Dementia Flashcards
Definition of dementia
- a syndrome of progressive and significant impairment of ADL
- memory loss + 1 other cognitive impairment (language, visuospatial ability, calculation, judgement, problem solving)
Major RFs of dementia
age, fhx, low education level, females, vascular disease (smoking, DM, BMI>30, HTN)
Mild cognitive impairment
measurable cognitive impairment that does NOT disrupt ADL
Neurobiology of dementia
- Disruption of cerebral neuronal circuits
- Memory and cognitive functions (ACh receptors)
- Behavior and mood (noradrenergic, serotonin, dopamine)
Alzheimer’s Disease on imaging
diffuse atrophy of cerebral cortex, secondary enlargement of ventricular system, amyloid plaques
AD symptoms
MEMORY
frontal lobe: anosognosia, executive fxtn impairment (navigation)
parietal/temporal: aphasia, visuospatial skills
Hippocampus: impaired ability to form new memories
Frontal lobe impairment
executive function
anosognosia
Parietal/temporal impairment
Language
Visual-spatial skills
Hippocampus impairment
impaired ability to form new memories
2 types of vascular dementia
multi-infarct
diffuse white matter
multi-infarct vascular dementia signs on PE
focal neuro signs: hemiparesis, unilateral Babinski, visual field defect
multi-infarct vascular dementia on imaging
multiple lesions with focal damage
diffuse white matter vascular dementia
Chronic ischemia small vessels
Insidious and slowly progressive
diffuse white matter vascular dementia signs
Pyramidal signs
Cerebellar signs
signs of frontotemporal dementia
behavior/mood changes - poor personal and social skills, repetitive behaviors, disinhibition
MEMORY spared
Pick’s disease
rare subset of frontotemporal dementia with Pick’s bodies on microscope
Parkinsonian dementia
dementia follows Parkinson’s disease
What are Lewy Bodies?
very tiny abnormal protein structures found in brain neurons
CJD
prion disease of infectious proteins rapidly progressive dementia issues with muscle coordination myoclonus eventually can't move or speak and enter coma subtypes: Kuru, Mad Cow
Huntington’s Disease
- autosomal dominant degenerative brain disorder
- chorea, behavior disturbances, executive impairment
Wernicke’s Encephalopathy
MALNOURISHED individual (freq alcoholic) Vit B1/thiamine deficiency
Where does Vit B12 absorption occur?
distal ileum
Korsakoff’s Syndrome
IRREVERSIBLE dementia from CHRONIC B1 deficiency
Vit B12 deficiency
pernicious anemia
Lewi Body dementia
Abnormal aggregates of proteins that develop in nerve cells of substantia nigra and cortex in PARKINSON’S DISEASE
Dementia precedes Parkinsons
Most common cause of dementia
Alzheimer’s (55%)
Drugs that increase incidence of dementia
ANTICHOLINERGICS
Tricyclic antidepressants (doxepin)
antihistamines (chlorpheniramine)
antimuscarinics for bladder control (oxybutynin)
Meds to treat cognitive symptoms
Cholinesterase inhibitors: Donepezil (Aricept)
Neuropeptide Modifying Agents: Memantine (Namenda) - blocks glutamine
Meds to treat behavioral symptoms
SSRI: Prozac (fluoxetine), Celexa (citalopram)
Antipsychotics: Risperdone (risperdal)
Diffuse atrophy of cerebral cortex
Alzheimer’s
How is dementia different than delirium?
- delirium has rapid onset (dementia insidious and progressive)
- delirium involves hallucinations, agitation, and clouded consciousness (dementia doesn’t)
Primary deficit of delirium is ______.
attention
Primary deficit of delirium is ______.
attention
How are dementia and delirium the same?
both have memory impairment and confusion
78 yo who has is admitted due to visual hallucinations, inconsistent participation in personal care activities, inability to manage at home.
DDXs?
Lewy Body dementia
Alzheimer’s/vascular dementia
Delirium
Medication with biggest risk of delirium
Benzodiazepines
When is the best time to use benzodiazepines for delirium?
using benzos for alcohol withdrawal and DTs (delirium tremors) can be life-saving
- also use for acute seizures
