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Symptoms > Dementia > Flashcards

Dementia Flashcards

1
Q

_________ is a MEDICAL EMERGENCY.

A

Delirium

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2
Q

What are the 3 steps in the Cognitive Continuum?

A
  • Preclinical [Normal Cognitive function]
  • Minor neurocognitive disorder [Mild Cognitive Impairment]
  • Major neurocognitive disorder [Dementia]
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3
Q

What are Instrumental Activities of Daily Living?

A
  • Cooking
  • House cleaning
  • Laundry
  • Management of medications
  • Management of the telephone
  • Management of personal accounts
  • Shopping
  • Use of transportation
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4
Q

What are Activities of Daily Living (ADLs)?

A

DEATH

  • Dressing
  • Eating
  • Ambulating
  • Toileting
  • Hygiene (Bathing)
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5
Q

What is the Mini-Cog Exam?

What are the 3 steps?

A
  • Ask patient to remember 3 unrelated words
    • Banana, Sunrise, Chair
    • Village, Kitchen, Baby
    • Leader, Season, Table
  • Ask patient to draw the face of a clock. After the numbers are on the clock, ask patient to draw hands to read 10 min after 11:00
  • Ask patient to recall the 3 words
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6
Q

How is the Mini-Cog exam scored?

A
  • 3 recalled words
    • Negative for cognitive impairment
  • 1-2 recalled words + normal clock
    • Negative for cognitive impairment
  • 1-2 recalled words + abnormal clock
    • Positive for cognitive impairment
  • 0 recalled words
    • Positive for cognitive impairment
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7
Q

What is the laboratory work up for all patients?

A
  • CBC
  • Electrolytes
  • Creatinine
  • Glucose
  • TSH
  • Vitamin B12
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8
Q

What is the laboratory work up for selected cases?

A
  • HIV serology
  • RPR
  • Heavy metal screening
  • LFTs
  • MMA
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9
Q

What is a normal score for the Montreal Cognitive Assessment test? (MOCA)

A

> 26/30

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10
Q

How are Neurocognitive Disorders defined according to DSM-V?

A
  • Delirium
  • Neurocognitive disorders [not delirium]
    • Minor
    • Major
  • Further subdivision based on etiology
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11
Q

What is the Dementia/Major Neurocognitive Disorder Diagnostic Criteria for DSM-5?

A
  • Evidence of significant cognitive decline from a previous level of performance in one or more cognitive domains based on:
    • Concern of the individual, knowledgeable informant, or the clinician that there has been a significant decline in cognitive function AND
    • A substantial impairment in cognitive performance (documented)
  • The cognitive defects interfere w/ independence in everyday activities
  • The cognitive defects do not occur exclusively in the context of a delirium
  • The cognitive defects are not better explained by another mental disorder
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12
Q

What are the 6 cognitive domains?

A
  • Complex attention
  • Executive function
  • Learning & memory
  • Language
  • Perceptual-motor
  • Social cognition
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13
Q

What are the 4 components of a dementia diagnosis?

A
  • >2 cognitive domains affected
  • Impaired occupational function
  • Evidence of progression
  • No alternative diagnosis
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14
Q

Mild Cognitive Impairment (MCI)

  • Onset
  • Domain
  • Motor
  • Progression
  • Imaging
A
  • Onset: Gradual
  • Domain: >Memory
  • Motor: Rare
  • Progression: 12%/yr to Alzheimer’s
  • Imaging: Normal or Alzheimer’s pattern
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15
Q

Alzheimer’s Disease

  • Onset
  • Domain
  • Motor
  • Progression
  • Imaging
A
  • Onset: Gradual
  • Domain: Memory, Language, Visuospatial
  • Motor: Late
  • Progression: Gradual (8-10 yrs)
  • Imaging: Atrophy, small hippocampal volume
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16
Q

Vascular Dementia

  • Onset
  • Domain
  • Motor
  • Progression
  • Imaging
A
  • Onset: Sudden & gradual
  • Domain: Depends on location
  • Motor: Depends on location
  • Progression: Depends on ischemia pattern
  • Imaging: Cortical or subcortical MRI changes
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17
Q

Lewy Body Dementia

  • Onset
  • Domain
  • Motor
  • Progression
  • Imaging
A
  • Onset: Gradual
  • Domain: Memory, visuospatial, hallucinations, fluctuating
  • Motor: Parkinsonism
  • Progression: Gradual & cognitive fluctuations
  • Imaging: Atrophy
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18
Q

What is the prevalence of dementia by age?

