Dementia Flashcards
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?
Dementia
Anterograde amnesia, slow onset, with NO impact on attention / arousal which may suggest delirium
Short-term memory is involved with what brain structure?
Pre-frontal cortex
Long-term memory is involved with what brain structure?
Hippocampus
What is the most common cause of dementia in people 65 or older in the US?
Alzheimer’s Dz Dementia
What is the greatest risk factor for Alzheimer’s Dz development?
Age
What is the presenting clinical picture for a PT with Alzheimer’s Dz?
Memory loss
~~~(short or long term)
Apraxia
~~~(impaired coordination of movements)
Language
~~~(mild aphasia to muteness)
Visual Impairment
~~~(spatial impairment)What does the diagnostic criteria for Alzheimer’s Dz include?
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
What is the best diagnostic test you can give a PT to determine if mild cognitive impairment is present?
Montreal Cognitive Assessment (MOCA)
When administering a Mini-Mental Status Exam what questions should you ask?
What are the associated scores with each category?
Orientation
Registration
Attention / Calculation (Serial 7s)
Recall
Language
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?
Brain CT or MRI EEG CBC (lytes) TSH B12 Screen for Depression
When is a lumbar puncture indicated for a PT with suspected Dementia?
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)
If imaging were performed on a PT with severe Alzheimer’s Dz; what findings could you expect to see?
Amyloid Beta plaques
Neurofibrillary tangles
Hippocampal atrophy
Granular-vascular degeneration of neurons
What kinds of Tx would you consider for a PT with mild-moderate dementia associated with Alzheimer Dz?
Cholinesterase Inhibitor (Donepezil, rivastigmine, galantamine) (memantine)
Vitamin E supplementation
Exercise therapy
Cognitive stimulation therapy
How would a vascular dementia PT present if the Middle Cerebral Artery were infarcted/occluded?
Aphasia
Confusion
Anosognosia
How would an Anterior Cerebral Artery infarct with dementia present clinically?
Frontal Lobe!!
Poor thinking, planning
Decreased initiative
How would a Posterior Cerebral Artery infarct present?
Parietal –> vision
Visual distortions
Hallucinations
CORTICAL BLINDNESS!!!!!!!!!
What are the two patterns of Frontotemporal Dementia you should be attempting to work through as you assess your PT?
Changes in behavior
Problems with language
Frontotemporal dementia follows what inheritance pattern? (Appx. 1/4 of the time)
Autosomal dominant in 10-25% of PTs
Family Hx in 40% of PTs
Frontotemporal disease shares a connection with what other 2 conditions?
Lou Gehrig’s Dz (Amyotrophic Lateral Sclerosis)
Motor neuron disease
Lewy Body Dementia shares the same protein (alpha-synuclein) anomaly as what Dz?
Parkinson’s Disease
Hunched posture
Balance issues
Rigid muscles
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?
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
What drugs should be used with EXTREME CAUTION in Dementia w/ Lewy Bodies?
Why should you use extreme caution?
Antipsychotic drugs
Altered consciousness
Impaired swallowing
Hallucinations / Delusions
Worsened Parkinson’s symptoms
What drug may be prescribed to Tx the altered REM sleep associated S/Sx and acted out dreams observed with Lewy Body Dementia?
Clonazepam
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?
XS CSF
1. Thinking / Reasoning issues (Dementia)
2. DIFFICULTY WALKING (Gate Apraxia)
~~~Magnetic Gait~~~
3. Loss of bladder control (INCONTINENCE)
What are some of the potential causes of Normal Pressure Hydrocephalus?
IDIOPATHIC
Hemorrhage
Infxn
Inflammation
What clinical study could help in making an accurate diagnosis for a suspected PT with Normal Pressure Hydrocephalus?
MRI (looking for ventricular enlargement)
What are the uncontrolled spastic movements in the head and arms?
What Dz is this associated with?
Chorea movements
Huntington Dz
What is spongiform pathology associated with?
Creutzfeldt-Jakob Dz (PRNP gene mutation)
What is the typical clinical presentation of Frontal Temporal Dementia?
Sexually uninhibited Lack of social tact Distractibility Lack of empathy Personal hygiene neglect Repetitive / Compulsive behavior
What kind of dementia is associated with chronic alcoholism?
Korsakoff Syndrome***
