Dementia and Delirium

Question 1

Dementia, Depression, Delirium commonly have overlapping symptoms

Answer 1

ok

Question 2

Dementia=

Answer 2

Impairment of intellectual/ cognitive function of sufficient severity to interfere with social or occupational activities

Question 3

Delirium=

Answer 3

Clouding of consciousness with reduced capacity to shift, focus, and sustain attention to environmental stimuli.
I’m delirious right now,,,can’t focus or sustain attention

Question 4

Key features of dementia

Answer 4

• cognitive deficits in multiple domains, usually but not always including memory
• Progressive deterioration over months to years
• cognitive impairment interferes with activities of daily life
• No disruption of alertness

Question 5

Key features of delirium

Answer 5

• Acute disorder generally assoc with medical illness, drugs, metabolic disorders
• Deterioration over days to weeks
• Fluctuating course
• altered level of consciousness, exciteable, delusions, hallucinations

Question 6

Some causes of Dementia we need to know

Answer 6

• Alzheimer’s
• Dementia with Lewy Bodies
  Frontotemporal Demetia

Question 7

Alzheimer’s Dz characterized by what neuropathology findings

Answer 7

• Loss of cerebral cortical neurons
• Neuritic plaques containing Beta Amyloid
• Neurofibrillary Tangles

Question 8

features inconsisten with Alzheimers

Answer 8

• Sudden or acute onset
• focal neurological findings
• seizures or gait disorder

Question 9

WHat is a neuritic plaque

Answer 9

Composed of dystrophic neurites or synapses containing tau protein aggregates surrounding a core of beta-amyloid

Question 10

WHat are neurofibrillary tangles

Answer 10

cortical pyramidal cells filled with aggregates

Question 11

Autosomal dominant Alzheimers (early onset) is linked to what three genes

Answer 11

• APP (chrom 21)
• Presinilin 1 (chrom 14)
• Presinilin 2 (chrom 1)

Question 12

Sporadic alzheimers (late onset)

Answer 12

Apo E4 chrom 19
a2 macroglob (chrom 12)

Question 13

50% of late onset ALzheimer’s cases carry one or more copies of the APOE4 allele

Answer 13

ok

Question 14

Homozygosity for APOE4 basically assures that by age 80 the individual will develop alzheimer’s disease

Answer 14

ok

Question 15

Combination of APOE3/APOE4=

Answer 15

second most likely to develop alzheimers

Question 16

Strong Risk Factors for Alzheimers

Answer 16

Age
Genetics
Down’s Syndrome

Question 17

Weak Risk factors for Alzheimers

Answer 17

Education level/mental activity
Female
Head Injury
Hypercholesterolemia
Smoking

Question 18

The levels of acetylcholine in the cortex of pts with alzheimers disease is….

Answer 18

low…one reason is because the nucleus basalis becomes atrophied in alzheimers pts. This nucleus generally harbors neurons that innervate the neocortex using Ach

Question 19

Pharmaceutical compaines have targeted which two enzymes as tx for ALzheimers disease

Answer 19

AChe: Because of ACh is low in AD and AChE generally inactivates synaptic ACh. By blocking this pocess you increase levels of ACh.

BuChE is made by astrocytes and it too cleaves ACh., Pharmaceutical companies have also targeted this enzyme

Question 20

Lewy Bodies are what?

Answer 20

Eosinophilic, spherical inclusions with a halo appearance located in the cytoplasm of neurons located in the Substantia Nigra in PD pts.

Question 21

Dementia with Lewy Bodies

Answer 21

Dementing disease with the clinical characteristics of PD plus an early presenting Dementia characterized frequently by hallucinations, delusions, etc…
Dementia BEFORE Parkinsons is key

Question 22

Lewy bodies present where in the brain of DLB patients

Answer 22

Neocortex

Question 23

DLB pts respond less well to what drug?

Answer 23

Levodopa

Question 24

DLB pts extremely sensitive to what drugs

Answer 24

Neuroleptic drugs given for hallucination

Question 25

Frontotemporal Dementia…These disorers showpreferential atrophy of the frontal lobe and/or temporal lobes

Answer 25

ok

Question 26

Microscopic characterization of Frontotemporal dementia

Answer 26

deposition of ubiquitin and hyperphosphorylated Tau protein with neurons

Question 27

Clinical features of FTD

Answer 27

Emphasis on prominent personality and behavioral changes with less prominent memory loss.
Pts may show:
- loss of personal awareness, disinhibition, impulsiity, withdrawla

Question 28

Picks disease age of onset

Answer 28

5th decade

Question 29

30-40% of picks disease features chromosomal mutation where?

Answer 29

chromosome 17 for Tau protein

Question 30

Picks disease characteristics

Answer 30

progressive loss of judgement with disinhibition, social misconduct, or withdrawal out of proportion.

If temporal lobe is primarilyinvolved then there is early loss of receptive language function

Question 31

Pick bodies

Answer 31

intracytoplasmic inclusions of tau protein

Question 32

Folstein mini-mental status exam

Answer 32

workup for dementia….score less than 27 is suspicious of impaired cognition, depression, or a combination