Dementia and Delirium Flashcards
Alzheimer’s disease: Life Expectancy
Time course of dementia is VERY variable, but generally, older at diagnosis = faster progression
10 years from diagnosis until death
Once end-stage disease is reached, average life expectancy is 1 year or less
Definition of Alzheimer’s Disease neurocognitive disorder: Memory loss
Short Term memory affected more than remote memory
Loss is relatively slow – months to years, not hours or days
Affects ability to carry out activities of daily living (if not = Mild Cognitive Impairment)
Symptoms besides short term memory loss AD
New problems with words in speaking and writing
Trouble understanding visual images and spatial relationships
Challenges in planning or solving problems
Personality changes
Symptoms AD
Misplacing things
Poor judgment
Withdrawal from social activities
Confusion with time or place
Later symptoms AD
Unable to communicate Incontinence Unable to feed or dress themselves Fail to recognize family Unable to walk 2/3 die in a nursing home
Alzheimer’s Disease (“AD”)
The most common type
Increasingly common as age progresses, but it is NOT normal aging
May occur together with other forms of dementia, leading to diagnosis of “mixed disorder
The Pathology AD
Plaques (beta amyloid), neurofibrillary tangles (tau hyperphosphorylation)
Plaques develop first during a long pre-clinical phase
Tangles, and synaptic loss, accelerate slightly before the symptomatic phase appears
Neuronal loss
Predictable decline in Alzheimer’s
Preclinical AD 20 yrs - biomarkers
Mild Cognitive Impairment 5 years
Symptomatic AD 10 years
Death
Vascular type
Often occurs along with AD (mixed pattern)
Step-wise progression
Risk factors for vascular disease
Diagnosed with CT scan
Lewy body
Has symptoms of both dementia and Parkinson’s Disease
These two occur together instead of sequentially like in Parkinson’s
Visual hallucinations and falls
Pick’s or Frontotemporal type
Too much or abnormal tau protein = Pick bodies
Frontal and temporal areas of brain
Rare, younger onset
Behavior changes, emotional, language
Normal Pressure Hydrocephalus
Too much fluid around the brain
May be reversible with shunt
Diagnosed with CT or MRI
Wacky, Wet, and Wobbly
Neurocognitive disorders caused by other diseases
Infections HIV Syphilis Creutzfeldt-Jakob -prion Deficiencies B12 deficiency Hypothyroidism Chronic alcohol abuse Korsakoff’s syndrome-thiamine
Diagnosis
Brain biopsy could make definitive diagnosis but DON’T DO THIS
We “rule out” other diagnoses.
Clinical memory tests Mini-cog
Objective evidence of impairment:
Clock Drawing Test (executive control and visual spatial skills)
3 object recall
1-2 recalled objects with normal clock = OK
1-2 recalled objects with abnormal clock = impaired
0 recalled objects =impaired
