Dementia Flashcards
Delirium
- A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).
- 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.
- Theres a disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).
Types of dementia
- Alzheimer’s
- Frontotemporal
- Lewy Body
- Parkinson’s Vascular
- Huntington’s
- HIV
- Traumatic Brain Injury
- Prion Disease
Dementia causes a progressive decline in intellectual functioning severe enough to _______
interfere with person’s normal daily activities and social relationships
Dementia causes progressive declines in
- memory
- visual-spatial relationships
- performance of routine tasks
- language and communication skills
- abstract thinking
- ability to learn and carry out mathematical calculations
2 categories of dementia
Reversible and Irreversible
*Individuals must have intensive medical physical to rule out reversible types of dementia
Reversible causes of dementia
"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
Irreversible causes of dementia
- Alzheimer’s
- Lewy Body Dementia
- Pick’s Disease (Frontotemperal Dementia)
- Parkinson’s
- Heady Injury
- Huntington’s Disease
- Jacob-Cruzefeldt Disease
Alzheimer’s Dementia
- 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
Alzheimer’s dementia- About 0.1 % autosomal dominant inheritance, which have an onset before age
65
-This form of the disease is known as early onset familial Alzheimer’s disease
Alzheimer’s dementia-
Most of autosomal dominant familial AD can be attributed to mutations in one of three genes:
- 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.
Most cases of Alzheimer’s disease do not exhibit
autosomal-dominant inheritance
Alzheimer’s dementia- environmental and genetic differences may act as risk factors. The best known genetic risk factor is the
inheritance of the ε4 allele of the apolipoprotein E
know mini mental status exam
in other deck too
Frontotemporal Dementia
- 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
Symptoms of Frontotemporal Dementia
-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
Frontotemporal Dementia shows a prominent decline in ______, but a relative sparing of _________
- 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
Frontotemporal Dementia average age of onset is
53 years followed by fatal progression lasting less than 4 years
Compared to Alzheimer’s disease, FT Dementia does not have impairments in
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
FT shows prominent personality and behavioral disturbances accompanied by only relatively mild ________
memory impairment
On CT/MRI, FT shows
- 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)
FT has some gene mutations, 10% linked to mutant gene on _______
chromosome 17, which codes for tau (MAPT)
Dementia with Lewy Bodies
- 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
Dementia with Lewy Bodies age
Older than 65
-sometimes initially diagnosed as alzheimer’s
Pathology of Dementia with Lewy Bodies age
- 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.
