Dementia

Question 1

dementia

Answer 1

progressive deterioration of intellectual function; typically characterized by preservation of consciousness

Question 2

most important risk factor for dementia

Answer 2

INCREASING AGE

Question 3

difference between forgetfulness and dementia

Answer 3

“benign” forgetfulness is normal part of aging, and unlike dementia, usually doesn’t cause significant impairment in ADL…but may be a risk factor for Alzheimer’s

Question 4

What are 4 broad categories of etiologies of dementia?

Answer 4

1. primary neurologic disorder
2. infections
3. metabolic disorders
4. drugs and toxins (abuse, alochol, aniline dyes, metals like lead)

Question 5

What primary neurologic disorders can cause dementia?

Answer 5

1. Alzheimer’s (MOST COMMON)
2. vascular dementia (multi infarct dementia, binswanger disease)
3. space occupying lesions (tumor or hematoma)
4. normal pressure hydrocephalus
5. lewy body dementia
6. Pick disease
7. misc neuro (MS, parkinson’s, Huntington’s, Wilson’s

Question 6

stepwise decline due to a series of cerebral infarctions

Answer 6

multi-infarct dementia

Question 7

insidious onset, due to diffuse subcortical white matter degeneration, most commonly seen in patients with long standing HTN and atherosclerosis

Answer 7

Binswanger disease

Question 8

triad of dementia, gait disturbance, urinary incontinence;

Answer 8

normal pressure hydrocephalus (wet, wacky, weird)

Question 9

What infections can cause dementia?

Answer 9

HIV, neurosyphilis, Creutzfeld Jakob, cryptococcal infection of CNS, progressive mmultifocal leukoencephalopathy

Question 10

What metabolic disorders can cause dementia?

Answer 10

thyroid (hyper/hypo), vitb12 deficiency, thiamine deficiency, niacin deficiency

Question 11

untreated, can lead to Korsakoff dementia (irreversible)

Answer 11

thiamine deficiecy, commonly seen in alcoholics

Question 12

Pseudodementia vs dementia

Answer 12

pseudodementia (SEVERE depression), may cause a decline in cognition that is difficult to distinguish from Alzheimer’s but is responsive to antidepressant therapy

Question 13

What labs/tests can be helpful in evaluating dementia?

Answer 13

CBC, chem panel, TSH, vitb12, folate, VDRL (syphilis), HIV screen, CT/MRI of head

Question 14

What meds can have adverse cognitive side effects?

Answer 14

glucocorticoids, opiates, sedative hypnotics, anxiolytics, anticholinergics, lithium

Question 15

Reversible causes of dementia

Answer 15

hypothyroidism, neurosyphilis, subdural hematoma, medications, vitb12/folate deficiencies, normal pressure hydrocephalus, depression

Question 16

Irreversible causes of dementia

Answer 16

Alzheimers, Pick dx, Lewy body dx, unresectable brain mass, HIV dementia, Korsakoff syndrome (preceded by thiamine deficiency), creutzfeld Jakob, Parkinson/Huntingtion, multi infarct dementia, progressive multifocal leukoencephalopathy

Question 17

4th most common cause of death in US

Answer 17

Alzheimer’s disease (AD)

Question 18

Risk factors for AD

Answer 18

age, family hx, Down syndrome

Question 19

Two pathologic features of AD

Answer 19

1. senile plaque accumulation, amyloid beta protein)

2. neurofibrillary tangles (tau) that accumulate in cytoplasm of neurons

Question 20

Avg time from onset of AD to death

Answer 20

5-10 years; begins insidiously but progresses at steady rate

Question 21

Stages of AD

Answer 21

Early - mild forgetfulness, impaired ability to learn new material. decline in work performance, concentration problems, impaired judgement

intermediate - memory progressively impaired, visuospatial disturbances, may repeat questions over and over

later - assistance needed for ADL, difficulty remembering names of friends/relatives, paranoid delusions

advanced - complete debilitation, incontinence, forgets name

Question 22

How to dx AD

Answer 22

mostly clinical but CT/MRI of head can show diffuse cortical atrophy with enlargement of ventricles

Question 23

First line treatment for AD

Answer 23

cholinesterase inhibitors (since AD brains have been shown to have less Ach).
ex: donepezil, rivastigmine, galantamine

AVOID ANTICHOLINERGIC DRUGS!!!

Question 24

Which vitamin in megadoses has been shown to slow progression of moderately severe AD

Answer 24

vitamin E

Question 25

Presentation of Lewy body disease

Answer 25

VISUAL HALLUCINATIONS PRESENT FIRST!

• progression may be more rapid than AD
• EPS and fluctuating mental status
• sensitive to adverse effects of neuroleptics

Question 26

Treatment for LBD

Answer 26

similar to AD (cholinesterase inhibitors), +neuroleptics for hallucinations and psychotic features; selegiline can slow progression of dx (MAO inhibitor)