Dementia Flashcards
What’s included in the Mini-Cog?
- remember 3 words, repeat to you
- Draw clock and then add a time onto it (2 points)
- Repeat 3 previous words (3 points)
How to interpret Mini-cog scoring?
0-2 positive for dementia
3-5 negative
If mini-cog is less or equal to 2, what’s the next step?
SLUMS, MOCA, MMSE
What does SLUMS test for?
- Orientation, item recall, math, naming, clock, story comprehension
How does SLUM score?
- HS graduates:
When to refer patients to hospice
FAST score = 7, loss of speech, locomotion, and consciousness
What’s classic features of AD?
Memory, language, visual-spatial disturbance, indifference, delusions, agitation
What’s classic features of FTD?
Personality change, executive dysfunction, hyperorality, preservation (relative) of visual-spatial skills
What’s classic features of LBD?
Visual hallucinations, delusions, EPS, fluctuating MS, sensitivity to antipsychotic meds
What’s classic about vascular dementia?
Abrupt onset, stepwise deterioration, prominent aphasia, motor signs
What’s included in the eval of dementia?
- H & P
- Functional Status
- exclude Depression PHQ9
- Eval MS: attention, immediate and delayed recall, remote memory, executive function
Correct: Neuroimaging may detect 5% cases of clinical significant structural lesions would otherwise be missed
Correct
FDG-PEC scan
if PFD is suspected, medicare covers
Florbetapir F18 (amyvid)
FDA apporved for detection of amyloid plaque (scan), but medicare not cover
What defines “mild cognitive impairment”?
- modest cognitive decline that does not interfere with “capacity for independence in everyday activities”
- MMSE 26-30; MOCA
What defines “major” criteria?
Significant impairment is evident or reported and when it does interfere with a patient’s independence to the point that assistance is required
What’s the prognosis with nursing home residents with advance dementia
70% die within 6 months of admission
What are 4 non-cognitive symptoms of dementia?
- Psychotic symptoms: 20%, delusion, hallucinations
- Depressive: 40%, may precede onset of AD
- Apathy
- Agitation or Aggression: 80%
Risk factors for Dementia - definitive
- Age
- APOE4 (whites)
- AFib
- Depression
- Down syndrome
- Fam Hx
Possible risk factors for dementia
- delirium
- head trauma
- heavy smoking
- hypercholestrolemia
- HTN
- Lower education level
- post menopausal HT
Possible protectants
- Antioxidants (vitamin E, beta carotene)
- Mediterranean diet
- Physical activites
What are the common anticholinergic meds to avoid?
Benztropine, diphenhydramine, hydroxyzine, oxybutynin, TCAs, clozapine, and thioridazine
What are 3 examples of cholinesterase inhibitor?
Galantamine, Rivastigmine, Donepezil
How to treat mild to moderate AD pharmacologically?
Cholinesterase inhibitor/Donepezil++++ Vitamin E 2000IU/day
- only 10-25% show modest global impairment
- Less rapid cognitive decline
- Also benefit for LBD, Parkinson disease, and vascular dementia
- ADR: nvd, dyspepsia, anorexia, weight loss, leg cramps, bradycardia, syncope, insomnia, agitation
How to treat moderate to severe AD pharmacologically?
Memantine alone or M + D
- ADR include: confusion, dizziness, constipation, and headache
When to D/C cognitive enhancers?
FAST = 7 loss of speech, locomotion, and consciousness
