Dementia

Question 1

What are the 6 Types of Dementia?

Answer 1

1. Alzheimer’s Dementia
2. Vascular Dementia
3. Dementia w/ Lewey Bodies
4. Frontotemporal Dementia (FTD)
5. Normal Pressure Hydrocephalus (NPH)
6. Depression

Question 2

What are the 2 clinical manifestations of Alzheimer’s?

Answer 2

1. Memory impairment

2. Dementia

Question 3

Age w/ Alzheimers?

Answer 3

Usually greater than 60

Incidence and prevalence of AD increases w/ age

Question 4

What is the earliest manifestation in AD?

Answer 4

Memory impairment

Question 5

What is declarative memory?

Answer 5

Facts and Events (memory of recent events)

Question 6

What type of memory is impaired in early AD?

Answer 6

Memory that is served by the hippocampus and medial temporal lobes

Question 7

What are other deficits that may appear in AD patient? (5)

Answer 7

1. Language (verbal disfluency and anomia)
2. Visuospatial skills (misplacement of items, difficulty navigating)
3. Insight (reduced insight into deficits)
4. Apraxia (difficulty performing learned motor tasks)
5. Executive Function (less motivated/engaged)

Question 8

How do patients w/ Frontotemporal Dementia typically present?

Answer 8

• usually w/ behavioral issues

- at first appear subdued, then become disinhibited and impulsive ….. (some accompanying memory issues)

Question 9

What does MRI scan show for FD?

Answer 9

Atrophy of the frontal and temporal lobes

Question 10

Gene pattern for FD?

Answer 10

Autosomal dominant inheritance pattern 10-25%

Question 11

What is Lewey Body Dementia?

Answer 11

Type of degenerative dementia

Question 12

How can you distinguish Lewey Body Dementia? (2 Clinical features)

Answer 12

1. Early appearance of visual hallucinations
2. Parkinsonism:
   a. rigidity
   b. stooped posture
   c. gait imbalance

Question 13

How do patients w/ vascular dementia present?

Answer 13

Memory loss and associated vascular diagnoses (TIA or Stroke)

Question 14

What is the most common form of Vascular Dementia?

Answer 14

Small Vessel Ischemic Disease (white matter disease… seen on MRI)

Question 15

What are the 4 Vascular risk factors pts w/ Vascular Dementia have?

Answer 15

HTN
Hyperlipidemia
DM
Tobacco Use

Question 16

What is the pathology of Normal Pressure Hydrocephalus (NPH)?

Answer 16

Enlarged ventricular size w/ a “normal” pressure (no increased intracranial pressure)

Question 17

What is the classic triad for Normal Pressure Hydrocephalus (NPH)

Answer 17

WET, WACKY, WOBBLY

1. WET - Urinary incontinence
2. WACKY - Dementia
3. WOBBLY - Gait distrubance …. magnetic gait (steps are short w/ decreased stride length, a broadened base, diminished cadence)… feet appear to be “stuck” to the floor

Question 18

NPH most commonly occurs in what age group

Answer 18

Greater than 60

Question 19

What does MRI show on NPH pts?

Answer 19

Ventriculomegaly

Question 20

What is the treatment for NPH?

Answer 20

Shunt (59% improvement)

Question 21

Define pseudodementia.

Answer 21

When patients present w/ symptoms of memory loss, but the real problem is depression

Question 22

Treat the depression….

Answer 22

…memory improves!!!!