Dementia

Question 1

There has been a PROGRESSIVE decline and loss of cognitive function in your PT over time. Their family member describes they are unable to learn new things. What do you suspect Delirium or Dementia? Why?

Answer 1

Dementia

Anterograde amnesia, slow onset, with NO impact on attention / arousal which may suggest delirium

Question 2

Short-term memory is involved with what brain structure?

Answer 2

Pre-frontal cortex

Question 3

Long-term memory is involved with what brain structure?

Answer 3

Hippocampus

Question 4

What is the most common cause of dementia in people 65 or older in the US?

Answer 4

Alzheimer’s Dz Dementia

Question 5

What is the greatest risk factor for Alzheimer’s Dz development?

Answer 5

Age

Question 6

What is the presenting clinical picture for a PT with Alzheimer’s Dz?

Answer 6

Memory loss 
      ~~~(short or long term)
Apraxia 
       ~~~(impaired coordination of movements)
Language 
       ~~~(mild aphasia to muteness)
Visual Impairment 
       ~~~(spatial impairment)

Question 7

What does the diagnostic criteria for Alzheimer’s Dz include?

Answer 7

Progression over 6 months
~~~SLOW onset –> DEMENTIA (quick is delirium)
Anterograde Amnesia (cannot make new memories)
Multiple Cognitive Deficits (memory/language)
Not due to another condition
Impairment in functioning

Question 8

What is the best diagnostic test you can give a PT to determine if mild cognitive impairment is present?

Answer 8

Montreal Cognitive Assessment (MOCA)

Question 9

When administering a Mini-Mental Status Exam what questions should you ask?

What are the associated scores with each category?

Answer 9

Orientation

Registration

Attention / Calculation (Serial 7s)

Recall

Language

Question 10

Your 70 y.o. PT is complaining of recent memory loss and spatial/visual impairment S/Sx… What kind of labs or studies would you consider for this PT?

Answer 10

Brain CT or MRI
EEG
CBC (lytes)
TSH
B12
Screen for Depression

Question 11

When is a lumbar puncture indicated for a PT with suspected Dementia?

Answer 11

CNS infxn is likely
PT younger than 55y/o
Reactive Serum Syphilis serology
Rapid progressive dementia
High suspicion of (metastatic cancer, hydrocephalus, immunosuppression, CNS vasculitis)

Question 12

If imaging were performed on a PT with severe Alzheimer’s Dz; what findings could you expect to see?

Answer 12

Amyloid Beta plaques
Neurofibrillary tangles
Hippocampal atrophy
Granular-vascular degeneration of neurons

Question 13

What kinds of Tx would you consider for a PT with mild-moderate dementia associated with Alzheimer Dz?

Answer 13

Cholinesterase Inhibitor (Donepezil, rivastigmine, galantamine) (memantine)

Vitamin E supplementation

Exercise therapy

Cognitive stimulation therapy

Question 14

How would a vascular dementia PT present if the Middle Cerebral Artery were infarcted/occluded?

Answer 14

Aphasia
Confusion
Anosognosia

Question 15

How would an Anterior Cerebral Artery infarct with dementia present clinically?

Answer 15

Frontal Lobe!!
Poor thinking, planning
Decreased initiative

Question 16

How would a Posterior Cerebral Artery infarct present?

Answer 16

Parietal –> vision
Visual distortions
Hallucinations
CORTICAL BLINDNESS!!!!!!!!!

Question 17

What are the two patterns of Frontotemporal Dementia you should be attempting to work through as you assess your PT?

Answer 17

Changes in behavior

Problems with language

Question 18

Frontotemporal dementia follows what inheritance pattern? (Appx. 1/4 of the time)

Answer 18

Autosomal dominant in 10-25% of PTs

Family Hx in 40% of PTs

Question 19

Frontotemporal disease shares a connection with what other 2 conditions?

Answer 19

Lou Gehrig’s Dz (Amyotrophic Lateral Sclerosis)

Motor neuron disease

Question 20

Lewy Body Dementia shares the same protein (alpha-synuclein) anomaly as what Dz?

Answer 20

Parkinson’s Disease
Hunched posture
Balance issues
Rigid muscles

Question 21

Lewy Body Dementia differs from the Alzheimer’s Dementia and Vascular Dementia by what abnormal sleep finding?

What other differences might help you differentiate between LBD and Alzheimer’s Dementia?

Answer 21

Acting out dreams (impaired REM sleep)

Hallucinations, delusions, and misidentification of people is MORE COMMON in EALRY STAGE LBD than AD

Movement symptoms > in LBD than AD

Question 22

What drugs should be used with EXTREME CAUTION in Dementia w/ Lewy Bodies?

Why should you use extreme caution?

Answer 22

Antipsychotic drugs

Altered consciousness
Impaired swallowing
Hallucinations / Delusions
Worsened Parkinson’s symptoms

Question 23

What drug may be prescribed to Tx the altered REM sleep associated S/Sx and acted out dreams observed with Lewy Body Dementia?

Answer 23

Clonazepam

Question 24

76 y/o PT presents to your clinic with a Hx of Normal Pressure Hydrocephalus; what S/Sx can you expect to see in this PT?

What is the triad?

Answer 24

XS CSF
1. Thinking / Reasoning issues (Dementia)
2. DIFFICULTY WALKING (Gate Apraxia)
~~~Magnetic Gait~~~
3. Loss of bladder control (INCONTINENCE)

Question 25

What are some of the potential causes of Normal Pressure Hydrocephalus?

Answer 25

IDIOPATHIC
Hemorrhage
Infxn
Inflammation

Question 26

What clinical study could help in making an accurate diagnosis for a suspected PT with Normal Pressure Hydrocephalus?

Answer 26

MRI (looking for ventricular enlargement)

Question 27

What are the uncontrolled spastic movements in the head and arms?

What Dz is this associated with?

Answer 27

Chorea movements

Huntington Dz

Question 28

What is spongiform pathology associated with?

Answer 28

Creutzfeldt-Jakob Dz (PRNP gene mutation)

Question 29

What is the typical clinical presentation of Frontal Temporal Dementia?

Answer 29

Sexually uninhibited
Lack of social tact
Distractibility
Lack of empathy
Personal hygiene neglect
Repetitive / Compulsive behavior

Question 30

What kind of dementia is associated with chronic alcoholism?

Answer 30

Korsakoff Syndrome***