dementia + delerium Flashcards
memory loss +
cognitive dysfunction: executive function, decision-making, language, personality
dementia
loss of neurons in: prefrontal cortex (executive function, personality) temporal lobe (hippocampus - memory)
dementia
most common causes of dementia
1) Alzheimer’s disease
2) vascular dementia
3) Lewy body dementia
INTRACELLULAR tau protein: neurofibrillary tangles
EXTRACELLULAR beta-amyloid: senile plaques (amyloid plaques)
Alzheimer’s disease
genetic form of dementia associated with abnormal proteins:
presenilin 1
presenilin 2
amyloid precursor protein (APP): APP gene on chrom 21
early-onset Alzheimer disease
down syndrome has increased risk of
early-onset Alzheimer disease
extra copy of chrom 21: extra copy of amyloid precursor protein gene (APP gene)
dementia associated with abnormal protein: apoE4 apolipoprotein (chaperone protein helps to induce B sheet formation)
late-onset Alzheimer disease
treatment of Alzheimer disease will slow down progression of disease
1) cholinesterase inhibitors (donepezil, galantamine, rivastigmine): ↑ Ach
2) NMDA antagonist (memantine): glutamate receptor → excitotoxicity (form of neurotoxicity)
dementia associated with:
overstimulated NMDA receptor (glutamate R) +
↓ Ach
Alzheimer disease
dementia evaluation
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
eosinophilic cytoplasmic inclusions that contain α synuclein
seen in:
Parkinson disease
Lewy Body dementia (in neurons of cortex)
parkinsonian features begins >1 year before dementia
Parkinson disease
dementia +/- co-current parkinsonian features (resting tremor, bradykinesia) or parkinsonian features occur
Lewy Body dementia
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
frontotemporal dementia (Pick disease)
rapidly progressive dementia (wks-mo)
personality changes
myoclonus (muscle spasm)
creutzfeldt-jacob disease
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)
creutzfeldt-jacob disease “spongioform encephalopathy” or “mad cow disease”
dementia
ataxia
loss of pupillary light reflex
3° syphilis
dementia + megaloblastic anemia + peripheral neuropathy
vitamin B12 deficiency
dementia + urinary incontinence + magnetic gait
normal pressure hydrocephalus
Wet
Wacky
Wabbly
dementia + syncopal episodes
lewy body dementia
dementia + dysarthria + liver disease
Wilson disease
dementia + myoclonus
creutzfeldt-jakob disease
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)
delerium
most common causes of delerium - delerium evaluation
drugs: BZD, drugs with anticholinergic drugs (mad as hatter - avoid if elderly, may highlight underlying dementia)
UTI
