Dementia Flashcards
What is dementia?
A collection of symptoms affecting thinking and social abilities resulting from damage to the brain. Interfering with daily functioning
What conditions can mimic dementia?(6)
Delirium Depression/schizophrenia Drugs/alcohol mental retardation normal age memory decline mild cognitive impairment
What is needed for a diagnosis of dementia?
- deatailed history + collateral history
- Cognitive and mental exam
- MMSE, CDT, MoCA, STMS
What can be the causes of dementia? (8)
Neurodegenerative - AD, LBD, FTD, HD
Vascular - infarcts, amyloid, vasculitides
Neurological - MS, NPH
Nutritional - B12, Thiamine, Niacin
Infectious - HIV, Prion, Syphilis, Cryptococcus
Metabolic - Hepatic, renal, Wilsons
Traumatic - hematoma, dementia pugilistica
Toxic - alcohol, heavy metals, anticholinergic, CO
What is the most common type of dementia?
Azlheimer’s disease
What are the features of Alzheimer’s disease?(4)
- Gradual cognitive decline
- fresh memory impairement - remote memory intact
- changes in language, reasoning, executive funct.
- seldom before age of 65
What are the three stages of alzheimer’s in terms of daily activities?
- Need some assistance with daily activities
- Trouble taking care of themselves, but still involved
- Need help to eat, walk, go to the toilet
What are the three stages of alzheimer’s in terms of behavior and cognition?
- Sad/ avoid social - misplacing items, forgets appointements/names/recent events
- changes is sleep, wandering, easily upset - trouble recognizing family members, difficulty expressing self
- Touching things over and over, sleeping
- less speaking, less response to care partners
What is the pathophysiology behind Alzheimer’s?
Hippocampus most impacted
Amyloids plaques, Neurofibrillary tangles
What are the risk factors for Alzheimer’s?(5)
genetic - apoE4, femal gender head injury lower education smoking
What drugs can be used to treat Alzheimer’s? (2)
Cholinesterase inhibitors:
- DOnezepil
- Rivastigmine, galantamine
NMDA channel modulator:
- mementine
What are the three clinical variants of frontotemporal degeneration?
- Frontal variant/Pick disease
- Semantic dementia (temporal variant)
- progressive nonfluent aphasia
What is the pathological findings in PIck disease?
atrophy of frontotemporal region
Pick’s cells
50% are familial
What are the symptoms of frontotemporal dementia?(4)
Personality changes: rude, inappropriate, obsessive, aggressive
Speech problems: Reduced quantity/quality/loss - reduced understanding
Eating habits: overeating, alcohol, sweets, objects
Attention: cant maintain line of thought, easily distracted
What is Primary progressive Aphasia?
Progressive language disorder with preservation of other mental functions for 2 years
Divided into: - Progressive non-fluent aphasia
- Semantic dementia
What is Semantic dementia?
Circumscribed multimodal disorder of conceptual knowledge (word meaning and comprehension)
- bilateral assymmetric degeneration of ant. temp lobe
What is progressive non-fluent aphasia?
impaired production of speech /word retrival
preserved ria and non-verbal comm.
What is needed to diagnose Lewy body dementia?
Dementia and 2 of the following three:
- motor feature of Parkinsonism
- visual hallucinations
- Fluctuating cogniton
Suggestive:
- early falls and
- oversensitivity to neuroleptics
What is vascular dementia?
Multiple cognitive deficits manifested by both:
- memory impairement
- aphasia/apraxia/agnosia/executive disturb.
+impaired socal/occupation
focal signs
not delirium
What are the risk factors for vascular dementia?(4)
Age
cardiovascular risk factors
elevated homocysteine
genetic (CADASIL)
What is normal pressure hydrocephalus(NPH)?
ventricles enlarge at expense of brain
normal CSF pressure
due to a gradual blockage of CSF drainage
What can be the cause of normal pressure hydrocephalus (NPH) ?(2)
complication of cerebral infection or hemorrrhage
Idiopathic
What are the characteristic symptoms of NPH? (4)
Urinary incontinence - wet
Dementia - wacky
Wide gait - wobbly
also a general slowing of activity
What is the treatment for NPH?
shunting of CSF from ventricles to peritoneum
What is the pathophysiology of Huntington disease?
AD - Trinucleotide repeat, chromosome 4
- degeneration of caudate and putamen (striatum)
When does the symptoms of Huntington disease usually develop?
30-50 years of age (can vary greatly)
What are some early symptoms of Huntington disease?
slight uncontrollable movements stumbling/clumsiness lack of concentration short term memory lapses depression irritability mood changes - sometimes aggressive
How is Huntington disease diagnosed?
genetic testing + history and exam
