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geriatrics > dementia, delirium, depression > Flashcards

dementia, delirium, depression Flashcards

1
Q

what are the functions of glia cells

A

support neurons by providing insulation, supplying nutrients, and removing pathogens

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2
Q

what isthe function of epindymal cells

A

create membrane around the brain and spinal cord

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3
Q

what are the functions of astrocytes

A

connect the blood vessels and supply nutrients

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4
Q

what is the function of microglial cells

A

destroy pathogens and remove cellular debris

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5
Q

what are the functions of oligodendrocytes

A

create myelin sheaths that insulate the axon of the neuron

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6
Q

what does damage to microglia cells result in

A

chronic pain

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7
Q

what are implications of decreased numbers of neurons and increase in size and number of neuroglial cells

A

increased risk for neuro probs including CVA

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8
Q

what are implications of change with decline in nerves and nerve fibers

A
  • parkinsonism
  • slower conduction of fibers across the synapses
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9
Q

what are the implications of atrophy to the brain and increase in cerebral dead space

A
  • modest decline in short term memory
  • alteration in gait pattern
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10
Q

what are implications of change with thickened leptomeninges in the spinal cord

A
  • increased risk of hemorrhage before symptoms present
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11
Q

what does damage to oligodendrocytes result in

A

multiple sclerosis

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12
Q

what does damage to neurons result in

A
  • ALS
  • Alzheimers
  • parkinsons
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13
Q

what are the results of the normal aging process regarding neurons

A

-neurons decrease in number
-glial cells decrease in size and number
-damage in DNA
-malfunctioning DNA damage response
-decline in nerves and nerve fibers

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14
Q

what is cerebral atrophy

A

loss in neurons and the connections between them

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15
Q

what is the difference between generalized and focal atrophy

A
  • gen - brain shrinks
  • focal - affecting only a limited area of the brain
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16
Q

what occurs to leptomeninges in the normal aging process

A

they thicken

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17
Q

what is a possible result of thickening leptomeninges of the spinal cord

A

compression of nerves

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18
Q

what are symptoms of cerebral atrophy

A
  1. dementia
  2. seizures
  3. aphasias
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19
Q

what are aspects of normal aging in regards to cognitive function

A
  • difficult recalling names or locations
  • subtle deficits in memory
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20
Q

T/F in normal aging, 3 word recall remains intact

A

TRUE

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21
Q

T/F dementia is different in each person

A

True

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22
Q

what are the two innermost layers of tissue (meninges) that cover the brain and spinal cord

A
  • pia mater (inner layer)
  • arachnoid mater (outer layer)
  • CSF flows between these
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23
Q

how do you obtain hx from a patient w a cog impairement

A
  • hx should be obtained from pt and verified from a reliable source
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24
Q

t/f you cannot rely on results of a cognitive assessment if the patient as altered levels of consciousness or delirium

A

True

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25
Q

what are labs that you should obtain in a patient w cognitive impairment

A
  • Vit B12 and TSH
  • Lumbar puncture
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26
Q

what diagnostic imaging can be ordered for a patient with cog impairment

A
  • noncontrast CT/MRI to r/o causes of dementia
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27
Q

what are possible differential dx for cog dysfunction

A

-alzheimers
-dementia with lewy body
-depression
-substance abuse

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28
Q

what are indications of mild cognitive impairment

A
  • Intermediate -intermediate stage between normal cognition and dementia
  • difficulty remembering names, appointments, and solving complex issues
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29
Q

what are the test results of mild cognitive impairment

A

abnormal memory but NO functional impairment

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30
Q

what is the management of mild cognitive impairment

A
  • look for reversible causes
  • regular exercise
  • cognitive training
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31
Q

what are some reversible causes of mild cognitive impairment

A
  • medication side effects
  • sleep disturbances
  • depression
  • vitamin B12 deficiency
  • hypothyroidism
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32
Q

what is dementia

A

the general term used to describe various conditions in which there are deficits in multiple areas of cognitive function resulting in impairment in daily functioning

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33
Q

at what age does the prevelance of dementia start doubling every 5 years

A

60 years

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34
Q
A
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35
Q

what are the types of dementia

A
  • alzheimers
  • vascular dementia
  • dementia with lewy bodies
  • frontotemporal dementia
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36
Q

what is alzheimers disease

A

neurodegenerative disorder of uncertain etiology and pathogenesis resulting in cognitive and behavioral impairment

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37
Q

where does the damage of alzheimers appear

A

hippocampus and entorhinal cortex

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38
Q

what occurs to the size of the brain in alzheimers brain

A

it shirn ks:)

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39
Q

what are the 2 types of cerebral cortex lesions associated with alzheimers

A
  • amyloid plaques
  • neurofibrillary tangles
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40
Q

what are amyloid precursor protein

A

protein found on the membrane of various cells throughout the body and concentrated in the synapse of the neuron

