Dementia and Alzheimers Flashcards
What is the prevalence of Alzheimer’s?
1/3 over 80
Describe the prognosis of Alzheimers
10 years from diagnosis to death; faster progression if diagnosed at older age
Which type of memory is affected more in Alzheimers?
Short Term
In addition to memory loss what are other sxs of Alzheimers?
- Problems with words in speaking and writing
- Trouble with spatial relationships
- Difficulty in problem solving
- Personality Changes
- Misplacing things
- Poor judgement
- Social isolation
Late stage symptoms of Alzheimers include what?
- Cannot communicate
- Incontinence
- Cannot feed/dress
- Cannot recognize family
- Cannot walk
Describe the pathology of Alzheimers
- Beta Amyloid Plaques develop slowly, long before symptoms
- NF Tangles and synaptic loss accelerate and occur at onset of symptoms
- Neuronal Loss
Mild cognitive impairment occurs when compared to the onset of AD symptoms?
5 years
Which neurocognitive disorder presents as a stepwise deterioration?
Vascular Type
What is the CT finding of Vascular Dementia?
White areas outside of the ventricles
Which dementia presents with visual hallucinations and frequent falls?
Lewy Body Dementia
What is the pathologic finding in Lewy Body Dementia?
Accumulations of Alpha Synuclein
What are Pick Bodies?
Abnormal accumulations of too much Tau
What demographic is affected by Pick’s (Frontotemporal) Dementia?
Younger Age
Which type of dementia presents with behavioral changes, especially in emotional and language (ex- nursing home patient becomes hypersexual)?
Pick’s (Frontotemporal) Dementia
Which type of dementia presents as wet, wacky and wobbly?
Normal Pressure Hydrocephalus
What may reverse the sxs of Normal Pressure Hydrocephalus?
A shunt
What are other potential causes of Neurocognitive disorders?
- Infection (HIV, CJ, Syphilis)
- Deficiencies (B12 or Hypothyroidism)
- Chronic Alcohol
What lab studies should be done for dementia?
- CBC
- CCP
- B12
- TSH
- Head CT without Contrast
What are genetic risks for early onset Alzheimers?
- APP (21)
- Presenilin 1 (14)
- Presenilin 2 (1)
What is a genetic risk for Alzheimers that increases the risk based on the number of copies of the allele the patients get?
APOE gene (4)
What are risk factors for Alzheimers?
- HTN
- Diabetes
- Hypercholesterolemia
- Smoking
What are potential drugs for Alzheimers?
- Donepezil
- Rivastigmine
- Galantamine
(All AchE Inhibitors)
What is a drug given for the late stage of Alzheimers that blocks NMDA receptors in the Glutamate pathway?
Memantine
What are the symptoms of delirium?
- Inattention
- Acute onset
- Disorientation/Altered consciousness
- Disorganized thinking
- No pre-existing problem or medical cause
What are risk factors for Delirium?
- Male
- Older than 65
- Depression or Terminal Illness
- Polypharmacy
- Lack of physical activity
- Alcohol Abuse
- Vision and Hearing Loss
What causes Delirium?
Drugs Electrolyte/Encodrine Lack of Drugs (withdrawal) Infection (UTI, pneumonia) Reduced Sensory Input Intracranial Infection, Hemorrhage, Stroke or tumor Urinary/fecal retention Major Organ Issue (MI, COPD, renal/hepatic failure)
What type of surgery increases a patients risk for getting delirium?
- Orthopedic
- Thoracic
- Abdominal Aortic Aneurysm Repair
Why do surgeries cause delirium?
Blood loss
What are the first labs you should do for delirium?
- CBC
- Chem/electrolytes
- BUN/Creatinine
What are secondary tests you can order for delirium?
- Chest X Ray
- UA or culture
- Head CT
- UTS
How to prevent delirium?
- Reorient the patient (news)
- Minimize sleep deprivation
- Walk
- Water, food and Oxygen
- Treat pain
- Hearing Aids and Glasses
- Do not use restraints and minimize catheters
- Prevent constipation
When is medication used for delirium?
Haloperidol or atypicals (risperidone, olanzapine and quetiapine) may be given if SEVERE agitation only
Would would the secondary treatment be for delirium?
Benzodiazepines
