Dementia Flashcards
core clinical criteria for dementia
cognitive/behavioral symptoms that:
- interfere with the ability to function at work
- represent decline from previous levels of functioning
- not explained by delirium or major psychiatric disorder
- cognitive impairment is detected and diagnosed through history taking and objective cognitive assessment
- involves >/= 2 domains
domains in core clinical criteria
- impaired ability to acquire and remember new information
- impaired reasoning and handling of complex tasks, poor judgment
- impaired visuospatial abilities
- impaired language functions
- changes in personality, behavior, or comportment
normal aging vs dementia
table 2
9 items
potentially reversible causes of dementia
drugs endocrinopathies metabolic disorders emotional depression nutritional deficiencies tumor/trauma infection/infirmities of the senses arteriosclerosis
most frequent dementing disease
cerebral atrophy maiinly alzheimer but including lewy-body, parkinison, frontotemporal, and pick disease
what is mild cognitive impairment
aka pre-dementia
- memory complaints that are mild and do not interfere with daily functioning but still disproportionate to patient’s age and education
- normal process of aging
treatment for pre-dementia
observe, cholinesterase inhibitors
definition of alzheimer’s disease
neurodegenerative disease characterized by a clinical dementia with prominent memory impairment and specific microscopic pathology including senile plaques and neurofibrillary tangles
treatment for alzheimer’s disease
cholinesterase inhibitors for mild, moderate, and severe AD
memantine for moderate and severe AD
NIA-AA cirteria: probable ad dementia
insidious onset, gradual
clear cut history of worsening condition
NIA-AA criteria: probably ad dementia categories
amnestic presentation (most common, learning and recall impairment) non-amnestic presentation (language, word finding) visuospatial presentation (spatial cognition) executive dysfunction (impaired reasoning, judgment, and problem solving)
NIA-AA criteria: probable ad dementia with increased level of certainty
probable ad dementia with documented decline on subsequent evaluations
probably ad dementia in a carrier of causative ad genetic mutation
NIA-AA criteria: possible ad dementia
atypical course: meets the core clinical criteria, sudden onset or insufficient historical detail
etiologically mixed presentation: meets all core criteria but has (1) cerebrovascular disease (2) dementia with lewy bodies ( 3) other neurological disease/medication
DSM 5 criteria for AD
- meet criteria for major or minor neurocognitive disorder
- insidious onset
- not explained by other diseases
DSM 5 criteria for major neurocognitive disorder
probable AD: 2 present, possible AD: 1 present
1 evidence of a causative ad genetic mutation
2a clear decline in memory and learning
2b steadily progressive, gradual decline in cognition
2c no evidence of mixed etiology
DSM 5 criteria for mild neurocognitive disorder
probable ad: evidence of causative ad genetic mutation
possible ad: no evidence of a causative ad mutation and ALL 3 PRESENT
- clear evidence of decline in memory and learning
- progressive, gradual decline
- no evidence of mixed etiology
features of familial alzheimer
earlier onset (<65 yo) associated with asynchronous myoclonus, epilepsy, aphasia, paratonia
genetic defect in familial alzheimer
amyloid precursor protein
presenilin 1
presenilin 2
main pathology of AD
amyloid neurotoxicity
factors related to amyloid neurotoxicity
apo e: modifies formation of plaques (apo e2 is PROTECTIVE)
apo e4: elevated serum ldl, results in inadequate clearance of ab 42 promoting amyloid toxicity
tau protein: promotes microtubule assembly and structure
typical locations of reduced brain weight
bilateral hippocampal or medial temporal lobes
patho hallmarks of AD
neurofibrillary tangles and neuritic plaques in parietal lobe
granulovacular degeneration of neurons (pyramidal layer)
what are neurofibrillary tangles
helical filaments composed of hyperphosphorylated microtubular protein (tau)
what are neuritic plaques
spherical deposits composed of amyloid (B amyloid) surrounded by degenerating nerve terminals
cholinergic therapies available
choline, lecithin
muscarininc cholinergic agonist drugs
cholinesterase inhibitors
cholinesterase inhibitors availbale
donepezil, rivastigmine, galantamine
GI side effects are most common
nmda receptor antagonists
moa: vs glutamic acid
memantine
current recommended practice for AD treatement
mid/early stage: cholinesterase inhibitor
mild to mod stage: cholinesterase inihibitor or nmda antagonist or both
severe late stage: both
definition of vascular dementia
cognitive decline in the setting of cerebrovascular disease
- cognitive impairment is early with deficits in executive dysfunction
proposed mechanism critically located single infarcts
MCA: severe aphasia with additional cognitive impairment
PCA: amnesia with bilateral inferomedial temporal or thalamic damage
ACA: abulia, memory impairment or language disturbance
MCA: acute confusion or psychosis with non-language dominant parietal lobe damage
symptoms of binswanger disease
abulia abnormal behavior pseudobulbar palsy pyramidal signs disturbed gait urinary incontinence
features of lewy body dementia
dementia, visual hallucinations, parkinsonism, and rem sleep behavior disorder
treatment for lewy body dementia
cholinesterase inhibitors
most common differential diagnoses for lewy body dementia
alzheimer’s disease and mixed dementia
dementia with lewy bodies vs parkinson’s disease dementia
DLB: cognitive impairments are coincident with or appear within 1 year of the motor signs
PDD: cognitive decline occurs in the course of well established parkinson disease
core features of dementia with lewy bodies
fluctuating cognition
visual hallucinations
spontaneous features of parkinsonism
suggestive features of dementia with lewy bodies
REM sleep behavior disorder
sever neuroleptic sensitivity
low dopamine transporter uptake in basal ganglia (SPECT/PET)
probably and possible dementia with lewy bodies
probable: >/= 1 suggestive + core feature
possible: >/=1 suggestive
patho in dementia with lewy bodies
- (neuron loss) neurodegeneration associated with abnormal a-synuclein metabolism + formation of lewy bodies
- neuronal loss in substantia nigra (dopamine) and nucleus basalis of meynert (acetylcholine)
treatment for dementia with lewy bodies
cholinesterase inhibitors (rivastigmine, donepezil) memantine (namenda) SSRI (sertaline and escitalopram) dopaminergic agents (levodopa/carbidopa) atypical antipsychotics (quetiapine)
definition of frontotemporal dementia
progressive neurodegenerative disorder with
- behavioral or frontal variant frontotemporal dementia*
- semantic variant primary progressive aphasia
- non-fluent/agrammatic variant primary progressive aphasia
symptoms of behavioral variant frontotemporal dementia
at least 3
- early behavioral dishibition
- early apathy or inertia
- early loss of sympathy or empathy
- early perservative, stereotypes, or compulsive/ritualistic behavior
- hyperorality and dietary changes
- executive or generation deficits with relative sparing of memory and visuospatial functions
seven pathologies of frontotemporal dementia
pick’s disease (tau- and ubiquitin positive spherical inclusions)
familial ftd with tau positive inclusions
argyrophilic grain disease
ubiquitin positive inclusions
tdp-43 immunoreactive inclusions
neuronal filament inclusions
treatment of frontotemporal dementia
management of symptoms
SSRIs (sertaline, citaloprams, escitalopram) and atypical antipsychotics
