loss + cognition loss
• personality changes, but visuospatial function spared
• fluctuating cognitive impairment + visual hallucinations
• dementia (late onset) + tremor + akinesia + rigidity
• rapidly progressive + myoclonus + 14-3-3
• slowly progressive
• gait abnormalities + incontinence + dementia

Question 11

Alzheimer’s px (on CT and clinically)

Answer 11

• diffuse cortical atrophy
• hydrocephalus
• Sylvian fissure enlarged

-memory loss that affects daily life

Question 12

Alzheimer’s tx

Answer 12

• inc ACh
• donepezil
• rivastigmine
• galantamine

-memantine –> protects neurons of brain

Question 13

Huntington’s disease genetics

Answer 13

• autosomal dominant
• chromosome 4p
• CAG trinucleotide repeat
• high penetration

Question 14

Huntington’s dx, tx

Answer 14

• genetic testing
• CT –> cerebral atrophy, caudate atrophy

-clozapine (for behavioral changes)

Question 15

Huntington’s px

Answer 15

-personality changes = irritability, apathy, anxiety, depressed, psychotic

• dementia
• movement disorder = chorea