Dementia, Cohen I

Question 1

cognition

Answer 1

mental process of knowing, including aspects like awareness, perception, reasoning and judgement

Question 2

dementia defintion

Answer 2

deterioration cognition, higher intellectual process, organic disease of brain

Question 3

DSM IV

Answer 3

development of multiple cognitive deficits that are sufficiently severe to cause impairment in occupational or social functioning

Question 4

is dementia reversible

Answer 4

irreversible

Question 5

common initial presentation of dementia

Answer 5

delirium

Question 6

primary causes of dementia

Answer 6

• —alzheimers
• -lewy body dementia/Parkinsons
• -multi infarct/Vascular dementia
• -fronto-temporal demential
• -alcoholism/VitB12 deficiency
• subdural hematomas, creutzfeldt jacob, HIV, normal P hydrocephalus, tumors, progressive supranuclear palsy, huntington, MS, CTE

Question 7

findings micro in alzheiemrs

Answer 7

plaques of amyloid

tangles of tau- containing microtubules inside neurons

Question 8

what amyloid collects in alzheimers

Answer 8

beta amyloid

AB42 from amyloid precursor protein

Question 9

where is most cell death in alzheimers

Answer 9

temporal and parietal lobes

Question 10

major connection to alzheimers

Answer 10

downs by age 50 60s

Question 11

what NT is lost in alzheimers

Answer 11

Ach

Question 12

what collection amyloid or tau is thought to have role in dementia

Answer 12

tau

amyloid blockers or lowering agents not helpful in alzheimers

Question 13

prevalence of Alzheimers

Answer 13

> 80 majority
65 common
M

Question 14

associations with development of alzheimers

Answer 14

mentally inactive people
victims head trauma
homozygous e4 allele ApoE

Question 15

begining of alzheimers

Answer 15

loss of memory for recent information or events like appointments
objects misplaced
trouble recalling names of DISTANT friends at first
repeating stories
restricted speech, cannot complete sentence

Question 16

progression alzheimers

Answer 16

visuospatial decline (wandering)
gait disorder with dizziness and poor posture (extension)

Question 17

mental state alzheimers

Answer 17

boredom, lack of social inhibitions
irritability
paranoia
denial relationships
depression
can become violent or anxious and agitated

Question 18

what is “sundowning”

Answer 18

confusion and agitation at night

Question 19

apraxia

Answer 19

loss of simple actions because loss of connections between cortical sites
(inability to button clothing or brush hair etc)

Question 20

Mild alzheimers

Answer 20

safe at home
some help with acticities
not threat to self

Question 21

moderate alzheimers

Answer 21

kept at home with great effort

full or nearly full caregiver

Question 22

severe alzheimers

Answer 22

nursing home or assisted liviing for round-the-clock supervision

Question 23

Dx of alzheimers

Answer 23

clinical

Question 24

What is PiB

Answer 24

pittsburgh compound that binds to beta amyloid deposition in brain

Question 25

amyloid levels and tau levels in CSF in alzheimers

Answer 25

dec beta amyloid increase tau (soluble)

Question 26

MRI of alzheimers

Answer 26

atrophy in medial temporal lobes

Question 27

Must rule out for Dx alzheimers

Answer 27

B12 thyroid renal and hepatic problems

Question 28

thought behind ACHE inhibitors in alzheimers

Answer 28

increase Ach for relief memory impairment, agitated behavior and concentration

Question 29

effect of ACHEI in alzheimers patients

Answer 29

modest gains with slower decline | no major difference than non-Tx patients in 2-3 years

Question 30

ACHEI used in alzheimers

Answer 30

donepezil rivastigmine galantamine

Question 31

most widely used ACHEI in alzheimers

Answer 31

donepezil

Question 32

effects of rivastigmine

Answer 32

vomtiing, diarrhea | also have as skin pathc to lower effects

Question 33

which ACHEI in alzheimers has extended release

Answer 33

galantamine

Question 34

MOA memantine

Answer 34

antagonizes glutamate and NMDA R may prevent cell death from too much glutamate used alone or with ACHEI

Question 35

Good Tx for alzheimers

Answer 35

keep patient mentally and physically active | prevent from seeking social isolation

Question 36

"mild cognitive impairment"

Answer 36

patients who function well in social and occupation very limited problems with memory do not meet requirements for alzheimers

Question 37

Second common cause dementia

Answer 37

lewy body dementia

Question 38

presentation lewy body dementia

Answer 38

``` agitated decreased facial animation slowness and imbalance mild to no tremor dementia M>W ```

Question 39

dementia in lewy body

Answer 39

Fluctuating!!!!

Question 40

key signs to lewy body to distinguish from alzheimers

Answer 40

visual hallucinations!! parkinosism bad response to antipsychotic drugs

Question 41

lewy body patients may improve with what therapy

Answer 41

ACHEI

Question 42

what is aggregate in lewy body

Answer 42

alpha synuclein | also senile plaques and neurofibrillary tangles

Question 43

lewy body involves what parts of brain

Answer 43

diffuse | ANS severely effected

Question 44

worse prognosis alzheimers or lewy body

Answer 44

lewy body | death 5-7 yearas

Question 45

what drugs make agitation in lewy body disease worse

Answer 45

antipsychotics olanzapine risperidal haloperidol

Question 46

lewy body incorrectly Dx as

Answer 46

parkinsons

Question 47

Tx parkinsonism Sx in lewy body disease

Answer 47

low doses levadopa