Dementia Flashcards
Is dementia an inherent aspect of aging?
no!
what percentage of patients over 65 years old have alzheimer’s dementia?
6-8 percent
after the age of 65, at what rate does the prevalence increase every 5 years?
doubles every 5 years after 65
what percentage of people over the age of 85 have alzheimers dementia?
45 percent
what percentage of vascular dementia cases co-occur with AD?
15-20 percent
what is the second most common cause of dementia?
lewy body dementia
what percentage of caregivers suffer psychological distress (esp. depression)
nearly half
what will you see on imaging of an alzheimer’s dementia brain?
amyloid plaques/oligomers
tau neurofibrillary tangles
cytoplasmic alpha-synuclein inclusion bodies should make you think of which two diagnoses?
lewy body dementia
parkinsons dementia
tau or ubiquitin proteins should make you think of what type of dementia?
frontotemporal
what are the four DEFINITIVE risk factors for developing alzheimer’s dementia?
1) age
2) family history
3) APOE4 allele
4) down syndrome
what are four POSSIBLE risk factors for developing alzheimer’s dementia?
1) head trauma
2) fewer years of formal education
3) late onset MDD
4) cardiovascular RF (HTN, DM, etc)
the presence of amyloid precursor proteins (APP) and presenilin proteins (PS1 and PS2) should make you think what?
early onset alzheimers
diagnosed usually before 60
APOE 2/3/4 on chromosome 19 should make you think of what?
late onset alzheimers
APOE4 carries greatest risk
APOE2 is considered to be what in terms of dementia?
protective!
what is the highest score you can get on the MMSE? what areas of functioning does the MMSE address?
highest score = 30
orientation, registration, attention, recall, naming, repetition, 3-step command, language, visuospatial
how many items are on the mini-cog? whats the highest score?
2 items (score = 5)
assesses visuospatial, executive functions, recall
besides the MMSE and the minicog, what are two other commonly used assessments?
SLUMS and MoCA
when should you consider brain imaging in your patient who is presenting with dementia-like symptoms?
1) age less than 65
2) neurologic signs are asymmetric or focal
3) clinical picture suggests normal-pressure hydrocephalus
4) patient has had recent fall or head trauma
normal aging is characterized by what type of performance on memory tests?
no evidence consistent, progressive deviations
some decline in processing and recall of new information (slower, harder)
will a patient with normal aging have difficulty on their ADLs due to cognition?
no
weird question
cognition remains mostly intact just slow
subjective complaint of decline in at least ONE domain that is noticeable and measurable but NO impairment in independent living is considered what level of cognitive impairment?
mild
what percentage of people with amnestic mild cognitive impairment maintain a stable level of impairment or return to normal cognitive status in 3-5 years?
50 percent
what are the 4 distinguishing signs of delirium?
1) ACUTE onset
2) cognitive fluctuations over hours or days
3) impaired consciousness and attention
4) altered sleep cycles
once delirium has cleared in your otherwise healthy patient, what is the first thing you should start working up?
dementia
the symptoms of ______ and _____ often overlap and can be hard to differentiate
depression and dementia
what are some overlapping symptoms between depression and dementia?
impaired concentration, lack of motivation, loss of interest, apathy, psychomotor retardation, sleep disturbance
what are three key findings that will clue you into depression over dementia?
depressed people:
1) demonstrate decreased motivation during cognitive testing
2) express cognitive complaints that exceed measured deficits
3) maintain language and motor skills
what percentage of people presenting with reversible dementia and depression progress to true dementia within 5 years?
50 percent
memory impairment and difficulty learning new information is the core feature of this disease
alzheimer’s
are motor symptoms common in alzheimer’s disease?
rare early
apraxia later (difficulty performing purposeful actions)
what will lab tests of a person with alzheimers look like?
normal
what will imaging of a person with alzheimer’s brain look like?
possible global atrophy
small hippocampal volumes
what about onset will help you differentiate between alzheimer’s dementia and vascular dementia?
alzheimers dementia = insidious onset
vascular dementia = sudden or stepwise
what are the cognitive symptoms of vascular dementia?
depend on the anatomy of the ischemia
dysexecutive syndrome common (cognitive, behavioral, emotional disturbances occurring together)
what will a person with vascular dementia’s motor skills be like?
depends on location of ischemia
what is the prognosis of vascular dementia?
it is a stepwise progression with further ischemia
labs of a person with vascular dementia?
normal
imaging of a person with vascular dementia?
cortical or subcortical changes on MRI
onset of lewy body dementia? how do these patients typically progress?
onset is gradual
memory and visuospatial difficulties, hallucinations
will a person with lewy body dementia have symptoms throughout the day? what is a hallmark of this disease?
NO
fluctuations of are common
which progresses faster, lewy body dementia or alzheimers?
both are quite gradual, but lewy body dementia is faster than AD
what will labs and imaging of lewy body dementia look like?
normal labs
imaging = possible global atrophy
motor symptoms of lewy bodydementia?
parkinsonism
for a diagnosis of lewy body dementia, both dementia and at least one of the these symptoms must be present (4):
1) detail visual hallucinations
2) parkinsonian signs
3) changes in alertness or attention
4) poor visuospatial abilities often out of proportion to other cognitive deficits
if parkinson’s disease has been diagnosed or present for over 2 years before cognitive symptoms are seen, is the person’s dementia more likely alzheimer’s dementia or parkinson’s dementia?
parkinson disease dementia
if parkinsonian symptoms are present at the same time as cognitive symptoms, what diagnosis should we consider?
lewy body dementia
this type of dementia is characterized by executive, language, and behavioral dysfunction
frontotemporal dementia
this type of dementia is characterized by disinhibition and hyperorality
frontotemporal dementia
what are the motor symptoms of frontotemporal dementia?
none; but may be associated with ALS in rare cases
is the onset of frontotemporal dementia gradual or sudden?
gradual, usually under 60 years old!
what will imaging of a person with frontotemporal dementia’s brain look like?
atrophy in frontal and temporal lobes
