Dementia Flashcards
What can be defined as a progressive decline in intellectual function that is severe enough to compromise social or occupational functioning?
dementia
What can be defined as a decline that has not resulted in a change in the level of function?
mild cognitive impairment
When does dementia typically begin?
after 60
The prevalence of dementia ______ every 5 years after the age of 60, so that in persons 86 or older ____ have dementia
doubles
half
Is dementia more common men or women?
Women
What are the 2 general causes of dementia?
- Sporadic primary neurodegenerative disease
- As a result of another disease (i.e. stroke)
What is thought to be a protective mechanism against dementia?
ongoing intellectual stimulation
What are 5 risk factors for dementia?
- Age
- Family history
- Vascular disease risk factors
- Diabetes
- History of significant head injury
What can be defined as an acute confusional state that often occurs in response to an identifiable trigger?
delirium
What does delirium involve?
fluctuating levels of arousal (drowsiness or agitation)
What typically improves delirium?
treatment or removal of the trigger
Describe the relationship between dementia and delirium
Dementia patients are especially susceptible to episode of delirium, however recognition of dementia is not possible until the delirium lifts. This leads to the diagnosis of dementia in otherwise medically stable patients.
______ disease sometimes leads to complaints of impaired cognition
Psychiatric
When should symptoms of psychiatric disease resolve?
Following appropriate psychiatric treatment
_____ disorders are commonly seen in patients with neurodegenerative disease
Mood
True or False
Persistent untreated mood disorders may predispose to the development of age-related dementia
True
What do symptoms depend on?
area of the brain affected
What are 6 signs and symptoms of dementia?
- Short Term Memory Loss
- Word-Finding Difficulty
- Visuospatial Dysfunction
- Executive Dysfunction
- Apathy
- Apraxia
Short-term memory loss results from pathologic changes in what area of the brain?
hippocampus
Difficulty finding words results from pathologic changes in what area of the brain?
temporoparietal junction of the left hemisphere
Visuospatial dysfunction results from pathologic changes in what area of the brain?
right parietal lobe
Executive dysfunction results from pathologic changes in what areas of the brain?
- frontal Lobe
- subcortical areas (basal ganglia and cerebral white matter)
Apathy results from pathologic changes in what areas of the brain?
- frontal Lobe
- subcortical areas (basal ganglia and cerebral white matter)
Apraxia results from pathologic changes in what areas of the brain?
- frontal lobe
- parietal lobe (especially left)
What are 2 exams used to asses the neuropsychological aspect?
- Folstein Mini Mental State Exam (MMSE)
- Montreal Cognitive Assessment
\_\_-\_\_ = normal cognition \_\_-\_\_ = mild cognition impairment \_\_-\_\_ = moderate cognition impairment \_\_-\_\_ = severe cognition impairment
27-30
21-26
11-20
0-10
What are the 2 goals of the neuropsychological assessment?
- To enhance localization by defining the cognitive domains that are impaired
- To quantify the degree of impairment
What imaging modality is preferred in the diagnosis of dementia?
MRI
What do the MRI findings reveal?
Global or focal brain atrophy worse than expected based on patient age
What imaging modality allows for the assessment of metabolic activity of the brain?
PET imaging with fluorodeoxyglucose
What special imaging technique should be done in patients suspected of Alzheimer’s disease?
PET imaging with radiolabeled ligand for beta-amyloid
What 3 serum values must be measured in order to diagnose dementia?
- Vitamin B₁₂
- Free T₄
- Thyroid-stimulating hormone
What 3 diseases are common in dementia patients?
- Vitamin B₁₂ deficiency
- Hypothyroidism
- Syphilis
What lab testing must be done if Alzheimer’s is suspected?
ApoE genotyping
The presence of - ApoE epsilon-4 alleles indicates increased risk
1-2
Spinal fluid measurements indicate ____ levels of beta-amyloid and _____ levels of tau protein
decreased
increased
What are the 4 common causes of age-related dementia?
- Alzheimer Disease
- Vascular Dementia
- Dementia with Lewy bodies
- Frontotemporal Dementia (FTD)
What is the pathology behind Alzheimer disease?
Plaques containing beta-amyloid peptide, and neurofibrillary tangles containing tau protein, occur throughout the neocortex
What is the pathology behind vascualr dementia?
multifocal ischemic damage
What is the pathology behind dementia with Lewy bodies?
Alpha-synuclein-containing Lewy bodies occur in the brainstem, midbrain, olfactory bulb, and neocortex.
What is the pathology behind frontotemporal dementia?
Tau protein, TAR DNA-binding protein 43 (TDP-43), or fused-in-sarcoma (FUS) protein
What is a difficult diagnosis to establish from dementia?
Normal Pressure Hydrocephalus
What are the symptoms of normal pressure hydrocephalus?
- Gait apraxia
- Urinary incontinence
- Dementia
How is normal pressure hydrocephalus differentiated from dementia?
The MRI image reveals enlarged ventricles and overall atrophy of the brain
What are the nonpharmacological approaches to treating dementia?
- aerobic exercise
- mental stimulation
What 2 drugs are used in the treatment of cognitive symptoms?
- Cholinesterase Inhibitors
- Memantine
What drugs are considered to the first-line therapy for Alzheimer disease and dementia with Lewy bodies?
Cholinesterase Inhibitors
True or False
Cholinesterase inhibitors treat symptoms, but do not reverse the progression of the disease
True
What are the 3 most commonly used cholinesterase inhibitors?
- donepezil (Aricept)
- rivastigmine (Razadyne)
- galantamine (Exelon)
What drug treats moderate-severe Alzheimer disease?
Memantine
How does memantine work?
It acts on the glutamatergic system by blocking NMDA receptors
