Dementia (5Q) Flashcards
Dementia: risk factors
- Age
- Family Hx
- Vascular disease/ Diabetes
Dementia: protective factors
Education, continuing intellectual stimulation
Dementia: patient
Over 60 yo, w/ risk doubling every 5 years after that.
Differentiate delirium from dementia
Delirium: acute confusional state that often occurs in response to an identifiable trigger. (eg, drugs, infection, metabolic disturbance, sleep deprivation, or other neurologic disease.
Delirium will have a fluctuating level of arousal including drowsiness or agitation that improves with removal of precipitating factor.
Word-finding difficulty (def and lesion location)
a dementia symtom- refers to difficulty recalling the names of people, places, or objects (low-frequency first), resulting in speech laden with pronouns and circumlocations. NO problems with articulation, fluency, or word meaning.
Suggests lesion in temproparietal junction of L hemisphere.
Visuospatial dysfunction (def and lesion location)
Symptom of dementia: results in poor navigation and getting lost in familiar places, inability to identify familiar faces or buildings, or trouble discerning object from background.
Suggests lesion in R parietal lobe.
Short-term memory loss (def and lesion location)
It is what it sounds like. Suggests lesion in hippocampus.
Executive dysfunction (def and lesion location)
easy distractability, impulsivity, mental inflexibility, slowed processing, impaired judgement, poor planning.
Suggests lesion in frontal lobe or subcortical areas (basal ganglia, white matter).
What are some other Sx of dementia (not including short term memory loss, word-finding difficulty, visuospatial dysfunction, executive dysfunction)? Where do they suggest lesions?
Apathy- damage to frontal lobe, basal ganglia, or white matter.
Apraxia- loss of learned motor behaviors- damage in frontal or parietal (esp L) lobes.
Why is it so important to have a baseline assessment of functional status (ADLs, IADLs) for geriatric patients?
Cognitive and functional decline may ONLY be noticeable when compared to pt’s baseline.
What are the limitations of mini-mental status exams (including Folstein MMSE and Montreal Cog Assessment)?
They are insensitive to mild cognitive impairment, may be biased negatively by language/attention problems, does not correlate with functional capacity.
Dementia screening guidelines for asymptomatic older patients:
There aren’t any! Current suggests for patients >70: Test registration (apple, book, car), clock test (hands at 11:10), short term memory (repeat 3 words after clock test). If there is any abnormality (remember <3 words or have a weird clock), then do a full MMSE.
For whom is brain imaging indicated? What are you looking for?
Any patient with a new, progressive cognitive complaint. Goal is to rule out occult cerebrovascular disease, tumor, or other structural abnormality (not provide positive evidence of disease). MRI is preferred.
When is a PET scan useful?
When you are trying to distinguish between several dementia causes (eg, Alzheimer and frontotemporal dementia). Specifically, PET imaging with a radiolabeled ligand for beta-amyloid is sensitive to amyloid pathology and provides positive evidence of Alzheimer).
Alzheimer pathology
Plaques containing beta-amyloid peptide and neurofibrillary tangles containing tau protein occur throughout neocortex.
