Dementia

Question 1

Dementia

Answer 1

• 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

Question 2

Dementia Epidemiology

Answer 2

• 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.

Question 3

Alzheimer’s Disease (AD)

Answer 3

• 6th leading cause of death in US
• insidious onset and slow, continuous progression.

Question 4

Etiology of AD

Answer 4

• 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

Question 5

Dx of AD

Answer 5

• 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

Question 6

Neuropsych Testing for AD

Answer 6

• 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

Question 7

AD Impairment

Answer 7

• 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

Question 8

Tx for AD

Answer 8

• 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

Question 9

Prog for AD

Answer 9

• 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

Question 10

Lewy Body Dementia (DLB)

Answer 10

• Lewy Bodies (clumps of proteins not properly digested by cells, overproduction) in frontal

Faster onset
Fluctuating course (“sundowning”)
visual hallucinations
Parkinsonian motor features

Question 11

Dx of DLB

Answer 11

• behavioral observation.
• MMSEs daily.
• more sundowning
• Parkinsonian symptoms + dementia symptoms simultaneously, as opposed to well before, which would be characteristic of PD.

Question 12

Tx of DLB

Answer 12

• cholinergics + dopaminergics
• pts monitored daily

Question 13

Vascular Dementia

Answer 13

• 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

Question 14

Dx of VaD

Answer 14

• 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

Question 15

Tx of VaD

Answer 15

• 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

Question 16

Picks Disease

Answer 16

• most common frontal lobe dementia
• early onset + faster morbidity
• insidious onset w/ personality change
• Pick Bodies (collections of tau proteins similar to those found in AD) in frontal lobe

Question 17

Differential Dx of AD and Frontal Lobe Dem/PiD

Answer 17

• AD-memory deficits come 1st.
• FLD-personality changes (depression, uncontrolled temper, overreactivity, mania, sometimes psychosis) seen b4 memory symptoms start.
• mix up with psychiatric disorder. Must examine personal and familial history, particularly for FLD and for psychiatric disorders
• FLD more likely to be assoc w/ progressive non-fluent aphasia

Question 18

Tx of Pick’s and FLD

Answer 18

• cholinergic drugs
• Management of behavioral symptoms (supportive psychotherapy, antidepressants, antipsychotics)

Question 19

Wernicke-Korsakoff’s Dementia

Answer 19

• caused by: Lack of Thiamine (Vitamin B1), which causes brain atrophy, starting with the hippocampus
• Due to: alcoholism and malnutrition – alcohol leeches B1 out of body, and poor nutrition prevents it from being recovered.

Question 20

Symptoms of Wern-Kors Dementia

Answer 20

• Wernicke’s encephalitis:

Ataxia (unsteady gait)
Uneven pupil size
Nystagmus (jerky eye movement on pursuit)
Photophobia
Coma

emergency, and patients will die without immediate treatment

• Korsakoff’s psychosis:

Amnesia (primarily anterograde)
Hallucinations

Question 21

Tx of Wernicke-Korsakoff

Answer 21

• IV infusion of vitamin B1 + glucose, then continuous doses of B1.
• any amnesia gained is permanent
• anterograde amnesia.
• maintaining diet/not drinking