Dementia Flashcards
(56 cards)
What are some of the symptoms of dementia in newly diagnosed (MCI) patients? (2)
What are some hallmarks to look for?
- Poor orientation to time or place
- Impaired recent memory
**Look for mood changes
Alzheimer’s disease (AD):
- Definition
- Disease Characteristics (2)
- Risk factors (3)
Degenerative brain disorder leading to progressive loss of memory and other cognitive functions
- Changes in personality, bx, judgment
- Loss of ADLs
Risks: Advanced age, family hx, Downs’ Syndrome
After age 65 what happens to the prevalence of alzheimer’s disease?
Doubles with every decade; 50% patients over 85 have alzheimer’s
What is the third leading cause of death in the US?
What is the #1 cause of dementia?
Alzheimer’s disease
Describe the general progression of Alzheimer’s disease:
How long is the average course of disease?
Which symptoms show up first?
- Average course of disease = 1 decade
- Memory impairment–> cognitive impairment +/- changes in mood and bx
What are the diagnostic criteria for alzheimer’s disease? (5)
- Memory impairment
- Aphasia, Apraxia, or Agnosia (1 of 3)
- Altered Executive function
- Decline in social/ occupational function
- Gradual onset cognitive decline
What should you look for in the physical exam to dx alzheimer’s?
Subtle signs of neglect and parkinsonian features
What will you seen in the MMSE of a patient with alzheimers?
Decreased recall and reasoning (proverbs) abilities
What 4 things are evaluated by the mini mental status exam?
- Performance of simple tasks
- Abstract thought
- Addition and subtraction
- Communication
Which neurotransmitter is decreased in patients with alzheimer’s dementia?
In which parts of the brain is it decreased?
Acetylcholine: connects these structures to basal forebrain (degenerates w low Ach)
- Hippocampus
- Cerebral cortex
- Amygdala
What are the characteristic senile plaques seen in Alzheimer’s made of?
Where are they located?
Degenerative presynaptic endings +/- astrocytes and microglia (AB peptide)
Located in the neurophil of the cerebral cortex
What are the characteristics neurofibrillary tangles seen in alzheimer’s dementia?
Intracytoplasmic proliferation of twisted filaments located in the pyramidal cells of the hippocampus and cerebral cortex
**Hyperphosphorylated tau
Where is the earliest brain lesion seen in alzheimer’s disease?
What is seen on fMRI?
Physiologic lesion in the hippocampus
Decreased oxidative metabolism seen in fMRI
List three treatment options for patients with Alzheimer’s:
- Cholinesterase inhibitors
(mild to moderate disease) - Antipsychotics/ Antidepressants
(For bx symptoms) - Estrogen replacement therapy
Which AchEi has less neuropsych sx and why?
Rivastigmine; can via patch form for sustained release
How does food affect tacrine metabolism (AchEi)
Decreases bioavailability 30-40%
How does food affect donepezil (AchEi) metabolism?
NOT AT ALL
How does food affect rivastigmine metabolism?
Slows rate and increases absorption 30%
How is galantine metabolism affected by food?
Slows rate but not extent of absorption
Memantine/ Namenda:
What is the MOA?
What does it treat?
Binds NMDA receptors (ANTAgonist)
Given in does of 5-20mg per day to treat Alzheimers
What vitamin is given as a treatment for alzheimers?
Vitamin E (1000U BID)
What are two important preventative measures against developing alzheimers?
Smoking cessation and aerobic exercise
5 Symptoms typically inconsistent with Alzheimer’s Dementia:
1- Sudden onset 2- Focal neurologic findings 3- Seizures (early in the course) 4- Abnormal gait/coordination 5- Preservation of memory function
7 Signs Atypical of Alzheimer’s Disease:
1- Dominant non-memory sx
2- Prominent behavioral, personality, psychotic Sx
3- Early parkinsonism
4- Early bulbar/ brainstem signs
5- Unexplained motor or reflex asymmetries
6- Unexplained (early) UMN or LMN signs
