Dementia and Delirium Flashcards
Dementia, Depression, Delirium commonly have overlapping symptoms
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Dementia=
Impairment of intellectual/ cognitive function of sufficient severity to interfere with social or occupational activities
Delirium=
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
Key features of dementia
- 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
Key features of delirium
- Acute disorder generally assoc with medical illness, drugs, metabolic disorders
- Deterioration over days to weeks
- Fluctuating course
- altered level of consciousness, exciteable, delusions, hallucinations
Some causes of Dementia we need to know
- Alzheimer’s
- Dementia with Lewy Bodies
Frontotemporal Demetia
Alzheimer’s Dz characterized by what neuropathology findings
- Loss of cerebral cortical neurons
- Neuritic plaques containing Beta Amyloid
- Neurofibrillary Tangles
features inconsisten with Alzheimers
- Sudden or acute onset
- focal neurological findings
- seizures or gait disorder
WHat is a neuritic plaque
Composed of dystrophic neurites or synapses containing tau protein aggregates surrounding a core of beta-amyloid
WHat are neurofibrillary tangles
cortical pyramidal cells filled with aggregates
Autosomal dominant Alzheimers (early onset) is linked to what three genes
- APP (chrom 21)
- Presinilin 1 (chrom 14)
- Presinilin 2 (chrom 1)
Sporadic alzheimers (late onset)
Apo E4 chrom 19 a2 macroglob (chrom 12)
50% of late onset ALzheimer’s cases carry one or more copies of the APOE4 allele
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Homozygosity for APOE4 basically assures that by age 80 the individual will develop alzheimer’s disease
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Combination of APOE3/APOE4=
second most likely to develop alzheimers
Strong Risk Factors for Alzheimers
Age
Genetics
Down’s Syndrome
Weak Risk factors for Alzheimers
Education level/mental activity Female Head Injury Hypercholesterolemia Smoking
The levels of acetylcholine in the cortex of pts with alzheimers disease is….
low…one reason is because the nucleus basalis becomes atrophied in alzheimers pts. This nucleus generally harbors neurons that innervate the neocortex using Ach
Pharmaceutical compaines have targeted which two enzymes as tx for ALzheimers disease
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
Lewy Bodies are what?
Eosinophilic, spherical inclusions with a halo appearance located in the cytoplasm of neurons located in the Substantia Nigra in PD pts.
Dementia with Lewy Bodies
Dementing disease with the clinical characteristics of PD plus an early presenting Dementia characterized frequently by hallucinations, delusions, etc…
Dementia BEFORE Parkinsons is key
Lewy bodies present where in the brain of DLB patients
Neocortex
DLB pts respond less well to what drug?
Levodopa
DLB pts extremely sensitive to what drugs
Neuroleptic drugs given for hallucination
Frontotemporal Dementia…These disorers showpreferential atrophy of the frontal lobe and/or temporal lobes
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Microscopic characterization of Frontotemporal dementia
deposition of ubiquitin and hyperphosphorylated Tau protein with neurons
Clinical features of FTD
Emphasis on prominent personality and behavioral changes with less prominent memory loss.
Pts may show:
- loss of personal awareness, disinhibition, impulsiity, withdrawla
Picks disease age of onset
5th decade
30-40% of picks disease features chromosomal mutation where?
chromosome 17 for Tau protein
Picks disease characteristics
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
Pick bodies
intracytoplasmic inclusions of tau protein
Folstein mini-mental status exam
workup for dementia….score less than 27 is suspicious of impaired cognition, depression, or a combination