  • 65-75
  • >75
  • >85
A
  • 65-75
    • Outpatient: 2.1%
    • Inpatient: 6.4%
  • >75
    • Outpatient: 11.7%
    • Inpatient: 13.0%
  • >85
    • Outpatient: -
    • Inpatient: 31.2%
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19
Q

What are the typical pathologic findings of Alzheimer’s disease?

A
  • Decreased brain weight
  • Atrophy of gyri & widening of sulci
  • Senile Plaques (amyloid)
    • Diffuse: EC accumulation of Aß protein
    • Neuritic: EC accumulation of Aß protein & tau containing neurites
  • Neurofibrillary Tangles
    • Intraneuronal accumulation of abnormally phosphorylated tau (normal MT associated protein)
    • Not unique to AD, found in other degenerative diseases
20
Q

What is the typical prognosis of Alzheimer’s disease?

A
  • Estimates of median survival: 5-9 yrs
  • 3 yrs (2.7-4 yrs)
21
Q

Dementia can lead to impairments in…..

A

“Make safety a priority before it’s a problem!”

  • Judgment
  • Orientation
  • Behavior
  • Physical ability
22
Q

What are some safety issues in dementia?

A
  • Home environment
  • Medications
  • Firearms
  • Wandering & getting lost
  • Driving
23
Q

What is the second most common type of dementia?

What is the second most common type of degenerative dementia?

A

Vascular dementia

Lewy body dementia

24
Q

Lewy Body Dementia

  • Prevalence
  • Sex & Age
  • Inheritance
A
  • 10-20% of dementias
  • M > W
  • Mean age of onset = 75 yrs
  • Most cases sporadic
  • Autosomal dominant inherited form
    • alpha-synuclein gene
25
Q

What are the clinical features of Lewy Body Dementia?

A
  • Gradual cognitive decline; Dementia often presenting symptom
  • Early in course: attention, visuospatial & executive function, poor job performance getting lost
  • Later in a course memory is impaired
26
Q

What are the 3 core clinical features of DLB?

A
  • Fluctuation in alertness
    • Seconds to days
    • In btwn episodes functioning may be normal
  • Vivid visual hallucinations
    • Simple or complex
    • Early sign, often precedes motor symptoms
  • Parkinsonism
    • Bradykinesia & rididity
    • Tremor is less common than PD
    • Motor symptoms develop later in a course of illness or in concordance w/ dementia
    • If motor symptoms present >1 yr before dementia, think PD dementia
27
Q

What are some suggestive features of DLB?

A
  • Repeat falls
  • Neuroleptic sensitivity resulting in severe pakinsonism, typical more than atypical, not dose related
  • REM sleep disorder - vivid dreams in REM sleep w/o muscle atonia, patients act out their dreams
  • Syncope or LOC
  • Orthostasis - associated w/ carotid sinus sensitivity
  • Autonomic dysfunction - urinary incontinence or retention, constipation, impotence
  • Auditory hallucinations & delusions
  • Depression - 40% will have MDD
28
Q

In DLB, what does MRI show?

What does SPECT/PET show?

A
  • MRI - generalized atrophy
  • SPECT/PET scan - decreased perfusion in occipital lobes
29
Q

What is the neuropathology of Lewy Body Dementia?

A

Lewy bodies

Alpha-synuclein

30
Q

What are Lewy Bodies?

A

round, eosinophilic, intracytoplasmic inclusions in the nuclei of neurons

31
Q

What is alpha-synuclein?

Where is it found?

A
  • Major component of Lewy bodies
  • Deep cortical areas throughout the brain
  • Anterior, frontal & temporal lobes
  • Cingulate gyrus & insula
32
Q

_________ are often present but NFTs are rare in DLB.

____________ are sparse or absent.

A

Amyloid plaques

NFTs

33
Q

Neuronal loss in DLB is greater in __________, ____________, __________ and _____.

A
  • Frontal lobes
  • Nucleus basalis of Meynert
  • Substantia nigra
  • LC
34
Q

In DLB, there are decreased cortical levels of _____________.

