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CSI- Winter > Dementia > Flashcards

Dementia Flashcards

1
Q

Delirium

A
  1. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
  2. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.
  3. Theres a disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).
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2
Q

Types of dementia

A
  • Alzheimer’s
  • Frontotemporal
  • Lewy Body
  • Parkinson’s Vascular
  • Huntington’s
  • HIV
  • Traumatic Brain Injury
  • Prion Disease
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3
Q

Dementia causes a progressive decline in intellectual functioning severe enough to _______

A

interfere with person’s normal daily activities and social relationships

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4
Q

Dementia causes progressive declines in

A
  • memory
  • visual-spatial relationships
  • performance of routine tasks
  • language and communication skills
  • abstract thinking
  • ability to learn and carry out mathematical calculations
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5
Q

2 categories of dementia

A

Reversible and Irreversible

*Individuals must have intensive medical physical to rule out reversible types of dementia

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6
Q

Reversible causes of dementia

A 
"DEMENTIA" 
D-drugs, delirium 
E-emotions (depression) & endocrine disorders
M-metabolic problems
E-eye & ear problems
N-nutritional disorders
T-tumors, toxicity, trauma to head
I-infections 
A-alcohol, arteriosclerosis
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7
Q

Irreversible causes of dementia

A
  • Alzheimer’s
  • Lewy Body Dementia
  • Pick’s Disease (Frontotemperal Dementia)
  • Parkinson’s
  • Heady Injury
  • Huntington’s Disease
  • Jacob-Cruzefeldt Disease
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8
Q

Alzheimer’s Dementia

A
  • Insidious onset/gradual progression
  • Memory & learning impairment, sometimes executive impairment
  • Then perceptual-motor & language impairment
  • Social cognition affected late in disease
  • Gait disturbance, dysphagia, incontinence, myoclonus, seizures
  • 5% Diagnosed between around age 65, prevalence increases steeply, esp in 80s
  • Mean survival 10yrs after diagnosis
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9
Q

Alzheimer’s dementia- About 0.1 % autosomal dominant inheritance, which have an onset before age

A

65

-This form of the disease is known as early onset familial Alzheimer’s disease

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10
Q

Alzheimer’s dementia-

Most of autosomal dominant familial AD can be attributed to mutations in one of three genes:

A
  • those encoding amyloid precursor protein (APP)
  • those encoding presenilins 1 and 2

*Most mutations in the APP and presenilin genes increase the production of a small protein called Aβ42, which is the main component of senile plaques.

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11
Q

Most cases of Alzheimer’s disease do not exhibit

A

autosomal-dominant inheritance

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12
Q

Alzheimer’s dementia- environmental and genetic differences may act as risk factors. The best known genetic risk factor is the

A

inheritance of the ε4 allele of the apolipoprotein E

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13
Q

know mini mental status exam

A

in other deck too

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14
Q

Frontotemporal Dementia

A
  • Encompasses Pick’s disease and several related illnesses.
  • Insidious onset/gradual progression
  • Reflect loss of frontal and temporal lobe function
  • FT dementia accounts for 15% cases of dementia
  • Higher proportion in individuals younger than 65
  • Tau inclusions, pick bodies
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15
Q

Symptoms of Frontotemporal Dementia

A

-Broad decline in insight
-Social skills, interpersonal conduct
-And executive functioning
-Mental rigidity
-Easily distractibility, labile affect and speech and language impairments
(echolalia and perseveration)
-Disinhibition
-Apathy
-Loss of sympathy/empathy
-Perseverative or compulsive behavior
-Hyperorality and diet changes

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16
Q

Frontotemporal Dementia shows a prominent decline in ______, but a relative sparing of _________

A
  • prominent decline in social cognition or executive abilities
  • also decline in language ability, object naming, grammar
  • Relative sparing of learning, memory, and perceptual-motor function
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17
Q

Frontotemporal Dementia average age of onset is

A

53 years followed by fatal progression lasting less than 4 years

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18
Q

Compared to Alzheimer’s disease, FT Dementia does not have impairments in

A

visual-spatial abilities – a function governed largely by the parietal lobes

  • maintain their ability to copy a picture but not to draw one from their memory.
  • do not lose their sense of direction, even in new surrounding
  • do not manifest constructional apraxia
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19
Q

FT shows prominent personality and behavioral disturbances accompanied by only relatively mild ________

A

memory impairment

20
Q

On CT/MRI, FT shows

A
  • Frontal and anterior temporal lobes are atrophic. -Plaques and tangles are uncommon or absent
  • Pick’s disease – neurons containing argentophilic (silver staining) inclusions (Pick bodies)
21
Q

FT has some gene mutations, 10% linked to mutant gene on _______

A

chromosome 17, which codes for tau (MAPT)

22
Q

Dementia with Lewy Bodies

A
  • Cognitive decline, ≥1 yr prior to onset of parkinsonism features
  • Fluctuating cognition w/ variations in attention/alertness (looks like delirium)
  • Recurrent VH
  • REM sleep behavior disorder
  • Severe neuroleptic sensitivity (50%)
  • Lewy bodies have greater distribution than in Parkinson’s
23
Q

