Dementia Flashcards
Initial work up for dementia/cognitive impairment
CBC BMP with electrolytes Vit b12 and oflate level TSH RPR CT/MRI head RULE OUT DEPRESSION
detailed history and physical exam of course
pathological hallmarks of Alzheimers (AD)
- brain atrophy
- senile plaques (extracellular amyloid deposits surrounded by dystrophic axons)
- neurofibrillary tangles NFTs (intracellular tau protein)
risk factors for AD
age, female gender, hx severe head trauma, Down syndrome
Genetic risk factors AD
ApoE4 on chromosome 19 (early/late onset)
amyloid precursor protein (APP) (early onset)
amyloid beta precursor protein ABPP
presenlin1/2 PS1/PS2
a2 microglobulin
Sequence of symptoms that AD presents with
MEMORY LOSS FIRST (lost in familiar places, usually picked up by close contacts)
then progressively loses speech, understanding, and decision making…late disease you lose elementary motor, visual, somatosensory, and gait)
psychiatric manifestations AD
personality changes (apathetic/impulsive) aggression paranoid thoughts/delusions sleep disturbances "sundowning"
how to diagnose AD
CLINCALLY
no test can definitely diagnose AD except for brain biopsy (postmortem?)
CSF findings AD
elevated tau protein
low AB-42
MRI findings AD
small hippocampus, amygdala, and thalamus
up to 40% size reduction
PET and SPECT findings AD
bilateral temporoparietal hypometabolism (not specific)
Treatment goals for AD
- symptom prevention (psychiatric)
- preventing/slowing progression (AchE inhibitors, NMDA antagonist)
- prophylaxis (limited data, vitE, NSAIDs)
AchE inhibitors for AD
donepezil
rivastigmine
galatamine
(“go DO, RIVer, Gallantly)
side effects donepezil and rivastigmine
hepatic toxicity
diarrhea/abdominal cramps
MOA memantine
NMDA receptor antagonist
two recognized types of vascular dementia
- macrovascular (large infarcts)
2. microvascular (subcortical ischemia a/w cerebral small vessel disease; lacunes/deep white matter changes on MRI)
