Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin med exam 2 > Dementias > Flashcards

Dementias Flashcards

1
Q

Dementia

A

An umbrella term
DECLINE in cognitive impairment
not explained by delirium or other psychiatric disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cognitive impairment involves:

A

at least 2 of these:

visuospatial skills 
language skills 
memory 
judgement, reasoning or handling complex tasks 
changes in personality or behavior
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Alzheimer disease

A

most common type of dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Risks for Alzheimer

A

Age
FH- autosomal dominant genetic mutations (earlier onset)
lower education level
woman> men

no racial or ethic differences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pathophysiology for Alzheimer dementia

A

neuritic plaques (made of beta amyloid and other proteins)

neurofibrillary tangles (made from hyperphosphorylated tau)

decreased acetylcholine (acetyl cholinesterase breaks down acetylcholine)

hippocampus first regions to be affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clinical presentation of Alzheimer (memory)

A

insidiously and progressively

memory impairment

  • explicit (declarative- factual) memory often declines early (dependent on hippocampus)
  • memory for recent events (anterograde long-term episodic amnesia)

test: repeat words

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clinical presentation of Alzheimer (executive function)

A

less motivated, organized and abstract thinking
finances organization
driving, shopping, housekeeping
job

NOT ADL’s

anosognosia- unaware of deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clinical presentation of Alzheimer (behavioral & neuropsychiatric)

A

apathetic, irritable, socially disengaged

overt agitation, aggression, psychosis, wandering

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical presentation of Alzheimer’s disease

A

memory
executive function
behavioral and neuropsychiatric

dyspraxia/apraxia- inability or difficulty to execute a learned motor task- ex: comb hair

olfactory dysfunction

sleep disturbances

visuospatial deficits- copy a shape, read a clock, etc

seizures

changes can destabilize pts- some pts have a set routine, so do not realize there is an issue, taking them out of the routine and environment it is obvious there is a problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Possible progression of Alzheimer

A

Mild- memory
Mod- impaired language, confusion, apraxia, visuospatial deficiencies interfere with ADLs
Severe- ambulatory and wander or loose ability to talk, delusions, sleep patterns, withdrawn
End- mute, bedridden, death is aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Alzheimer diagnosis

A

histology- tissue sample and see plaques,
clinical dx- most commonly
labs and imaging- rule out others

cognition assessment-

  • MMSE (mini mental status exam): 8th grade and English
  • MoCA (Montreal cognitive assessment)
  • SLUMS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Treatment for Alzheimer- Mild mod dementia

A

Cholinesterase inhibitors

Aricept - most used
-s/e= insomnia, nausea, diarrhea

Exelon (PO or patch)

  • s/e= dizziness, headache, agitation, falling, weight loss, n/v, anorexia
  • oral makes these worst

Razadyne (BID or ER versions)
-s/e= nausea, vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment for Alzheimer- mod-severe

A

if moderate can take both (aricept and namenda)

Namenda
=NMDA receptor antagonist
-s/e= dizziness, headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Other therapies for Alzheimer

A

vitamin E
selegiline
anti-inflammatory drugs
ginkgo biloba

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Managing neuropsychiatric symptoms

A

1- consider delirium from medical cause, medication side effects, inexpressible pain

  1. anit-depressants (ex: celexa)
  2. anti-seizures (ex: gabapentin, tegretol, depakote)
  3. dextromethrophan- quinidine (neudexta)

Avoid using benzodiazepines (a sedative)
- it leads to dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Managing neuropsychiatric symptoms- antipsychotics

A

not first choice- increases mortality
used for safety of pt and/or caregiver

Seroquel
Risperidone
Zyprexa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Alzehimer prognosis

A

processive, incurable
8-10 years

causes of death: 
aspiration (most common) 
malnutrition 
secondary infections 
PE
heart disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q 
Vascular dementia (VaD) 
(sometimes called multi-infarct dementia)
A

second most common
overlap with Alzheimer

higher rate in those >65

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

VaD risk factors

A

cardiovascular disease
higher glucose levels/diabetes
HTN
afib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

VaD pathophysiology

A

Atherosclerosis–> infarction

  • large infarction (cortical) at level of major cerebral vessels and or
  • lacunar infarcts from small artery infarction (subcortical)
  • chronic (subcortical) ischemia in distribution of small arteries of periventricular white matter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Vascular dementia- cortical presentation

A

speech difficulty
trouble doing tasks
amnesia
executive dysfunction

stepwise or fluctuant course common

rapid decrease and have a new baseline

22
Q

Vascular dementia- subcortical presentation

A

gait dysfunction
personality & mood changes
urinary frequency , urgency
cognitive dysfunction

gradual or stepwise

23
Q

Vascular dementia dx

A

neurologic and cardio vascular exam + exam

imaging (MRI)- shows presence of infarcts

24
Q

Vascular dementia- tx

A

Risk factor management

  • antihypertensives
  • diabetes management
  • statin therapy
  • antiplatelet agents

Acetylcholinesterase inhibitors

  • donepezil
  • galantamine
  • rivastigmine (Alzheimer meds)

NMDA antagonists
- memantine

Calcium channel blockers

25
Q

Vascular dementia prognosis

A

have severe cardiovascular disease-

  • stroke
  • MI
26
Q

Lewy body dementia (LBD or DLB)

