Dementia Flashcards
dementia
progressive deterioration of intellectual function; typically characterized by preservation of consciousness
most important risk factor for dementia
INCREASING AGE
difference between forgetfulness and dementia
“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
What are 4 broad categories of etiologies of dementia?
- primary neurologic disorder
- infections
- metabolic disorders
- drugs and toxins (abuse, alochol, aniline dyes, metals like lead)
What primary neurologic disorders can cause dementia?
- Alzheimer’s (MOST COMMON)
- vascular dementia (multi infarct dementia, binswanger disease)
- space occupying lesions (tumor or hematoma)
- normal pressure hydrocephalus
- lewy body dementia
- Pick disease
- misc neuro (MS, parkinson’s, Huntington’s, Wilson’s
stepwise decline due to a series of cerebral infarctions
multi-infarct dementia
insidious onset, due to diffuse subcortical white matter degeneration, most commonly seen in patients with long standing HTN and atherosclerosis
Binswanger disease
triad of dementia, gait disturbance, urinary incontinence;
normal pressure hydrocephalus (wet, wacky, weird)
What infections can cause dementia?
HIV, neurosyphilis, Creutzfeld Jakob, cryptococcal infection of CNS, progressive mmultifocal leukoencephalopathy
What metabolic disorders can cause dementia?
thyroid (hyper/hypo), vitb12 deficiency, thiamine deficiency, niacin deficiency
untreated, can lead to Korsakoff dementia (irreversible)
thiamine deficiecy, commonly seen in alcoholics
Pseudodementia vs dementia
pseudodementia (SEVERE depression), may cause a decline in cognition that is difficult to distinguish from Alzheimer’s but is responsive to antidepressant therapy
What labs/tests can be helpful in evaluating dementia?
CBC, chem panel, TSH, vitb12, folate, VDRL (syphilis), HIV screen, CT/MRI of head
What meds can have adverse cognitive side effects?
glucocorticoids, opiates, sedative hypnotics, anxiolytics, anticholinergics, lithium
Reversible causes of dementia
hypothyroidism, neurosyphilis, subdural hematoma, medications, vitb12/folate deficiencies, normal pressure hydrocephalus, depression
Irreversible causes of dementia
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
4th most common cause of death in US
Alzheimer’s disease (AD)
Risk factors for AD
age, family hx, Down syndrome
Two pathologic features of AD
- senile plaque accumulation, amyloid beta protein)
2. neurofibrillary tangles (tau) that accumulate in cytoplasm of neurons
Avg time from onset of AD to death
5-10 years; begins insidiously but progresses at steady rate
Stages of AD
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
How to dx AD
mostly clinical but CT/MRI of head can show diffuse cortical atrophy with enlargement of ventricles
First line treatment for AD
cholinesterase inhibitors (since AD brains have been shown to have less Ach). ex: donepezil, rivastigmine, galantamine
AVOID ANTICHOLINERGIC DRUGS!!!
Which vitamin in megadoses has been shown to slow progression of moderately severe AD
vitamin E
Presentation of Lewy body disease
VISUAL HALLUCINATIONS PRESENT FIRST!
- progression may be more rapid than AD
- EPS and fluctuating mental status
- sensitive to adverse effects of neuroleptics
Treatment for LBD
similar to AD (cholinesterase inhibitors), +neuroleptics for hallucinations and psychotic features; selegiline can slow progression of dx (MAO inhibitor)
