Dementia Flashcards
1
Q
Dementia
A
- symptoms characterized by:
Memory Impairment
At least 1 other significant neuropsychological impairment (aphasia, apraxia, agnosia, cogn deficits)
Cogn impairment causes significant deficits in daily functioning and significant decline - progressive and sustained condition
- Delirium – Acute confusional state marked by loss of orientation.
- some diseases for which dementia is a frequently associated symptom so hard to Dx
2
Q
Dementia Epidemiology
A
- Females are more likely to have dementia then men (bc they live longer)
- Mortality=variable
- premorbid indicators playing important role in prog & course of disease.
3
Q
Alzheimer’s Disease (AD)
A
- 6th leading cause of death in US
- insidious onset and slow, continuous progression.
4
Q
Etiology of AD
A
- genetics + environmental influences
- Theories:
Genetic: approx 40% monozygotic concordance, associated with early onset (<65 years old)
Mutation: Chromosome 21, coding for Beta Amyloid
Accumulation of Beta Amyloid protein
Creation of neurofibrillary tangles via abnormal Tau protein
5
Q
Dx of AD
A
- conditional diagnosis, which can only be confirmed at autopsy
- dementias can be treated similarly, Alzheimer’s meds typically well-tolerated either way
- requires approximately 6 mos to 1 year of check-ups
- behaviorally Dxed, vs. medical tests.(By time CT/MRI picks it up, symptoms will be overt/obvious
- Check for incindental mem
6
Q
Neuropsych Testing for AD
A
- Mini-Mental Stat exam –progressive/continuous drop in scores in delayed memory and executive functioning, and eventually orientation
- Dementia Rating Scales
- California Verbal Learning Test
7
Q
AD Impairment
A
- Loss in memory consolidation & recall–>orientation.
- familiar names and faces become hard to recall, recognize one’s surroundings
- Visuomotor and visuospatial abilies decline
- Delusions and hallucinations
- Wandering behavior, confusion, and labile mood with behavioral outbursts
8
Q
Tx for AD
A
- Medication – cholinergic drugs, which lengthens period of mild to moderate cognitive deficits
- Therapy is adjunctive, such as memory aids
- psychotropics used in the case of hallucinations, delusions, or mood symptoms
- Psychotherapy for acceptance, end of life planning, and strategies to assist in impairments
9
Q
Prog for AD
A
- Age=negative prognostic indicator(but skewed, less years w/ moe age)
- death due to falling, respiratory failure, cardiac arrest, or infection such as pneumonia etc. but not usually AD
- become quiet due to apraxia and aphasia, and eventually motor cortex failure will cause lack of movement
10
Q
Lewy Body Dementia (DLB)
A
- Lewy Bodies (clumps of proteins not properly digested by cells, overproduction) in frontal
Faster onset
Fluctuating course (“sundowning”)
visual hallucinations
Parkinsonian motor features
11
Q
Dx of DLB
A
- behavioral observation.
- MMSEs daily.
- more sundowning
- Parkinsonian symptoms + dementia symptoms simultaneously, as opposed to well before, which would be characteristic of PD.
12
Q
Tx of DLB
A
- cholinergics + dopaminergics
- pts monitored daily
13
Q
Vascular Dementia
A
- lacunar infarcts
- Faster onset
Quick small degeneration in performance followed by little to no progression for a time (staircase)
Association with CVA - commonly comorbid with AD and DLB
14
Q
Dx of VaD
A
- CT: lacunar infarcts seen (w/ multiple TIAs, may be too small)
- prognostic indicators of CVA can be used for VaD:
- *HTN**
- *Hypercholesterolemia**
- *Obesity**
- Those at risk for VaD are also likely to be at risk for AD and DLB
15
Q
Tx of VaD
A
- stopped/controlled much more easily:
Antihypertensives
Anticholesterol drugs
Diet change and exercise - VaD is often not Dx until after significant damage
- Prognosis=good if Dx early, but damage done is typically irreversible
- premorbid IQ is a good prognostic indicator