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41
Q

what is beta amyloid protein

A

sticky fragment of the APP that is released when various enzymes are present

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42
Q

what is beta amyloid plaque

A

lesion consisting of beta amyloid proteins that occurs between neurons and thought to affect neuronal communication

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43
Q

what is the result of amyloid plaque formation

A

inhibition of dendrites from communicating w eachother

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44
Q

what are the jobs of the microtubules in the axon

A

transport nutrients, organelles, and other messages from the cell to the tip of the axon

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45
Q

what are tau proteins

A

glue that holds the microtubules in place, allowing them to function appropriately

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46
Q

what are neurofibrillary tangles

A

tau proteins breakdown and adhere to each other instead of adhering to the microtubules, resulting in inadequate transport from the cell body to the end of the axon , preventing neurons from communicating.

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47
Q

what are risk factors for alzheimers

A
  • age
  • female
  • hx of head trauma
  • diabetes
  • family history
  • vascular disease
48
Q

what are clinical presentations of alzheimers disease

A
  • difficulty learning and recalling information
  • visuospatial problems
  • language impairment
49
Q

what is the order of disorientation of alzheimers

A
  1. time
  2. place
  3. person
50
Q

t/f alzheimers patients often have insight into their symptoms

A

False

51
Q

what are behavior changes in alzheimer

A
  • early: depression, apathy, irritability
  • later: agitation and psychotic symptoms
52
Q

presentation of mild alzheimers

A
  • recalling new names
  • word recall
  • losing items
  • recognizing familiar faces
53
Q

what is the presentation of moderate alzheimers

A
  • disoriented to place and time
  • behavioral changes
  • psychotic symptoms
  • difficulty recognizing family and friends
  • easily lost
54
Q

what is the presentation of severe alzheimers

A
  • completely dependent on others for care
  • death
55
Q

how is alzheimers diagnosed

A

clinical diagnosis with with evidence of cognitive dysfunction leading to functional impairment after ruling out other causes of dementia

56
Q

t/f imaging of alzheimers is not diagnostic

A

True

57
Q

what is the 1st line therapy for alzheimers disease

A

acetylcholinesterase inhibitors

58
Q

MOA of acetylcholinesterase inhibitors

A

increases acetylcholine at the neuronal synapses in the brain

59
Q

what is the effect of acetylcholinesterase inhibitors

A

slows progression of alzheimers

60
Q

what are the acetylcholinesterase inhibitors

A
  • donepezil
  • Rivastigmine
  • galantamine
61
Q

SE of acetylcholinesterase inhibitors

A
  • nausea
  • anorexia
  • sleep disturbances
  • diarrhea
62
Q

what is the most serious SE of acetylcholinesterase inhibitors

A

bradycardia

63
Q

what is the counseling point for acetylcholinesterase inhibitors

A

take with food

64
Q

what is the MOA of NMDA receptor antagonists

A

reduces to destruction of cholinergic neurons and may inhibit B-amyloid production, thereby preserving memory

65
Q

what are the NMDA antagonists

A

memantine

66
Q

what are SE of memantine

A
  • dizziness
  • HA
  • Confusion
  • Constipation
67
Q

what is the combo drug for donepezil and memantine

A

namzaric

68
Q

nonpharmacologic interventions for alzheimers

A
  • physical activity
  • mentally stimulating activities
  • social activities
69
Q

what should you do when the patient is unable to express their needs?

A

discontinue AchEI and NMDA

70
Q

how do you test for executive functions in vascular dementia

A

one minute semantic test

71
Q

Behavioral management of alzheimers disease

A
  • SSRIs
  • Trazodone
72
Q

what does advanced alzheimers lead to

A
  • poor nutritional intake
  • urinary incontinence
  • skin breakdown
  • infections
73
Q

what are the s/s of spontaneous parkinsonism

A
  • bradykinesia
  • shuffled gait
  • tremors
  • very visual dreams
74
Q

first symptoms that helps differ dementia with lewy bodies from alzheimers

A

delusional misidentification

75
Q

what is the criteria for diagnosing dementia w lewy bodies

A

Probable
-two or more core clinical features of DLB with or without biomarkers
-only one clinical feature with biomarkers

Possible
-one clinical feature with no biomarkers
-one or more biomarker with no clinical features

76
Q

what would you see on an MRI w lewy bodies

A

-hippocampus atrophy
-atrophy of the basal ganglia structures and the dorsal midbrain

77
Q

what is the definitive diagnostic study of dementia w lewy bodies

A

lewy bodies present on autopsy

78
Q

t/f frontotemporal dementia has a strong family history component

A

True

79
Q

what is frontotemporal dementia

A

clinical syndrome that results from degeneration of the frontal and temporal lobes of the brain

80
Q

what is the clinical presentation of frontotemproal dementia

A

-behavioral variant
-semantic primary progressive aphasia variant
-primary progressive aphasia

