dementia

Question 1

Instrumental actiivties of daily living IADLS

Activities of daily living (ADLs)

Answer 1

IADL- Cooking, house cleaning, laundry, management of medications, management of the telephone, management of personal accounts, shopping, use of transportation

ADLs- dressing, eating, ambulating, toileting, hygeine (bathing

Question 2

differential diagnosis of dementia

Answer 2

Alzheimers, vascular disease, lewy body disease, CVA, Depression, frontotemporal degeneration, hypothyroidism, traumatic brain injury

Substance abuse, med adverse reaction/side effect, HIV infection, Prion disease, parkinsons disease, huntingtons disease

Question 3

mini cog test

Answer 3

Ask patient to remember 3 unrelated words

Ask pt to draw the face of a clock, after the numbers are written draw a time
ask pt to recall the 3 word, if you can recal a word or two and draw a clokc youre fine

anything less is cog impairmnet

Question 4

Labs for dementia

Answer 4

CBC, electrolytes, Creatinine, glucose, TSH, B12

HIV, RPR, heavy metal, LFTs, MMA

Question 5

Cognitive Domains

Answer 5

Orientation, registration, Visuospatial and executive functioning, language, attention and working memory, memory

Question 6

diagnosis of dementia

Answer 6

> 1 cognitive domain affected
Impaired occupational function
Evidence of progression
No alternative diagnosis

Question 7

Alzheimers

Answer 7

Senile plaques (SPs)- amyloid plaques

Diffuse plaque- extracellular accumulation of AB protein
Neuritic plaque- extracellular accumulation of AB protein and tau containing neurites

Neurofibrillary tangles (NFTs)- intraneuronal accumulation of an abnormally phosphorylated form of tau, a normal microtubule associated protein, NFTs are not uniqe to AD also found in other degenerative diseases

Question 8

safety issues in dementia

Answer 8

Home environment, medications, firearms, wandering and getting lost, driving

Question 9

no drugs to modify the disease course

Answer 9

Agents to treat cognitive issues- Cholinesterase inhiibtors, NMDA non-competitive antagonist (open channel blocker)

Agents to treat behavioral symptoms
Cholinesterase inhibitors and NMDA antagonists have modest efficacy

Atypical antipsychotics
Mood stabilizers
Antidepressants

Question 10

Synthesis and termination of Ach

Answer 10

Cholinergic Varicosity

CoA + Choline–> ACh (ChAT)

Ach is put in the vesicles via (VACht) inhibitied by vesamicol

Vesicular ATPase

moves to active zone, Botox inhibits the release from vesicles

CHT puts Choline in the neuron via CHT1

MACHr and nACHr

ACh is inhibited by AChE

Sludge- Salivation, lacrimation, Urination, Diarrhea, GI emesis

Question 11

Cholinesterase inhibitors

Answer 11

Treats AD, Lewy Body dementia, and vascular dementia

Reversible, centrally acting
First line therapy to treat cognitive impairments in mild to moderate dementia

Drugs- Donepezil, Rivastigmine, Galantamine

Modest improvement, many side effects ( 1/3 have GI problems, muscle cramping and abnormal dreams

USed with caution in patients with bradycardia or syncope, because of vagotonic properties

Question 12

memantine

Answer 12

NMDA is an open channel blocker (non competitive antagonist)

ADs (neurodegenerative disorders, includes excitotoxicity, oxidative stress, and neuroinflammation

significantly reduces the rate of clinical deterioration in Pts with moderate severe AD

Can be used together with anticholinergics

SE include headache and dizziness

Question 13

dementia is an umbrella term used to describe a range of symptoms associated with cognitive impairment

Answer 13

Alzheimers 50%-75%
Vascular 20-30%
Lewy body 10-25%
Frontotemperal 10-15%

Question 14

typical exam findingds o f dementia

Answer 14

Vascular dementia-vascular peripheral vascular findings, AAA, Cardiovascular findings such as atrial fibrillation

Parkinsons- pil rolling tremor, shuffling gait, freezing, rigidity, masked facies, hypophinia, micrographia

Other
NPH- magnetic gait, huntingtons chorea, FTD- hevioral findings, PPA- profound aphasia

Question 15

Dementia with Lewy bodies

Answer 15

Accounts for 10-20% of dementias

More frequent in men and mean age of onset is 75 yrs

Most cases are sporadic, there is an autosomal dominant inherited form associated with the alpha synuclein gene in some families

Diagnosis often missed as many of the clinical feature with other disorders

Gradual cognitive decline, dementia often presenting symptom

Early in course, attentipn, visospatial and executive function, poor job performance getting lost

Later in course memory is impaired

fluctuation in alertness and can last from seconds to days in between episodes functioning may be normal

Vivid visual hallucinations, simple or complex an early sign and often precede motor symptoms

Parkinsonism after dementia

Rem sleep disorder

Question 16

Alpha synuclein

Answer 16

alpha synuclein is a major component of Lewy bodies
Found in deep cortical layers throughout the brain
Anterior frontal and temporal lobes
cingulate gyrus and insula

amyloid plaques are often present but NFTs are rare in DLB
NF tangles are sparse or absent

Neuronal loss is more in DLB is greater in frontal lobes nucleus basalais of meynert S nigra and Lc

Decrease cortical levels of choline acetyl transferase