Dementias Flashcards
what is the pathophysiology behind Alzheimer’s
- neuritic plaques
- neurofibrillary tangles
- decreased Ach
what is one of the first areas of the brain affected in Alzheimer’s
hippocampus
___ is when one is unaware of their own mental health condition
anosognosia
Pt presents with apraxia, olfactory dysfunction, sleep disturbances, and visuospatial deficits.
What do you suspect?
Alzheimer’s
In Alzheimer’s, slight issues with recent memory suggests ___ progression
mild
In Alzheimer’s, having impaired language, confusion, mild apraxia, and visuospatial suggests ___ progression
moderate
In Alzheimer’s, having delusions, disinhibition, and wandering suggests ___ progression
severe
how would you assess a patient’s cognition
MMSE, MoCA, SLUMS
Tx of mild-moderate dementia
Cholinesterase inhibitors
- Donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Razadyne)
Tx for moderate-severe dementia
NMDA receptor antagonist
- Namenda
Tx for neuropsychiatric Sx
- antidepressants (Celexa)
- antiseizure (Depakote)
- AVOID BENZOs
- antipsychotics last resort
2nd most common form of dementia?
Vascular dementia (multi-infarct)
VaD from cortical infarct - presentation?
- stepwise/fluctuant decline
- speech difficulty
- trouble with tasks
- executive dysfunction
VaD from subcortical (lacunar) infarct - presentation?
- gait dysfunction
- personality & mood changes
- urinary frequency/urgency
- cognitive dysfunction
(more subtle)
VaD Tx
Ach-ase inhibitors
- donepezil, galantamine, rivastigmine
____ is a neurodegenerative disease characterized by dementia with or preceding parkinsonian Sx
Lewy Body Dementia (LBD)
early impairments of LBD
- attention
- executive function
- visuospatial function
Pt must have 2 of what 3 clinical features to have LBD
- cognitive fluctuations
- visual hallucinations
- parkinsonism
first-line Tx for LBD
cholinesterase inhibitors – Exelon (PO or patch)
differentiate between clinical presentation of pseudodementia and real dementia
- depressed = “I don’t know”
(dementia = act like they know) - depressed = emphasize failure
(dementia = delight in accomplishments) - depressed = complain about memory issues
(dementia = cover up memory probs)
frontotemporal dementia is the degeneration of the frontal/temporal lobes characterized by changes in _____, _____, _____
- personality
- language
- behavior
Pt presents with disinhibition, apathy/loss of empathy, hyperorality, and compulsive behaviors.
… Dx?
frontotemporal dementia - behavioral variant
Pt presents with difficulty articulating words, halting speech, distortion, and agrammatism.
… Dx?
frontotemporal dementia - nonfluent variant PPA
pt presents with impaired single word comprehension & object naming as well as mispronouncing of words.
… Dx?
frontotemporal dementia - semantic variant PPA
pt presents with impaired single word retrieval & repetition, errors in naming, and lack descriptive detail.
… Dx?
frontotemporal - Logopenic variant PPA
Tx for frontotemporal dementia
- SSRI trial
- atypical antipsychotic trial
(cholinesterase inhibitors dont help)
Tx for HIV-associated dementia
- antiretroviral therapy
must penetrate CNS well
