Dementia and ALZ Flashcards
Dementia
Progressive and chronic loss of cognitive function beyond that of aging
Delerium
Acute loss of cognitive function associated with loss of consciousness
Agitation
inappropriate motor or verbal outburst relative to the needs of the pt
Alz= epidemiology
MCC of dementia
How do etiologies of Alz differ?
there are 4
differ based on age of onset
and familial vs sporadic
Sporadic + late onset =
Unknown etiology
Sporadic + early onset=
Apoprotien E4
Familial + early onset=
APP mutation on chrom 21
presinillin 1 mutation on chrom 14
presinillin 2 mutation on chrom 1
Trisomy 21 and Alz
most down syndrome pts have Alz before age 40 b/c have 3 copies of chrom 21= APP
Alz pathophysiology
Increased A Beta protein in - hippocampus, frontal cortex, and medial temporal lobe
Glycogen sythesis kinase 3beta and a beta protein phosphorylation feedback loop causes vascular amyloid deposits- extracellular
hyperphosphorylation of tau proteins results in intracellular neurofibrillary tangles
Plaques and tangles
plaques are extracellular made of Abeta protein
Neurofibrillary tangles are intracellular made of hyperphosphorylated tau proteins
normal function of tau proteins
micro tubular assembly so it makes sense that they are intracellular
Alz Dx
Clinical diagnosis must be made but can only be confirmed after death with a brain biopsy
The 10 warning signs of Alz
Memory loss that affects work or social function Apraxia Aphasia Disorientation to place and time Poor judgement Problems with abstract thinking Repeatedly misplacing objects Changes in mood or behavior Changes in personality Loss of initiative
Pseudodementia
Depressive syndrome in elderly that mimics Alz but can be tx with anti depressants
Alz differential Dx
tumor multi infarct dementia metabolic disturbances NPH depression
What categories are tested by the MMSE
Orientation Alertness Verball Recall Language Visual Spacial Skills
Neurologic exma- (bi or unilateral, symmetric, asymmetric)
What EPS signs
asymmetric and laterality
EPS symptoms are Akinesia and akathisia
Labs ro rule out other causes of dementia
CBC- anemia
CMP- BUN, SCr, LFT, electrolytes
TSH
B12
What will MRI of alz look like
Diffuse cortical atrophy
effects WM> GM
Treatment for Alz
Stigmines- cholinesterase inhibitor blockers
memantine- glutamate receptor antagonist
Alz disease
slowly progressive dz, pts normally die of infxn
Other causes of dementia
PD HD CJD multiinfacrt dementia Frontotemporal dementia NPH SOL nutritional (B12) psychiatric Drugs or EtoH metabolic
multinfacrt dementia
many small strokes in someone with a hx of CV disease, get a slow decline in function, most likely have more laterallizing signs
Frontotemporal dementia
Pick’s disease
insidious personality changes, poor grooming and hygiene with emotional blunting.
Alz and Ach
One reason for Alz is thought to be due to lack of ACH.
ACH is made in the nucleus basalis of meynert and it has projections to the neocortex.
That is why you give cholinesterase inhibitors (stigmines) to tx and see atrophy of the hippocampus (location of the nucleus basali of meynert) and neocortex on imaging.
histological changes of Alz
plaques
tangles
loss of neurons
replacement with glial tissue
3 Signs of frontal lobe dz
paratonia- resistance to passive movement
oral reflexes- snout reflex
grasp reflex
What imaging modalities are used for Alz
MRI unless there is a CI in which case use
Non contrast CT
DSM criteria for Dementia related to Alz
multiple cognitive deficits with memory loss and one of more of: aphasia, apraxia, agnosia, decline or impairment of executive function.
Must cause impaired social or occupational functioning
gradual onset with continuing decline of cognition
cant be due to another condition
deficits cant exclusively occur during delirium
Gross pathology of Alz brain
cerebral atrophy
WM loss > GM loss
hydrocephalus exvaccuo
1 risk factor for Alz
age