A

choline acetyl transferase

35
Q

What is the prognosis of DLB?

What are some non-pharmacologic treatments?

A
  • Prognosis is very poor
  • No therapies are known to alter the natural progression of the underlying neurodegeneration or time of death
  • Average survival is similar to that of AD, about 8 years
  • Non-pharmacologic treatments is emphasized: addressing environmental, medical, psychologic & social factors; caregiver education & support
36
Q

What is the pharmacological management of DLB?

A
  • Pharmacological treatment is symptomatic, no FDA approved medications
  • Acetylcholinesterase inhibitors can offer benefit in realms of apathy, confusion, hallucination & somnolence
  • When antipsychotics are needed, atypical agents are preferred (Olanzapaine, Quetiapine) w/ the goal to avoid long-term usage
  • Antiparkinsonian medications: Levodopa-carbidopa well tolerated, avoid anticholinergics
  • REM sleep behavior disorder: low dose of Clonazepam; Melatonin might be helpful
37
Q

What does DLB look like on brain imaging?

A
  • MRI - generalized atrophy
  • SPECT/PET scan - decreased perfusion in occipital lobes
38
Q

What does AD look like on brain imaging?

A
  • MRI
    • generalized atrophy
    • shrinkage of hippocampus
    • enlarged ventricles
39
Q

What does FTD look like on brain imaging?

A
  • MRI - frontal & temporal atrophy
  • PET scan - decreased metabolism in frontal & occipital lobes
40
Q

What does vascular dementia look like on brain imaging?

A
  • MRI - white matter lesions
41
Q

Which 3 are the core features of DLB?

  • Visual hallucinations
  • Repeated falls
  • Parkinsonism
  • Cognitive fluctuations
A
  • Visual hallucinations
  • Parkinsonism
  • Cognitive fluctuations
42
Q

Which 3 are the supportive features of DLB?

  • Neuroleptic sensitivity
  • REM sleep disorder
  • Delusions
  • Non-REM sleep disorder
A
  • Neuroleptic sensitivity
  • REM sleep disorder
  • Delusions
43
Q

Alpha-synuclein is a major component of….

  • NFTs
  • Senile plaques
  • Lewy bodies
  • Amyloid-beta protein
A

Lewy bodies

44
Q

65 YO male has been frustrated as he is forgetting phone numbers & misplaces his keys. Otherwise he is doing well & his daily functioning is not impaired. His father had Alzheimer’s disease. On MMSE he scored 28/30, he lost 2 points on delayed recall. What is the most likely diagnosis?

  • Vascular dementia
  • Alzheimer’s disease
  • Mild cognitive impairment
  • Lewy body dementia
A

Mild cognitive impairment

45
Q

What is the second most common type of dementia?

  • Parkinson’s disease dementia
  • Frontotemporal dementia
  • Vascular dementia
  • Alzheimer’s disease
A

Vascular dementia

46
Q

Mr. Smith is a 60 YO male who was brought by his son for evaluation. Son reported that 4 yrs ago his father become social inappropriate, making sexual comments to his female neighbors. Mr. Smith was evicted from his apartment due to poor environmental hygiene & complaints made by his neighbors as he was urinating in a hallway.

On neurophysiology testing Mr. Smith showed executive & visuospatial deficits along w/ deficits in attention & language. The memory is preserved however he is not able to work or live independently.

Labs were w/i normal limites. On physical exam he had no focal signs & didn’t exhibit any signs of movement disorder. What is the most likely diagnosis?

  • Alzheimer’s disease
  • Lewy body dementia
  • Frontotemporal dementia (FTD)
  • Vascular dementia
A

Frontotemporal dementia (FTD)

47
Q

70 YO male came for evaluation due to memory problems that started a year ago. Physical exam was significant for bradykinesia, rigidity & pill-rolling tremor. You found in his history that he has parkinsonian features for the past 5 yrs & has been taking sinemet. Neurophysiology testing was done & showed deficits in executive function along w/ visuospatial, memory & language impairment. He has no Hx of stroke. What is the most likely diagnosis?

  • Frontotemporal dementia
  • Lewy body dementia
  • Parkinson’s disease dementia (PDD)
  • Vascular dementia
A

Parkinson’s disease dementia (PDD)

Symptoms (17 decks)

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