Dementia Flashcards
What is the leading cause of mortality in older adults?
Dementia
What is dementia?
- A decline in one or more cognitive domains from previous functioning that is severe enough to interfere with everyday activities
- Insidious onset and progressive decline
- No other medical or psychiatric explanation
How is mild neurocognitive disorder diagnosed?
Modest impairment and declining cognitive performance that does not interfere with ADLs
How is major neurocognitive disorder diagnosed?
Decline in one or more cognitive domains, 2 standard deviations below the norm, that interferes with ADLs
What are the six cognitive domains?
- Perceptual – motor function
- Language
- Learning and memory
- Social cognition
- Complex attention
- Executive function
What are some functions related to perceptual– motor function?
- Visual perception
- Visuoconstructional reasoning
- Perceptual – motor coordination
What are some functions related to language?
- Object naming
- Word finding
- Fluency
- Grammar and syntax
- Receptive language
What are some functions related to learning and memory?
- Free recall
- Cued recall
- Recognition memory
- Semantic and autobiographical long-term memory
- Implicit learning
What are some functions related to social cognition?
- Recognition of emotions
- Theory of mind
- Insight
What are some functions related to complex attention?
- Sustained attention
- Divided attention
- Selective attention
- Processing speed
What are some functions related to executive function?
- Planning
- Decision-making
- Working memory
- Responding to the feedback
- Inhibition
- Flexibility
What are the five types of dementia?
- Mild cognitive impairment
- Alzheimer’s disease
- Vascular dementia
- Frontotemporal dementia
- Dementia with Lewy bodies
How do we define mild cognitive impairment?
Impairment one or more cognitive domain
- More than normal aging
- Decline from baseline
- Does not interfere with ADLs
What is the difference between amnestic and non-amnestic MCI?
- Amnestic: memory, progresses to Alzheimer’s
- Non-amnestic: other 5 domains, progresses to other dementias
How do we manage MCI?
- Rule out modifiable causes
- Nonpharmacological management
- Frequent monitoring for progression
- Support and coping
- Good opportunity to discuss advanced care planning
How do we define vascular dementia?
- Presentation based on extent and location of cerebrovascular event
- Stepwise decline
- History of vascular risk factors, CVA or TIA
- Caused by small vessel ischemic disease, reduced blood flow leading to sell death
- MRI shows infarct and white hyperintensities
How do we manage vascular dementia?
- Mitigate risk factors: Smoking, DM, obesity, hypercholesterolemia, Atrial fibrillation, and atherosclerosis
- Heart healthy lifestyle: Heart health = Brain health
- Nonpharmacological management depending on presentation
- Monitor for progression
How do we define Alzheimer’s disease?
Impairment in one or more cognitive domain, primarily memory
- More than normal aging
- Decline from baseline
- DOES interfere with ADLs
Early changes are primarily recent and episodic memory, later progressing to difficulty with visuospatial function and language
- Usually see in 7th and 8th decades of life
What is the pathophysiology of Alzheimer’s disease?
- Caused by beta-amyloid plaque and neurofibrillary tau angles
- Amyloid: protein cleaved off to help with body functions - cleaved off at wrong point, can’t do it’s job, clumps
- Tangles: ties on train track - without these, train track falls apart and trains can’t run - these tend to clump too
- Leads to impaired cell functioning and cell death - can’t bring back neurons once they’ve died - this is why it’s progressing
What does Alzheimer’s disease looks like on MRI?
Shrinkage of the hippocampus and more CSF
What does mild Alzheimer’s disease look like?
- Forgetting words or names
- Difficulty at work
- Forgetting material just read
- Losing or misplacing valuables
- Difficulty with cleaning and organizing
What does moderate Alzheimer’s disease look like?
- Forgetting personal history
- Changes in food, less social interaction
- Disorientation to day or location
- Inappropriate clothing choice
- Some difficulty controlling bowel or bladder
- Changes in sleep
- Increase wondering
- Personality changes
What does severe Alzheimer’s disease like?
- Increasing disorientation
- Physical changes
- Limited communication
- Complications
What does the overall progression and life expectancy of Alzheimer’s disease look like?
- At first progresses slowly, but declines quickly toward the end of the disease
- Alzheimer’s life expectancy 8-10 years from time of diagnosis, although a huge range of 2-20 years
What is frontotemporal dementia?
- Progressive atrophy of frontal and/or temporal lobes
- Changes in behavior, personality, and/or language, while memory is preserved
- Early onset in 5th or 6th decades - most common dementia in people under 60
- Life expectancy of 6-9 years and 3-4 years after diagnosis
- Commonly misdiagnosed as anxiety, depression, etc.
What characterizes behavioral variants of frontotemporal dementia?
- Personality changes
- Executive dysfunction
- Behavior changes
- Flat affect, social blunting, inflexibility of routine (repeating of same routine, same rituals)
- Unusual to present with new mood disorder in 50s and 60s, will see progression, and structural changes on imaging
- May see changes in clothing
* Common = apathy, perseveration, disinhibition, and stereotyped behavior*
What is primary progressive aphasia (PPA)?
- Semantic dementia or semantic variance PPA
- Fluent speech
- Impairment in semantic categories
- Difficulty naming, recognizing objects, occurs in words that occur less frequently - Progressive nonfluent aphasia or agrammatic PPA
- Non fluent speech
- Speech errors
- Trouble with motor aspect of speech, can’t say many words together
- Sentences are shorter, telegraphic speech
- Phonologic errors, difficulty with complex grammer - Logopenic variant of PPA
- Slow, effortful speech
- No motor loss or grammar errors
Are the two proteins involved in pathophysiology of primary progressive aphasia?
- TDP-43
- FUS
What is dementia with Lewy bodies?
- Parkinson’s disease with dementia: Cognitive impairment > 1 year
- Motor changes occur BEFORE cognitive impariment
- Lewy Body demenita: Cognitive impairment < 1 year
- Motor changes occur with dementia
What are the core features of dementia with Lewy bodies?
- Fluctuation cognition with pronounced variations in attention and alertness
- Complex visual hallucinations
- Parkinsonism
What are the suggestive features of dementia with Lewy bodies?
- REM sleep behavior disorder
- Sensitivity to antipsychotics
- Low dopamine uptake
What is probable vs possible dementia with Lewy bodies?
- Probably: 2+ core features
- Possible: 1 core and 1 suggestive feature
What are the supportive features of dementia with Lewy bodies?
- Repeated falls and syncope
- Transient, unexplained loss of consciousness
- Autonomic dysfunction
- Hallucinations
- Visuospatial abnormalities
- Other psychiatric disturbances
Other types of dementias?
- Mixed
- Delirium induced
- Traumatic brain injury
