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PCM > Dementia and ALZ > Flashcards

Dementia and ALZ Flashcards

1
Q

Dementia

A

Progressive and chronic loss of cognitive function beyond that of aging

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2
Q

Delerium

A

Acute loss of cognitive function associated with loss of consciousness

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3
Q

Agitation

A

inappropriate motor or verbal outburst relative to the needs of the pt

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4
Q

Alz= epidemiology

A

MCC of dementia

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5
Q

How do etiologies of Alz differ?

A

there are 4
differ based on age of onset
and familial vs sporadic

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6
Q

Sporadic + late onset =

A

Unknown etiology

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7
Q

Sporadic + early onset=

A

Apoprotien E4

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8
Q

Familial + early onset=

A

APP mutation on chrom 21
presinillin 1 mutation on chrom 14
presinillin 2 mutation on chrom 1

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9
Q

Trisomy 21 and Alz

A

most down syndrome pts have Alz before age 40 b/c have 3 copies of chrom 21= APP

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10
Q

Alz pathophysiology

A

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

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11
Q

Plaques and tangles

A

plaques are extracellular made of Abeta protein

Neurofibrillary tangles are intracellular made of hyperphosphorylated tau proteins

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12
Q

normal function of tau proteins

A

micro tubular assembly so it makes sense that they are intracellular

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13
Q

Alz Dx

A

Clinical diagnosis must be made but can only be confirmed after death with a brain biopsy

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14
Q

The 10 warning signs of Alz

A 
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
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15
Q

Pseudodementia

A

Depressive syndrome in elderly that mimics Alz but can be tx with anti depressants

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16
Q

Alz differential Dx

A 
tumor
multi infarct dementia
metabolic disturbances
NPH
depression
17
Q

What categories are tested by the MMSE

A 
Orientation
Alertness
Verball Recall
Language
Visual Spacial Skills
18
Q

Neurologic exma- (bi or unilateral, symmetric, asymmetric)

What EPS signs

A

asymmetric and laterality

EPS symptoms are Akinesia and akathisia

19
Q

Labs ro rule out other causes of dementia

A

CBC- anemia
CMP- BUN, SCr, LFT, electrolytes
TSH
B12

20
Q

What will MRI of alz look like

A

Diffuse cortical atrophy

effects WM> GM

21
Q

Treatment for Alz

A

Stigmines- cholinesterase inhibitor blockers

memantine- glutamate receptor antagonist

22
Q

Alz disease

A

slowly progressive dz, pts normally die of infxn

23
Q

Other causes of dementia

A 
PD
HD
CJD
multiinfacrt dementia
Frontotemporal dementia
NPH
SOL
nutritional (B12)
psychiatric
Drugs or EtoH 
metabolic
24
Q

multinfacrt dementia

A

many small strokes in someone with a hx of CV disease, get a slow decline in function, most likely have more laterallizing signs

25
Q

Frontotemporal dementia

A

Pick’s disease

insidious personality changes, poor grooming and hygiene with emotional blunting.

26
Q

Alz and Ach

A

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.

27
Q

histological changes of Alz

A

plaques
tangles
loss of neurons
replacement with glial tissue

28
Q

3 Signs of frontal lobe dz

A

paratonia- resistance to passive movement
oral reflexes- snout reflex
grasp reflex

29
Q

What imaging modalities are used for Alz

A

MRI unless there is a CI in which case use

Non contrast CT

30
Q

DSM criteria for Dementia related to Alz

A

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

31
Q

Gross pathology of Alz brain

A

cerebral atrophy
WM loss > GM loss
hydrocephalus exvaccuo

32
Q

1 risk factor for Alz

A

age

PCM (12 decks)

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