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Primary Care Exam 3 > Dementia > Flashcards

Dementia Flashcards

1
Q

What is the leading cause of mortality in older adults?

A

Dementia

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2
Q

What is dementia?

A
  • 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
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3
Q

How is mild neurocognitive disorder diagnosed?

A

Modest impairment and declining cognitive performance that does not interfere with ADLs

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4
Q

How is major neurocognitive disorder diagnosed?

A

Decline in one or more cognitive domains, 2 standard deviations below the norm, that interferes with ADLs

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5
Q

What are the six cognitive domains?

A
  1. Perceptual – motor function
  2. Language
  3. Learning and memory
  4. Social cognition
  5. Complex attention
  6. Executive function
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6
Q

What are some functions related to perceptual– motor function?

A
  • Visual perception
  • Visuoconstructional reasoning
  • Perceptual – motor coordination
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7
Q

What are some functions related to language?

A
  • Object naming
  • Word finding
  • Fluency
  • Grammar and syntax
  • Receptive language
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8
Q

What are some functions related to learning and memory?

A
  • Free recall
  • Cued recall
  • Recognition memory
  • Semantic and autobiographical long-term memory
  • Implicit learning
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9
Q

What are some functions related to social cognition?

A
  • Recognition of emotions
  • Theory of mind
  • Insight
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10
Q

What are some functions related to complex attention?

A
  • Sustained attention
  • Divided attention
  • Selective attention
  • Processing speed
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11
Q

What are some functions related to executive function?

A
  • Planning
  • Decision-making
  • Working memory
  • Responding to the feedback
  • Inhibition
  • Flexibility
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12
Q

What are the five types of dementia?

A
  • Mild cognitive impairment
  • Alzheimer’s disease
  • Vascular dementia
  • Frontotemporal dementia
  • Dementia with Lewy bodies
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13
Q

How do we define mild cognitive impairment?

A

Impairment one or more cognitive domain

  • More than normal aging
  • Decline from baseline
  • Does not interfere with ADLs
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14
Q

What is the difference between amnestic and non-amnestic MCI?

A
  • Amnestic: memory, progresses to Alzheimer’s

- Non-amnestic: other 5 domains, progresses to other dementias

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15
Q

How do we manage MCI?

A
  • Rule out modifiable causes
  • Nonpharmacological management
  • Frequent monitoring for progression
  • Support and coping
  • Good opportunity to discuss advanced care planning
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16
Q

How do we define vascular dementia?

A
  • 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
17
Q

How do we manage vascular dementia?

A
  • 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
18
Q

How do we define Alzheimer’s disease?

A

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

19
Q

What is the pathophysiology of Alzheimer’s disease?

A
  • 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
20
Q

What does Alzheimer’s disease looks like on MRI?

A

Shrinkage of the hippocampus and more CSF

21
Q

What does mild Alzheimer’s disease look like?

A
  • Forgetting words or names
  • Difficulty at work
  • Forgetting material just read
  • Losing or misplacing valuables
  • Difficulty with cleaning and organizing
22
Q

What does moderate Alzheimer’s disease look like?

A
  • 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
23
Q

What does severe Alzheimer’s disease like?

A
  • Increasing disorientation
  • Physical changes
  • Limited communication
  • Complications
24
Q

What does the overall progression and life expectancy of Alzheimer’s disease look like?

A
  • 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
25
Q

What is frontotemporal dementia?

A
  • 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.
26
Q

What characterizes behavioral variants of frontotemporal dementia?

A
  1. Personality changes
  2. Executive dysfunction
  3. 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*
27
Q

What is primary progressive aphasia (PPA)?

A
  1. Semantic dementia or semantic variance PPA
    - Fluent speech
    - Impairment in semantic categories
    - Difficulty naming, recognizing objects, occurs in words that occur less frequently
  2. 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
  3. Logopenic variant of PPA
    - Slow, effortful speech
    - No motor loss or grammar errors
28
Q

Are the two proteins involved in pathophysiology of primary progressive aphasia?

A
  • TDP-43

- FUS

29
Q

What is dementia with Lewy bodies?

A
  • 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
30
Q

What are the core features of dementia with Lewy bodies?

A
  • Fluctuation cognition with pronounced variations in attention and alertness
  • Complex visual hallucinations
  • Parkinsonism
31
Q

What are the suggestive features of dementia with Lewy bodies?

A
  • REM sleep behavior disorder
  • Sensitivity to antipsychotics
  • Low dopamine uptake
32
Q

What is probable vs possible dementia with Lewy bodies?

A
  • Probably: 2+ core features

- Possible: 1 core and 1 suggestive feature

33
Q

What are the supportive features of dementia with Lewy bodies?

A
  • Repeated falls and syncope
  • Transient, unexplained loss of consciousness
  • Autonomic dysfunction
  • Hallucinations
  • Visuospatial abnormalities
  • Other psychiatric disturbances
34
Q

Other types of dementias?

A
  • Mixed
  • Delirium induced
  • Traumatic brain injury

Primary Care Exam 3 (4 decks)

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