Dementia Flashcards
What is critical in distinguishing age-associated cognitive changes from true dementia? What about mild cognitive impairment? Why is mild cognitive impairment important? What is the DSM criteria for dementia (“neurocognitive disorder in the DSM5)? What is the most common cause of dementia? What genes are associated with the early onset form?
With age-associated cognitive changes, there is NO functional impairment (despite normal difficulty with words, names, learning something new, sustaining attention). With mild cognitive impairment, there is objective memory impairment for age & education, but general cognition is preserved & ADLs are NORMAL. But, MCI is important b/c 10-15%/yr progress to AD. DSM for dementia: Memory decline/impairment w/ 1+ of aphasia, apraxia, agnosia, impaired executive fxn + impact social/occupational fxn + dx made in presence of clear sensorium. Most common dementia: AD. Genes assoc. w/ early-onset AD: presenilin 1, 2, APP (chr. 21).
Cite 13 RFs for AD.
Increasing age, female, FH of dementia, less education, low income, low occupational status, depression/other emotional illness, postoperative delirium, head injury, low folate/B12, elevated homocysteine, APO E4, alcohol use.
What are three impairments of all AD patients? Contrast depression with dementia? What about FTLD vs Alzheimer’s?
AD: Impaired cognition (of course!), Impaired functioning (need this!), Impaired behavior (probably present too!). W/ primary depression, (1) less motivation during cognitive testing, (2) cognitive complaints > measured deficits, (3) maintain language & motor skills. W/ FTLD, memory loss occurs LATER, but there are EARLY declines in behavior, social conduct w/ emotional blunting.
Major classes of drugs used to treat AD? Why use the former? Why the latter? What are three other classes of drugs that can be used to treat neuropsychiatric disturbances in AD? Give examples.
Anticholinergics & NMDA receptor antagonists. In AD, degeneration of the basal nucleus of Meynert gives wide-spread Ach deficiency (contributes to memory loss) – anticholinesterase drugs block degradation of Ach in order to increase NT amts and preserve memory fxn. NMDA receptor antagonists can be used b/c excitotoxicity may cause neuronal damage. Also: antipsychotics (risperidone, haloperidol), antidepressants (sertraline, venlafaxine), anxiolytics (buspirone, lorazepam).
Name 4 anticholinesterase drugs used to treat AD. Which one is obsolete? Which can be given 1/day? Which comes in a transdermal patch? In general, what are side effects? What are rarer side effects?
Tacrin (now obsolete), Donepezil, Rivastigmine, Galantamine. Donepezil 1/day. Rivastigmine transdermal patch. Side efects: N/V, sleep disturbance. Rare: syncope, bradycardia, odd dreams.
What NMDA antagonist is used to treat AD? What is this especially for? Side effects?
Memantine. This is not usually 1st line drug – best for moderate/severe AD. Side effects: Dizziness, Confusion, HAs, constipation.
What is the second most common cause of dementia? How is it treated?
Vascular dementia. Like AD, this is treated with anticholinesterase drugs: Donepezil, Rivastigmine, Galantamine.
What does dementia with Lewy bodies (DLB) look like compared to PD and other dementias? How is this treated? What drugs should be avoided?
Memory less affected than AD (still, a gradual onset short term memory loss occurs), w/ frontal/subcortical features (attention, alertness) + possibly neuropsychiatric symptoms (vivid hallucinations & delusions, REM sleep disorder) often with fluctuation/variation in symptoms AND motor symptoms of PD. Frequent falls & ANS dysfxn Treat with anticholinesterases (what else? – Donepezil, Rivastigmine, Glantamine). REM sleep disorder: Clonazepam. AVOID antipsychotics.
Is the Mini Mental Status Examination (MMSE) diagnostic? What about the Montreal Cognitive Assessment (MOCA)? What is a normal score? Mild? Moderate? Severe?
Screening NOT diagnostic. For MMSE, Normal: 30-27. Mild: 30-20. Moderate: 20-10. Severe: <10
What are the ADLs? IADLs? If impaired ADLs, what is needed?
ADLs: Dressing, Eating, Ambulating, Toileting, Hygiene. IADLs: Shopping, Housekeeping, Accounting, Food Prep, Transport. W/ impaired ADLs, nursing home is needed.