Dementia with Lewy Bodies age

A

Older than 65

-sometimes initially diagnosed as alzheimer’s

24
Q

Pathology of Dementia with Lewy Bodies age

A
  • abundance of intracytoplasmic inclusions (lewy bodies) in cerebral cortex neurons that stain with alpha- synuclein antibodies
  • Concentration of lewy bodies correlates with dementia
  • Similar to Alzheimer’s disease, but older individuals with nonspecific cognitive deficits.
25
Q

Non-cognitive features of Dementia with Lewy Bodies (aka-S/S)

A
  • characterized by mild extrapyramidal features, masked face, bradykinesia, and gait impairment.
  • sudden unexpected changes in cognition, attentiveness and alertness; mimics episodes of delirium or toxic-metabolic encephalopathy
  • Visual Hallucinations: detailed visions of people and animals, associated with lewy bodies in the temporal lobes
  • Visual hallucinations also frequently develop in pts with advanced Alzheimer’s and Parkinson’s disease – but not at the onset of these illnesses
26
Q

About 50% of patients with Dementia with Lewy Bodies have REM sleep behavior disorder, which consists of

A

running, punching, and similar motions while asleep

27
Q

DLB is similar to extrapyramidal symptoms you see in Parkinson’s however DLB does not __________

A

repond to Parkinson’s treatment with L-dopa

-also pt will have visual hallucinations

28
Q

DLB pt with visual hallucination can be treated with

A
  • antipsychotic agents
  • dopamine blockers, readily produce pronounced extrapyramidal signs
  • small amounts of antipsychotic agents can cause EPS (extrapyramidal symptoms)
29
Q

DLB treatment- what to give for cognitive function and visual hallucinations

A

Cholinesterase inhibitors stabilize or improve cognitive function and reduce visual hallucinations for several months

30
Q

DLB treatment- what will help REM sleep behavior disturbance

A

Long acting benzodiazepines, such as clonazepam, suppresses the REM sleep behavior disturbance

31
Q

Neurocognitive disorder due to Parkinson’s

A
  • Established Parkinson’s Disease prior to cognitive decline
  • Many diagnosed in their 60s, mild neurocognitive disorder occurs early but does not progress to major neurocognitive d/o until late
  • Apathy, depressed/anxious mood, hallucinations/delusions, change of personality
  • Lewy bodies present
32
Q

Vascular Dementia

A
  • Clinically consistent with vascular etiology:
    1. Onset of cognitive deficits is temporally related to cerebrovascular event
    2. Evidence for decline is prominent in complex attention and frontal-executive tasks
    3. Evidence of the presence of cerebrovascular disease
    4. History, physical exam, and/or neuroimaging
    5. Classically is acute stepwise decline in cognition
33
Q

Vascular Dementia risk factors

A
  • HTN, DM, obesity, smoking, high cholesterol, high homocysteine levels
  • Diagnosis: MRI/CT
34
Q

Med to give for Vascular Dementia

A

Because of frequent comorbidity of Alzheimer’s Disease, cholinesterase inhibitors provide symptomatic benefit in vascular dementia

35
Q

see comparative chart

A

slide 30, screen shot in folder

36
Q

Traumatic Brain Injury

A
  • LOC, post-traumatic amnesia, disorientation, neurological signs
  • Emotional and personality changes, physical sx (tinnitus, dizziness, fatigue)
  • CT/MRI– not always, but may reveal petechial hemorrhages or evidence of contusion
37
Q

HIV

A
  • Need documented infection with HIV
  • 25% of pts with HIV have mild neurocognitive D/O
  • Risk: poor control of HIV
  • CSF – high viral load; MRI- cortical thinning, ↓ brain volume, ↓ white matter
38
Q

Prion Disease

A
  • Rapid progression; most common is Creutzfeldt-Jakob
  • triad of dementia, myoclonus, and distinctive EEG patterns
  • CSF: 14-3-3 protein and tau protein
  • MRI: multifocal gray matter hyperintensities
39
Q

Huntington’s

A
  • CAG repeats on chromosome 4
  • 50% will develop dementia
  • MRI- volume loss in basal ganglia
40
Q

Treatment for vascular dementia

KNOW!

A
  • preventative measures: diet and exercise, control of HTN/DM, statins may slow progression
  • Cholinesterase inhibitors (donepezil, rivastigmine, galantamine, tacrine); Increase Ach, modest improvement in memory and goal-directed thought
  • NMDA antagonist - (Memantine); Protects neurons from excessive glutamate activity, which may be neurotoxic
41
Q

Psychosocial intervention:

A

Reduce stressors, education of caregivers, safety (assess driving, prevent wandering, reduce risk of falls)

42
Q

How to manage agitation

A
  • All antipsychotics have a black box warning: Risk of increased mortality when used for dementia- related psychosis – deaths due to cardiac or infectious events*
  • Antidepressants, cholinesterase inhibitors, non-pharmacologic (redirection, recreational therapy) antipsychotics, mood stabilizers, benzodiazepines
43
Q

Treatment for Lewy body dementia

A

use quetiapine or clozaril if need to use an antipsychotic

44
Q

Pseudodementia

A

-“Depression in old age”

-Depression occurs first, then neurocognitive deficits
Relatively abrupt onset

-Evaluation : MSE, neuropsychological testing - Lack of effort on part of the patient – “I don’t know”

45
Q

Treatment for psuedodementia

A

Improvement with antidepressant treatment

CSI- Winter (44 decks)

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