Dementia Flashcards
***Define dementia.
An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient.
- Progressive and disabling
- ***NOT an inherent aspect of aging
***What are the risks for dementia?
***Age (greatest risk factor) Family history Head injury Fewer years of education Genetics
***What are the causes of dementia?
- **1. Alzheimer’s Disease (most common cause of dementia).
2. Vascular (multi-infarct) dementia (#2 after AD; more of a stepwise decline).
3. Dementia associated with Lewy bodies.
4. Depression
5. Other (alcohol, Parkinson’s disease [PD], Pick’s disease, frontal lobe dementia, neurosyphilis)
What are the symptoms of AD?
memory impairment, cognitive decline, behavior and mood changes, difficulty learning/retaining new info., aphasia, apraxia, disorientation, visuospatial dysfunction, impaired judgment, delusions, aggression, wandering.
What is the DSM-IV Criteria for AD?
- Development of cognitive deficits manifested by: Impaired memory + 1 or more of the following: Aphasia, apraxia, agnosia, disturbed executive function
- Significantly impaired social, occupational function
- Gradual onset, continuing decline
- Not due to CNS or other physical conditions (e.g., PD, delirium)
- Not due to an Axis I disorder (e.g., schizophrenia)
What is the progression of AD?
Mild (loss of some IADLs)→ moderate (loss of all IADLs and some ADLs) → severe impairment (loss of ADLs)
What is the DSM-IV Criteria for Vascular Dementia?
- Development of cognitive deficits manifested by: Impaired memory + one or more of the following: Aphasia, apraxia, agnosia, disturbed executive function
- Significantly impaired social, occupational function
- Focal neurologic symptoms & signs or evidence of cerebrovascular disease
- Deficits occur in absence of delirium
What is Dementia associated w/ Lewy Bodies?
Dementia, visual hallucinations, ***parkinsonian signs, alterations of alertness or attention.
What is the difference between delirium and dementia?
Delirium and dementia often occur together in older hospitalized patients; the distinguishing signs of delirium are:
• Acute onset
• Cognitive fluctuations over hours or days
• Impaired consciousness and attention
• Altered sleep cycles
How do you evaluate pts with dementia?
MMSE, Mini-Cognitive Assessment, Labs, Imagaing
***How do you perform a Mini-Cognitive Assessment?
Step 1: ask pt. to repeat 3 unrelated words
Step 2: have pt. draw a clock at a certain time.
Step 3: ask pt. to recall 3 words (1 pt. per correct word)
# correct recall Clock drawing Result:
• 0 Normal Positive
• 0 Abnormal Positive
• 1 Normal Negative
• 1 Abnormal Positive
• 2 Normal Negative
• 2 Abnormal Positive
• 3 Normal Negative
• 3 Abnormal Negative
(Basically, if they cannot recall anything (0/3), it’s POSITIVE. If they can’t draw a clock, it’s POSITIVE (unless they recall 3/3–> negative))
***What labs are high yield in pts w/ abnormal cognitive tests?
CBC, chemistry panels, LFTs, syphilis, TSH, Vitamin B12
When should you use imaging? What types of imaging should you consider?
Use when: • Onset occurs at age < 65 years • Symptoms have occurred for < 2 years • Neurologic signs are asymmetric • Clinical picture suggests normal-pressure hydrocephalus Consider: • Noncontrast computed topography head scan • Magnetic resonance imaging • Positron emission tomography
What are the non-pharm management options?
- Cognitive enhancement (crosswords, reading)
- Individual and group therapy
- Daily routine (including regular appointments)
- Communication with family, caregivers
- Environmental modification (safety)
- Music and touch therapies
What are the pharm management options?
(band-aids)
• Cholinesterase inhibitors: donepezil, rivastigmine, galantamine
• Other cognitive enhancers: estrogen, NSAIDs, ginkgo biloba, vitamin D and E
• Antidepressants
• Antipsychotics
