dementia Flashcards
dementia vs. depression
decreased attention memory impairment apathy social withdrawal dont engage "i dont know"
personality changes in dementia
paranoia
disinhibition
socially inappropriate
risk factors dementia
age family hx head injury heart disease hereditary (APOE-e4)
praxis ex.
combing hair with toothbrush
folsteins MMSE
what does it contain?
scoring?
orientation registration attention and calculation recall language 1 point each correct answer total= 30 points
Mini cog
what does it contain?
scoring?
3 item recall and clock drawing
0-5
0-2 = dementia
only definitive dx test for dementia
biopsy
MRI dementia- not in who?
stent pacemaker joint replacement
Presentation frontotemporal dementia aka
frontotemporal dementia aka picks dx
damage in frontal and temporal–> hitting, personality changes, language impairment
Presentation dementia with lewy bodies
similar to alzheimers, fluctuating *
hallucinations* jerks
presents like parkinsons
Presentation of normal pressure hydrocephalis
dx?
dips drips dementia
dx: spinal tap, surgical shunt
Creutzfeldt-jacob
Mixed dementia
mad cow dx, fatal
mixed: ie vascular and parkinsons
Vascular dementia: \_\_\_ most common formerly known as \_\_\_\_\_ lesion is \_\_\_\_\_\_ risk factors presentation
2nd most common
formerly known as multiple infarct dementia
defining lesion is lacunar infarct
risk factors: HTN, smoking, cholesterol, PVD, CVD, diabetes
presentation: abrupt, stepwise, executive dysfx, gait change
have reality base
Alzheimers
_____ and _____
characterized by ______ and ______
brain atrophy of _____
progressive and fatal
char. by amyloid plaques and neurofibrillary tangles in the brain
brain atrophy of cerebral cortex (pronounced frontal, temp, parietal)
Frontal lobe:
Temporal lob:
Occipital:
frontal: behavior, emotion, problem solving
temporal: memory, word understanding
occipital: vision
MMSE Mild (preclinical) Early, mild Middle moderate severe
Mild: 26-30
Early mild: 21-25
Moderate: 11-20
Severe: 0-10
Mild cognitive impairment
no functional impairment
may not progressive past this stage
reported by caregiver
(26-30)
Early, mild impairment
when you see in office finances decreased insight r/o depression disoriented to date anomia (diff. naming) (21-25) 1-3 years after onset of sx
Middle moderate
disoriented to time/place cant express learn new things cant cook clean shop behaviors worsen: restless, anxious, depressed, delusions, aggression get lost aphasia (cant comprehend) (11-20) lasts 2-8 years
Severe impairment
unintelligible verbal output cant write or copy cant groom dress incontinent (0-10) can last 6-12 years
Treatment principles \_\_\_\_ prophylaxis for vascular and mixed dementia avoid \_\_\_\_\_\_ medications such as limit\_\_\_\_medications avoid \_\_\_\_\_ telling
stroke prophylaxis for vascular and mixed dementia
avoid anticholinergic medication (benztropine, benadryl, hydroxyzine, oxybutynin, tricyclic antidepressants, clozapine, thioridazine)
limit prn psychotropic medications
avoid truth telling
Dementia treatment
pharmacologic
Cholinesterase inhibitors (donezipil/aricept, galantamine/razadyne, rivastigmine/exelon) NMDA receptor antagonists (memantine/namenda)