A

neurodegenerative disease characterized by dementia with or preceding parkinsonian symptoms

  • hallucinations
  • cognition and/or alertness
  • dysautonomia
  • disordered sleep

2nd most common type of degenerative dementia after Alzheimer’s

27
Q

Lewy body dementia- epidemiology

A

lack of caffeine use

sporadic with discordance among monozygotic twins

28
Q

Lewy body dementia- pathophysiology

A

Lewy bodies (neuronal inclusions) in cerebral cortex, deep in the cortical layers throughout the brain

Also unbalance of ACTH and dopamine and serotonin transmission

29
Q

Lewy body dementia- clinical features

A

Cognitive dysfunction- attention, executive function, visuospatial function

REM sleep disorder

  • vocalization
  • motor behaviors

Neuroleptic (antipsychotics) sensitivity

  • irreversible parkinsonism & impaired consciousness
  • after taking these meds
30
Q

Lewy body dementia- supportive

A 
repeated falls 
syncope or transient loss of consciousness
severe autonomic dysfunction 
delusions 
depression
31
Q

Lewy body dementia- dx

A

PET- hypoperfusion of occipital region

MRI- generalized atrophy and white matter changes

Biopsy

32
Q

Lewy body dementia- tx

A 
Cholinesterase inhibitors (ACTH inhibitors- block breakdown) for cognitive & behavioral symptoms 
- Exelon- 1st line

Levodopa does not help like it does in Alzheimer’s. High doses actually makes psychosis worst.

Donepezil (aricept)

  • cholinesterase inhibitor
  • for cognitive and behavior measures

Antipsychotics
- avoid but if needed 2ary (ine, one)

Melatonin or clonazepam
- REM sleep behaviors

Disabling Parkinsonism
- Levodopa instead of dopamine agonist (sinemet)

33
Q

Lewy body dementia- prognosis

A

Progressive
Variable
More rapid than Alzheimer’s

34
Q

Core clinical features of Lewy body dementia

A

2/3

cognitive fluctuations 
visual hallucinations 
parkinsonism 
- bradykinesia 
- limb rigidity 
- shuffling gait 
- resting tumor 
- postural instability

If Parkinson’s diagnosis first then dementia = Parkinson’s dementia

35
Q

Pseudodementia

A

psychiatric illness but appear to be demented

Seen in an episode of major depression

36
Q

Pseudodementia- clinical presentation

A

Demented- make something up if they do not know the answer- cover up problems

Depressed- “I don’t know”, complain about memory issues

37
Q

Pseudodementia- tx

A

SSRI’s (antidepressants)

ECT electro compulsive therapy

Do not give acetylcholinesterase inhibitors or NMDA antagonists

38
Q

Frontotemporal dementia

A

umbrella term

degeneration of frontal or temporal lobes of the brain

characterized in changes of personality, language, and behavior

39
Q

Frontotemporal dementia- epidemiology

A

common cause of early- onset dementia

highly heritable

40
Q

Frontotemporal dementia- clinical features- behavioral variant

A

marked by processive change in personality and behavior

  • most common subtype
  • hyperorality
  • compulsiveness
  • apathy
41
Q

Frontotemporal dementia- clinical features- primary progressive aphasia

A

language impairment

  • word finding
  • usage
  • comprehension
  • sentence construction

types:
nonfluent variant PPA

semantic variant PPA

logopenic variant PPA

42
Q

Nonfluent PPA in Frontotemporal dementia

A

motor speech deficit with a lot of effort needed to produce words

43
Q

Semantic PPA in Frontotemporal dementia

A

cannot understand single words but fluency, repetition, and grammar is preserved

word finding difficulty

Mispronounce or misspell
- have surface dyslexia/dysgraphia

44
Q

Logopenic PPA in Frontotemporal dementia

A

Impaired single word retrieval & repetition

errors in speech and naming

can comprehend a single word

speech is “empty” tell a story but no details- vague

45
Q

Frontotemporal dementia- motor syndromes

A

Upper motor neuron signs
- hyperreflexia, spasticity, Babinski’s

Lower motor neuron signs
- weakness, muscle atrophy, fasciculations

Corticobasal syndrome
- alien limb syndrome, dystonia

Supranuclear palsy

In general:
NS in terms of MSK system is also being affected

46
Q

Frontotemporal dementia- dx

A

Functional imaging

- hypoperfusion or hypometabolism

47
Q

Frontotemporal dementia- tx

A

SSRI trial
- paroxetine (axil)

Atypical (2nd) antipsychotic
- seroquel

Cholinesterase inhibitors

48
Q

Frontotemporal dementia- prognosis

A

worst than Alzheimer’s- especially those with motor neuron disease

49
Q

HIV associated dementia (HAD)

& Signs and Symptoms

A

subcortical dysfunctional

  • attention- concentration
  • memory
  • behavior and mood changes
  • impaired psychomotor speed and precision
  • judgement intact

subacute onset- wax and wane

50
Q

HIV associated dementia (HAD)- imaging

A

cerebral atrophy

affects- basal ganglia and white matter

51
Q

HIV associated dementia (HAD)- tx

A

antiretroviral therapy- one that penetrates CNS well

Clin med exam 2 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions