Dementia

Question 1

Define dementia

Answer 1

decline in memory and at least one other cognitive function

decline impairs social or occupational functioning in comparison with previous functioning

not dementia if d/t other causes or psych issues

Question 2

Causes of dementia

Answer 2

degenerative

• -> Alzheimer’s disease
• -> Diffuse Lewy Body disease
• -> Parkinson’s disease
• -> Frontotemporal degeneration (Picks, semantic dementia, progressive nonfluent aphasia)

all determined definitively at autopsy

vascular, infectious, psych, toxic/metabolic, traumatic, tumors also causes

Question 3

Will you see disturbance of consciousness in dementia?

Answer 3

NO, they don’t look sleepy

Question 4

Treatment of Alzheimer’s disease

Answer 4

ACh esterase inhibitor

NMDA antagonist

Question 5

What is mild cognitive impairment?

Answer 5

memory complaint (usually by patient)

test abnormal memory for age but don’t meet criteria for dementia (normal cog fxn, ADLs)

precursor for Alzheimer’s (5x more likely)

may be delayed with Ach esterase inhibitor

Question 6

Define probable vascular dementia

Answer 6

presence of focal signs on neuro exam
–> hemiparesis, lower facial weakness, Babinski, sensory deficit, hemianopia, consistent with stroke

AND

evidence of infarcts on brain imaging

Question 7

Describe tetrad of Diffuse Lewy Body Disease

Answer 7

dementia
–> have periods that resemble delirium

parkinsonian symptoms
–> bradykinesia and rigidity, frequent falls WITHOUT tremor

prominent psychotic sx (visual hallucinations)
–> classic small animals/kids EARLY in disease (late in alzheimers)

extreme sensitivity to antipsychotic agents
–> poor response to parkinson meds

**progress more rapidly c/t Alzheimer’s with widely varying sx day to day

Question 8

Diffuse Lewy Body vs Alzheimer’s

Answer 8

psychotic sx early in lewy body, late in alzheimers

• -> you can talk a lewy body patient out of their hallucinations, but not with Alzheimer’s
• —–> see kids on ceiling and spouse says they’re just hallucinations, lewy body believes them
• —–> alz thinks wife is cheating on him, son says no because she is always with him, he won’t believe it

Lewy progresses quickly with widely varying sx day to day

Lewy has parkinsonian sx along with dementia

Question 9

Lewy body disease vs Parkinson’s disease

Answer 9

Midbrain lewy body (P) vs cortical/diffuse lewy body (L)

executive dementia late in P, cortical dementia early in L

resting tremor present in P, absent in L

autonomic dysfunction sometimes seen in P, prominent in L (also MSA)

hallucinations only in response to antiparkinsonian drugs in P (common in absence of drugs in L)

Question 10

Hallmark of frontotemporal degeneration

Answer 10

deterioration of social skills, personality, intellect, memory, language

often hereditary, in younger people

Question 11

Triad of NPH/ normal pressure hydrocephalus

Answer 11

dementia
gait disturbance (falls)
urinary incontinence

potentially reversible with shunting, although gait disturbance most likely to be reversed