Dementia, Delirium, Geri Depression Flashcards
what is dementia?
Acquired, persistent, and progressive impairment characterized by decline in cognition
what cognitive domains does dementia involve deficit in one or more?
- learning and memory
- language
- executive function (balancing checks)
- complex attention
- perceptual-motor
- social cognition
for dementia, the pt’s deficit must represent what? what must it be severe enough to do?
a decline from previous level of fxn
must be severe enough to interfere with daily function and independence
what is the most frequent form of dementia in the elderly?
alzheimer disease
what are the 4 main types of dementia in the elderly?
- Alzheimer disease (M/C)
- Vascular dementia
- Lewy body dementia
- Frontotemporal dementia
what pathology is seen in Alzheimer disease?
Amyloid plaques/oligomers
what pathology is seen in Frontotemporal dementia?
tau or ubiquitin proteins
what pathology is seen in Lewy body dementia?
α-synuclein inclusion bodies
what is the classic triad of findings for Alzheimer’s?
- Memory impairment
- Visuospatial problems
- Language impairment
what functions in AD are spared until later stages?
motor/sensory function
what are the sx’s like in early AD?
- Patients able to retain social functioning
- Ability to accomplish overlearned tasks
- Have difficulty in more complicated tasks (balancing checkbook)
what is a common sx of AD?
disorientation
what do pts with AD have disorientation to at first?
time/place/person -> reason why we ask these things first
language d/o in AD begins with what and progresses to what?
begins with subtle anomic aphasia and progresses to fluent aphasia and then mutism
what behavioral changes are common in AD?
Apathy and irritability (esp when dress and grooming)
Depression
Psychotic sx’s (delusions, hallucinations, paranoia) - in advanced stages
what is vascular dementia dx based on the presence of?
Dx based on presence of clinical/radiographic evidence of cerebrovascular disease in pt. with dementia
what supports the dx of vascular dementia?
- Sudden onset after stroke
- Step-wise decline in functioning
- Focal neuro sign on PE
what is step-wise decline in functioning in vascular dementia?
Something happens before each decline in functioning -> NOT PROGRESSIVE
4 causes of vascular dementia
- untreated HTN
- DM
- high cholesterol
- heart disease
what are the 3 neurologic signs of vascular dementia?
- Pronator drift
- Gait instability
- Slowing of motor performance
vascular dementia is a result of what?
damage to brain caused by problem with the arteries serving brain or heart
tx of vascular dementia?
control future infarct by controlling CVD risk factors
what are the 3 core features of Lewy body dementia?
- Parkinsonism
- Fluctuation in cognitive impairment
- Detailed visual hallucinations
when does Parkinsonism develop with Lewy body dementia?
after (or concurrent with) development of dementia
sx’s of Parkinsonism?
rigidity and bradykinesia
fluctuations in cognitive impairment for Lewy body dementia are seen in what?
level of alertness, cognitive functioning, functional status
what are the visual hallucinations like in Lewy body dementia?
vivid (often of animals, people, mystical things)
unlike psychosis, most DLB pts can distinguish hallucinations early on and not be bothered by them
at what decade/age does Frontotemporal Dementia develop?
early age, 5th decade
what is Frontotemporal Dementia characterized by?
early changes in personality and behavior (go to bank naked)
what are some sx’s that are highly suggestive of FTD?
- Hyperorality
- Early personality/behavior changes
- Early loss of social awareness (disinhibition)
- Compulsive/repetitive behaviors
- Progressive reduction in speech
who usually brings dementia problem to attention of provider?
spouse/informant (not the pt)
what is a good predictor of alter development of dementia?
informant-reported memory loss
pts with dementia have difficulty with one or more of the following:
- Retaining new information (trouble remembering events) -> Old memory is intact
- Handling complex tasks (balancing a checkbook)
- Reasoning (unable to cope with unexpected events)
- Spatial ability and orientation (getting lost in familiar places)
- Language (word finding)
- Behavior
what are useful questions for pt with dementia or information?
“When did you first notice the memory loss?”
“How has the memory loss progressed since then?”
can depression and dementia occur in the same pt?
YES
what should first appointment for pt with dementia focus on?
the hx
what must be r/o for pt presenting with dementia?
atypical presentation of medical illness