Dementia

Question 1

Delirious

Answer 1

unable to answer questions

frightened and agitated

Question 2

Dementia

Answer 2

not concerned with mistakes

tries to answer

Question 3

pseudodementia

Answer 3

“I don’t know” answers
won’t answer questions
get frustrated & afraid they’ll be wrong

Question 4

Dementia –progressive and mostly irreversible

Answer 4

progresses slowly (insidious onset) 
memory gaps
disoriented (memory, judgment, abstract thinking, and orientation gets worse over time)
poor task performance
worse as day goes on
appears unconcerned
appetite doesn't change

Question 5

Pseudodementia (depression with demenia syndrome)

Answer 5

progresses rapidly
forgetful
oriented
puts forth little effort
improves throughout day
communicates stress
diminishes stress

Question 6

Differentiating pseudodementia

Answer 6

Depression with dementia syndrome
hx. of depressive episodes
presence of vegetative signs (insomnia & weight loss)
tendency to "give up trying"
often misdiagnosed

Question 7

Primary Dementia

Answer 7

irreversible

• Alzheimer’s disease
• Vascular dementia
• Pick’s disease
• Lewy body disease

Question 8

Secondary Dementia

Answer 8

Usually reversible

-cause by other pathological process (hydrocephalus)

Question 9

Alzheimer’s disease

Answer 9

• widespread brain atrophy
• decreased availability of Ach and/or high glutamate (too much excitatory neurotransmitter = neuronal death)
• marked increased in neuritic plaques & neurofibrillary tangles
• genetic fx. (early-onset)

Question 10

Pick’s Dementia

Answer 10

• atrophy of frontal and anterior temporal lobes
  
  • behavior manifestations (disinhibition and extreme impatience

-some issues with antipsychotics (can get really crazy)

Question 11

Vascular dementia

Answer 11

• little TIAs
  
  • brain has multiple vascular lesion in cortex/subcortical areas
    
    • sx. appear more abrupt (stair-step deterioration) get a little worse with each TIA

-M>F

Question 12

Creutzfeldt-Jacob disease

Answer 12

• mad-cow disease
• caused by prions that cause spongiform encephalopathy (cells stripped of inner cell material)

Sx: personality changes and seizures
-can be dormant for years then hits and death within a year

Question 13

Diffuse Lewy Body Disease

Answer 13

• Lewy bodies in:
  
  • frontal and temporal cortex mainly
  • also in hippocampus and substantia Niagra

-sx. -severe visual hallucinations, fluctuating alertness (like delirium), some falls & EPS (shuffling walk, cogwheel movements)

Question 14

Normal pressure hydrocephalus

Answer 14

impaired return of CSF = too much fluid and pressure
enlarge ventricles can be seen on CT/MRIs

-reversible if surgery done early enough

Question 15

Huntington’s Disease

Answer 15

Insidious behavioral changes
Disruption of attention
Distinctive choreiform (Involuntary, forcible, rapid, jerky movements) movements appear later: facial twitches

Question 16

Huntington’s Disease cause

Answer 16

Mutation on chromosome 4
Autosomal dominant
CAG repeats 11-34 times
> 34 number of repeats, earlier the onset and more severe

Question 17

AIDS dementia

Answer 17

• classic triad of sx (cognitive, motor function, and behavioral sx)
• subcortical dementia with infiltration of infected macrophages or microglial cells in brain

Risk: 3x with CD4 of <200, 7x with CD4 of <100

Question 18

Wernicke Korsakoff syndrome

Answer 18

vitamin B1 low (rare and potentially reversible dementia)

low B1 (thiamine) = causes demyelination and axon loss in brain and spine

Sx: ataxia, nystagmus, confabulation (long-time story changes through the years b/c patient can’t remember what happened and makes stuff up)

Question 19

Alzheimer’s Risk Factor

Answer 19

Age
African-American and Hispanic
hypertension
DM
Head trauma (football)
women (a menopause especially)

Question 20

Alzheimer’s Stages

Answer 20

Stage 1 (mild): forgetfulness
Stage 2 (moderate): confusion
Stage 3 (moderate to severe): ambulatory dementia
Stage 4 (late): end stage

Question 21

Alz. Sample of Behaviors

Answer 21

Confabulation: unconscious attempt to maintain self-esteem
Perseveration: repetition of phrase or behaviors
Aphasia: loss of language ability
Apraxia: loss of purposeful movement in the absence of motor or sensory impairment
Agnosia: loss of sensory ability to recognize objects

Question 22

Cholinesterase inhibitors

Answer 22

• get rid of ACH enzyme that eats ACH
• for mild to moderate AD
• As AD progresses, brain produces less and less ACH making the meds not as useful

-aricept, Exelon, reminy/rivastigmine, Cognex

Question 23

Namenda (memantine)

Answer 23

• believed to regulate glutamate
• for moderate to severe AD
• mainly to delay the s/s

Question 24

Other meds to deal with AD as it progresses

Answer 24

for agitation and aggression

• depakote
• carbamazepine (tegretol)

SSRIs and atypical antipsychotics help quell agitation anxiety, and aggression (they have additive anticholinergic effects -prone to falls, but slow down the movements)

Question 25

delirium

Answer 25

acute onset
disturbances in consciousness
disturbed thnking, memory, attention, and perception
disorientation/confusion that fluctuates
always CAUSED BY AN UNDERLYING CONDITION
Rx: fix underlying cause

Question 26

Delirium causes

Answer 26

dehydration
UTIs 
ICU psychosis
Meds
hyperpyrexia

Question 27

Delirium sx.

Answer 27

clouding of consciousness
decreased awareness of environment/hypervigilance 
disorientation
memory impairment (remote/recent)
labile affect (mood all over the place)
impaired judgment/insight
may have hallucinations
agitated/stupor
attention deficit