Dementia Flashcards
TEST?: key features of CJD:
very rapid decline (over weeks to months) this is NOT present in AD, and marked myoclonus on exam
TEST: 3 D’s
Dementia, is characterized by:
Delirium:
memory impairment that has a gradual progression;
delirium is an acute confusional state that is brought on, usually by an underlining medical condition, marked by inattention being the main feature, highly disorganized thinking, waxing waining, etc.
To tell the difference between delirium and dementia, you can’t have a conversation with someone who is delirius because they won’t stop and focus, they’re constantly doing crazy things all the time; AD can have a whole conversation with you about what’s going on in 1974 but they can’t remember that it’s not 1974
TEST: The most common form of dementia is _____, the second most come is ______
AD, followed by vascular, followed by Lewy body although they’re underdiagnosed so we’re not sure, MANY DIAGNOSED WITH AD PROBALBY HAVE LEWY BODY
TEST: Stage 1 is characterised by _________, Stage 2 is characterised by _________, Stage 3 is characterised by _______
memory disturbances, poor judgement, carelessness in work habits, disorientation to space and time, etc;
restlessness, pacing, incontinence;
worsening language function, motor disturbances, incontinence of urine and feces
neuropathology: Early signs_____, then reduced ____ levels in ______ with increased buden in brain; location is important and the ______ is always effected
synaptic loss in limbic structures, B-amyloid levels in csf; Increase in Tau protein buildup and the temporal lobe is always affected (the time course involvement of other areas varies)
TEST: It is the concentration of tau proteins in the _____ that distinguishes the diagnoses of AD
Medial Temporal lobe (or temporal lobe)
Over _____of AD is sporadic and is later onset
Over 90% of AD is sporadic and is later onset
Family history _____ risk of AD in patients with first degree relative
Family history 10-30% risk of AD in patients with first degree relative
Genetic component of AD:
Not c/w Mendelian inheritance
______accounts for relationship with Down syndrome in their 40s
21q APP accounts for relationship with Down syndrome in their 40s
Late-onset AD:
Apolipoprotein E (ApoE) status:
Late onset associated with ApoE4 allele (chromosome 19)
ApoE2 allele protective
Early-onset AD:
Autosomal dominant: Amyloid precursor protein (APP) (chromosome 21) (Down) Presenilin 1 (PSEN1) (chromosome 14) (most severe) Presenilin 2 (PSEN2) (chromosome 1)
if there is an acute drop in memory and then stability, it may be_____, as one of the diagnositc criteria for AD is _____
trauma or vascular event, progressive worsening of memory and cognition, with no disturbance of activity, or hyper active, etc
62 y/o man, right handed, w/ MA in Ed, retired teacher and realtor
5-6 year hx of memory problems, insidious onset, gradual progression. Word finding problems, forgetting events and conversations, getting lost in familiar areas, forgetting appointments. Retired because unable to perform his duties as realtor.
Early Stage AD:
Cardinal symptom: impaired learning of new information, reflecting earliest involvement of medial temporal region
Verbal memory tests – most sensitive
decreased delayed recall
decreased immediate but NORMAL delayed recall is NOT likely dementia
Impairment should be judged relative to estimated premorbid status
Mild cognitive impairment: prognosis
80% of adults with amnestic MCI progress to AD within 6 years Best predictors of progression: poor memory performance APOE-e4 genotype hippocampal atrophy existing metabolic disease
Depression vs Dementia
If person with depression can internalize the information, they’ll recall it (maybe need some cueing) but AD they won’t;
Impaired attention and effort
May perform better on difficult tests
Memory impairment 2 to impaired attention; poor immediate memory, no additional loss with delay; pronounced benefit of cueing
Late-life depression = risk factor of AD
Important to differentiate cognitive symptoms (avoiding challenge) from affective symptoms (tearful, sadness)
TEST: “step-wise progression”
if someone takes a hit to their cognition (i.e. overnight) and then are stable, then a hit, then stable, etc, it is Vascular dementia, NEED TO HAVE EVIDENCE VIA IMAGINING; used to think there had to be a significant stroke, etc but actually there is more of a chance of small vessel disease
someone isn’t doing their shopping anymore; are they not shopping because they can’t walk and carry their basket/because it’s easier to have somone else do it, or bc they can’t manage a list and know how to find things
Vascular dementia: distinction executive function deficit reduced verbal fluency motor slowing depression, irritability or apathy often present
cognitive impairment with fluctuations and vivd visual hallucinations: not stressful, but vivid and well formed. Woman believes that a family of young children moved into the house, and so she cooks food for the kids to feed them, no idea that the hallucination isn’t real; could be about small animals that come into the room, parkinsonism, COGWHEEL, sleep problems, bradykinesia.
lewy body dementia, adverse reaction to l/dopa (falls syncope, autonomic dysfunctino)
diff between pd and lewy body
all in the timing: PD dementia, parkinsonism symptoms have been there at least a year or longer, in LBD, the cognitive changes come first or come in conjunction with the motor symptoms
TEST: diff between pd and lewy body
all in the timing: PD dementia, parkinsonism symptoms have been there at least a year or longer, in LBD, the cognitive changes come first or come in conjunction with the motor symptoms
TEST: 87 y.o. male, 8 yrs of education, retired ironworker
progressive memory loss for 2-3 years:
repeating questions
word finding difficulties
difficulty with IADLs (e.g., finances, cooking, driving)
visual hallucinations for 5 months; animals, people invading home paranoia, irritability
relevant med hx: atrial fib, macular degeneration, cataracts,
hearing loss, freq dizziness + falls, recent CT: generalized atrophy
meds: warfarin, furosemide, zinc, risperidone for hallucinations
Prominent motor symptoms on exam: cogwheeling, rigidity
Lewy Body DM
Differential Diagnosis: Fronto-temporal lobar degeneration
Earlier onset (45-65) than most AD, with exceptions May represent 20% of all cases <65 years of age seen in dementia clinic 4x more common in men, + FH in 1/3 cases Personality changes: withdrawal, irritability, social inappropriateness Often misdiagnosed as depression
TEST: if younger person, male, presents with completely impaired cognitive functioning but memory completely intact
Think FTLD- Picks disease
Fronto-temporal lobar degeneration
Gait disturbance, urinary incontinence, cognitive deficits (wobbly, wet, & wacky)
Cognitive deficits involve attention & executive function
Normal Pressure Hydrocephalus
Radiologist guides distinction between: atrophy leading to AD type dimentia, or enlarged ventricleswith preservation which point to nph
Additional conditions that can impair cognition:
Cardiovascular disease
Nutritional deficiencies: B12, folate
Type 2 diabetes & impaired glucose tolerance
COPD/sleep apnea
Thyroid dysfunction
Hypo: memory recall, visuospatial, psychomotor speed
Hyper: executive function
