Dementia - DONE

Question 1

DSM IV definition:

Answer 1

Irreversible and progressive cognitive impairment affecting memory and at least another area of cognition, not due to medical or affective disorders, affecting the daily functioning of the patient.

Question 2

What is dementia?

Answer 2

• An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient.
• Progressive and disabling
• NOT an inherent aspect of aging
• Different from normal cognitive lapses
• Caused by other than mood and consiousness disorder

Question 3

Slide 4

Answer 3

Slide 4

Question 4

Neurodegenrative disorders

Answer 4

• Alzheimer’s disease
• Dementia with lewy body
• Vascular dementia
• Frontotemporal lobar degeneration
• Corticobasal degeneration
• Parkinson’s disease with dementia
• Multiple system atrophy
• Huntington’s disease
• Prion disorders

Question 5

Slide

Answer 5

7

Question 6

Value of early detection:

Answer 6

• Identification of patients
• Identification of people in risk
• Reduction of direct and indirect costs
• Less caregiver’s stress
• Psychoeducation

Question 7

Types of dementia:

Answer 7

• Age of onset (presinile vs senile)
• Cause (primary vs secondar)
• Clinical course (reversible vs progressive)
• Localisation (cortical or posterior vs anterior)

Question 8

Alzheimer’s dementia:

Answer 8

Dementia NOT caused by other medical/mood or CNS disorder.

Question 9

Slide

Answer 9

11

Question 10

Symptoms and signs of AD:

Answer 10

• Memory impairment
• Gradual onset, progressive cognitive decline
• Behavior and mood changes
• Difficulty learning, retaining new information
• Aphasia, apraxia, disorientation, visuospatial dysfunction
• Impaired executive function, judgment
• Delusions, hallucinations, aggression, wandering

Question 11

AD - Diagnosis:

Answer 11

• CT scanning aids diagnosis by excluding multiple infarction or a mass lesion.
• MRI shows bilateral temporal lobe atrophy.
• SPECT usually shows temporoparietal hypoperfusion

Question 12

FTD =

Answer 12

Frontotemporal dementia

Question 13

FTD:

Answer 13

The development of multiple progressive cognitive deficits manifested by both:

• Impaired attention, executive function
• Personality changes**
• Intact memory/ VS skills
• Language deficits?
• Poor judgment and insight
• Frontal release signs

or executive dysfunction

Question 14

FTD - Age of onset:

Answer 14

20-80 yrs

typically 40 60, mean = 54 yo

Question 15

FTD - Affects:

Answer 15

Affects 1 in 100,000 (women>men)

Question 16

FTD - mean duration:

Answer 16

7 years

Question 17

FTD variants:

Answer 17

• Behavioral or frontal variant (see previous slide)
• Language or temporal variant
  Primary Progressive Aphasias
• Non Fluent PPA -PNFA
• Semantic PPA
• Logopenic PPA- form of language impairment caused by Alzheimer’s disease pathology

Question 18

AD - macro damage:

Answer 18

Temporal, assn ctx

Question 19

AD - micro damage:

Answer 19

Plaques & tangles

Question 20

AD - symptoms:

Answer 20

• Memory loss

- Impaired language & VS skills

Question 21

AD - treatment:

Answer 21

• Cholinergic replacement

- Anti-amyloid agent

Question 22

Pick’s - macro damage:

Answer 22

Frontotemporal

Question 23

Pick’s - micro damage:

Answer 23

Plaques (Pick’s bodies)

Question 24

Pick’s - symptoms:

Answer 24

• Personality change

- Impaired executive fn

Question 25

Pick’s - treatment:

Answer 25

Some behavioral?

Question 26

DLB =

Answer 26

Lewy body dementia

Question 27

DLB - clinical features:

Answer 27

1. Cognitive decline
2. Visual hallucinations**
3. Parkinsonism
4. Adverse reactions to neuroleptics
5. Falls/syncope/transient loss of consciousness
6. Other psychotic features
7. Extrapyramidal symptoms**

Question 28

VD =

Answer 28

Vascular dementia

Question 29

Vascular dementia - percentages:

Answer 29

• Accounts for about 20% of cases of dementia
• Another 20% of cases are a combination of AD and vascular causes
• Usually affects people between 60 and 75 years old
• Slightly more common in men

Question 30

Vascular dementia - onset:

Answer 30

Abrupt onset and stepwise progression

Question 31

Vascular dementia - location:

Answer 31

Might involve small, large or any vessel(s)

Question 32

Vascular dementia - Risk factors:

Answer 32

• History of stroke(s).
• Hypertension
• diabetes
• elevated Homocysteine

Question 33

Vascular dementia - symptom:

Answer 33

• Cognitive abnormalities depending on the areas affected

- “Sub-cortical” symptoms (slow processing, depression, emotional incontinence, somatic complaints)

Question 34

VD - Scores:

Answer 34

Hachinski Ischemic Score (HIS) vs ADDTC criteria

Question 35

Mixed dementia - symptoms:

Answer 35

• Symptoms of both neurodegenerative and vascular dementia

- Presence of “microangiopathic” disease, White matter disease

Question 36

Mixed dementia - risk factors:

Answer 36

Same risk factors as for neurodegenerative and vascular dementia

Question 37

Mixed dementia - Imaging:

Answer 37

• atrophy
• lacunar infarcts
• white matter disease

Question 38

Metabolic diseases:

Answer 38

• Cobalamin (B12), Folate deficiencies

- Hypothyroidism

Question 39

How to diagnose?

Answer 39

Levels of diagnosis

• General Practice
• Specialist (neurologist, psychiatrist, gerietrician, neuropsychologist)
• Laboratory testing
• Neuroimaging
• Genetics

Question 40

slide

Answer 40

27, 28, 29, 30, 33, 34, 35, 36

Question 41

Parkinson’s sign:

Answer 41

• Masked facies
• pill rolling resting tremor
• rigidity
• cogwheel
• festinating gate
• micrographia

Question 42

Factors that influence cognitive performance:

Answer 42

• age
• years of education
• testing language

Question 43

Dementia - differential diagnosis:

Answer 43

• dementia vs aging
• dementia vs MCI
• Dementia vs depression
• Other types of dementia