81
Q

what is “behavioral variant” in frontotemporal dementia

A
  • changes in personality
  • apathy
  • compulsivity
  • loss of empathy
82
Q

how to diagnose behavioral frontotemporal dementia

A

medial and orbital frontal degeneration on MRI

83
Q

how to diagnose primary frontotemporal dementia

A

lateral frontal lobe and precentral gyrus atrophy

84
Q

how do you manage frontotemporal dementia

A
  • regular exercise
  • speech therapy
  • behavioral therapy
85
Q

what is the primary progressive aphasia variant of frontotemporal dementia

A
  • inability to produce words
  • affects brocas area
86
Q

what is the diagnostic finding for semantic frontotemporal dementia

A

anterior temporal degeneration on MRI

87
Q

what is the semantic primary progressive aphasia variant of frontotemporal dementia

A

the loss of ability to recall words or objects

88
Q

what is normal pressure hydrocephalus

A

accumulation of CSF that causes enlargement of the ventricles in the brain and compression of surrounding structures

89
Q

what is the pathophysiology of normal pressure hydrocephalus

A

CSF builds up in the brain

90
Q

what is hte clinical presentation of nromal pressure hydrocephalus

A
  • abnormal gait
  • urinary incontinence
  • dementia
91
Q

after intervention for normal pressure hydrocephalus, _________ often improves but ______ do not

A

gait; dementia and incontinence

92
Q

what is the diagnostic finding of normal pressure hydrocephalus

A
  • MRI shows ventriculomegaly (HALLMARK)
  • high volume lumbar puncture
93
Q

where is the most common area to shunt CSF to in normal pressure hydrocephalus?

A

abdomen

94
Q

how do you manage normal pressure hydrocephalus

A

ventricular shunting

95
Q

clinical presentation of delirium

A

-acute onset
-attention deficits
-cognitive impairment

96
Q

what is vascular dementia

A

gradual or acute onset of cognitive dysfunction with clinical or radiographic evidence of cerebrovascular disease

97
Q

what is the pathophysiology of vascular dementia

A

pathophysiologic, small, micro-ischemic changes in the brain

98
Q

clinical presentation of vascular dementia

A

-memory impairment less severe than AD
-difficulty of times activities and executive functions
-behavioral symptoms
-depression

99
Q

what does imaging show in vascular dementia

A

MRI showing small infarcts and white matter lesions

100
Q

how do you manage vascular dementia

A

same as alzheimers

101
Q

what things are important to identify and treat in vascular dementia

A
  • HTN
  • smoking
  • DM
  • statins
  • antiplatelets
102
Q

what is dementia with lewy bodies

A

dementia identified by the presence of lewy bodies on histopathology of the brain tissue

103
Q

what is the etiology of dementia w lewy bodies

A

deposits of alpha-synuclein in the cell body

104
Q

what is the average onset for dementia w lewy bodies

A

75

105
Q

t/f dementia with lewy bodies has a strong family history component

A

false! its sporadic

106
Q

what is the hallmark sign of dementia w lewy bodies

A

spontaneous parkinsonism

bradykinesia, BIL limb rigidity, flat affect, gait changes, postural instability

107
Q

what is the clinical presentation of dementia w lewy bodies

A
  • insidious onset
  • memory is less affected
  • visuospatial abilities, problem solving, and processing speed are more severe
  • parkinson like symptoms
  • visual hallucinations
  • delusional misidentification
108
Q

t/f there is more atrophy of the medial temporal lobe in dementia with lewy bodies than alzheimers

A

False
In lewy bodies you will see greater atrophy in the basal ganglia structures and the dorsal midbrain as well as more pronounced cortical atrophy.

109
Q

what would a SPECT of dementia with lewy bodies show

A

reduction in dopamine uptake and perfusion

110
Q

what is the clinical course of dementia with lewy bodies

A
  • decrease in MMSE by 4-5 years per year
  • mean survival is 10 years
111
Q

how do you manage dementia w lewy bodies

A

cholinesterase inhibtors

memantine +/-
antipsychotics if psychosis is severe
SSRI for depression
melatonin for REM disorder
Sinemet for parkinsonsim
fludrocortisone for orthostatic hypotension

112
Q

what are risk factors for higher mortality in dementia with lewy bodies

A
  • older age
  • hallucinations
  • greater degrees of fluctuation
  • neuroleptic sensitivity
113
Q

what is the MCC of early onset dementia

A

frontotemporal dementia

114
Q

what is delerium

A

disorder characterized by an acute change in attention and cognition

115
Q

what is the greatest predisposing risk for delirium

A

preexisting cognitive impairment

116
Q

what is the management of delirium

A
  • identification and treatment of the underlying medical cause
  • eradication of contributing factors
  • management of delirium
117
Q

goal for management of delirium symptoms

A

an awake and manageable patient, not a sedated patient

geriatrics (12 decks)

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