dementia + delerium

Question 1

memory loss +

cognitive dysfunction: executive function, decision-making, language, personality

Answer 1

dementia

Question 2

loss of neurons in:
prefrontal cortex (executive function, personality)
temporal lobe (hippocampus - memory)

Answer 2

dementia

Question 3

most common causes of dementia

Answer 3

1) Alzheimer’s disease
2) vascular dementia
3) Lewy body dementia

Question 4

INTRACELLULAR tau protein: neurofibrillary tangles

EXTRACELLULAR beta-amyloid: senile plaques (amyloid plaques)

Answer 4

Alzheimer’s disease

Question 5

genetic form of dementia associated with abnormal proteins:
presenilin 1
presenilin 2
amyloid precursor protein (APP): APP gene on chrom 21

Answer 5

early-onset Alzheimer disease

Question 6

down syndrome has increased risk of

Answer 6

early-onset Alzheimer disease

extra copy of chrom 21: extra copy of amyloid precursor protein gene (APP gene)

Question 7

dementia associated with abnormal protein:
apoE4 apolipoprotein (chaperone protein helps to induce B sheet formation)

Answer 7

late-onset Alzheimer disease

Question 8

treatment of Alzheimer disease will slow down progression of disease

Answer 8

1) cholinesterase inhibitors (donepezil, galantamine, rivastigmine): ↑ Ach
2) NMDA antagonist (memantine): glutamate receptor → excitotoxicity (form of neurotoxicity)

Question 9

dementia associated with:
overstimulated NMDA receptor (glutamate R) +
↓ Ach

Answer 9

Alzheimer disease

Question 10

dementia evaluation

Answer 10

1) RPR (syphilis)
2) HIV (MI encephalopathy)
3) vitamin B12 deficiency (reversible)
4) low TSH
5) MRI of brain (normal pressure hydrocephalus is reversible, vascular dementia - microinfarctions = ischemic changes in white matter)
6) copper (wilson’s disease)
7) depression in elderly (“pseudodementia” - if true dementia pt doesn’t recognize problem, if aware of memory loss not dementia)
8) CBC, BMP

Question 11

eosinophilic cytoplasmic inclusions that contain α synuclein

Answer 11

seen in:
Parkinson disease
Lewy Body dementia (in neurons of cortex)

Question 12

parkinsonian features begins >1 year before dementia

Answer 12

Parkinson disease

Question 13

dementia +/- co-current parkinsonian features (resting tremor, bradykinesia) or parkinsonian features occur

Answer 13

Lewy Body dementia

Question 14

INTRACELLULAR inclusions of tau protein (pick bodies)
atrophy of frontal + temporal lobes
initial sx: behavior/personality change (frontal lobe) or progressive aphasia (difficulty expressing self or understanding others) → dementia

Answer 14

frontotemporal dementia (Pick disease)

Question 15

rapidly progressive dementia (wks-mo)
personality changes
myoclonus (muscle spasm)

Answer 15

creutzfeldt-jacob disease

Question 16

prion disease causing dementia
transmissible, infectious protein particles (misfolded protein) serving as template for host proteins → induce conformational change in host cells (misfolding of host proteins) → induce formation of B pleated sheets → neuronal death → vacuoles in brain (sponge)

Answer 16

creutzfeldt-jacob disease “spongioform encephalopathy” or “mad cow disease”

Question 17

dementia
ataxia
loss of pupillary light reflex

Answer 17

3° syphilis

Question 18

dementia + megaloblastic anemia + peripheral neuropathy

Answer 18

vitamin B12 deficiency

Question 19

dementia + urinary incontinence + magnetic gait

Answer 19

normal pressure hydrocephalus
Wet
Wacky
Wabbly

Question 20

dementia + syncopal episodes

Answer 20

lewy body dementia

Question 21

dementia + dysarthria + liver disease

Answer 21

Wilson disease

Question 22

dementia + myoclonus

Answer 22

creutzfeldt-jakob disease

Question 23

fluctuating level of consciousness (waxes/wanes)
ACUTE onset (hrs -days)
disturbance in sleep-wake cycle (difficult to arouse during day, up all night)
rapid ↓ attention span
↓ level of arousal
acute change
acute changes in mental status
disorganized thinking
visual hallucinations
usually reversible (not dementia)

Answer 23

delerium

Question 24

most common causes of delerium - delerium evaluation

Answer 24

drugs: BZD, drugs with anticholinergic drugs (mad as hatter - avoid if elderly, may highlight underlying dementia)
UTI

Question 25

orientation to:
person
place
time

Answer 25

order of loss:
time
place
person (self is last)