Dementia Flashcards
definition of eementia:
a decline in memory and at least one other cognitive function. the deficits should not be accounted for by another psychiatric condition.
degenerative causes of demential are determined definitively
at autopsy
alzheimers diffuse lewy body disease parkinsons disease FTLD PSP, CBD MSA huntingtons olivopontocerebellar degeneration
degenerative causes of dementia
Multiple infarction, single stroke binswanger's disease vasculitis SAH
vascular causes of dementia
fungal meningitis syphilis aids Creutzfeldt Jakob dz post-herpes simplex encephalitis
infectious causes of dementia
depression, alcohol abuse, drug related disorder, personality disorder, anxiety disorder
psychiatric causes of dementia
vitamin B12 deficiency thyroid failure system failure - liver, renal, cardiac, respiratory heavy metals toxins
toxic/metabloc causees of dementia
subdural hematoma closed head injury open head injury pugalistic brain injury anoxic brain injury
traumatic cause of dementia
glioblastoma
lymphoma
metastatic tumor (salt and pepper)
Tumors that cause dementia
examination of demetia patient
MMSE, look for cardiovascular risk factors (anything that clues you in to multiple strokes)
full neuro exam.
bloodwork and MRI= look normal for age early in the disease
Criterion for dx of alzheimers
dimentia established by MMSE, deficits in 2 or more areas of cognistion. progressive worsening. no disturbance of consciousness, onset between 40 and 90. absence of systemic disorders or other brain diseases that could account for the progressive deficits in memory and cognition.
treatment of alzheimers
slow progression
Ach inhibitors - donezepil, rivastimine, galantamine
NMDA R agonist - Memantine
How does mild cognitive impairment differ from alzheimers
memory complaint by the pt. tested abnormal memory for age, yet doesn’t meet criteria for dementia.
ACHeI medications
how does vascular dementia differ from alzheimers
= dementia + cerebrovascular disease
single big stroke or multiple little strokes.
If it’s vascular you will see focality on the exam. like aphasia, dysphasia, motor, visual abnormality.
Tetrad of symptoms in lewey body disease
alzheimers like dementia
parkinsonian symptoms
psychotic symptoms
extreme sensitivity to antipsychotic agents
Lewey body disease
progresses more rapidly than alzheimers
symptoms vary from one day to the next
unexplained falls a lot
unxplained periods of increased confusion that lasts days - weeks, and closely mimics delirium
parkinson features often present early. treemor absent, poor response to levodopa. Psychotic symptoms (early in dz) - hallucinations are not bothersom, generally animals or people
parkinsons vs diffuse lewey bodyq
parkinsons
=midbrain lewy bodies. dementia occurs LATE. Tremor. hallucinations d/t anti parkinsons drugs
lewey body disease
= cortical diffuse lewey bodies. dementia occurs early. prominent autonomic dysfunction. hallucinations common in absence of drugs
Frontotemporal lobar degeneration (picks disease)
inappropriate emotional stuff. changes in personality with impairment of intellect memory and language. varies grately in how it effects indifiduals. atrophy of frontal and temporal lobes.
lack of memory, lack of spontaneity, difficulty in thinking or concentrating, disturbances of speech
Normopressure hydroceph triad
dementia
gait disturbance
urinary incontinence
most likely feature of normal pressure hydrocephalus to be improved with shunting
gait distrubances.
