Dementias Flashcards
Mild Cognitive Impairment
- Impairment in 1 or more domains without functional difficulty
- Impairment is generally 1.5 SD below the mean
Alzheimer’s
Age, onset, symptoms, imaging
- Insidious onset and gradual progression
- Primary memory and learning impairment, and at least one other domain
- AVLT: limited ability to learn, rapid forgetting, recognition not aided by cues, frequent intrusion errors
- Encoding deficit
- Imaging: general atrophy
- Age: 65
Delerium
- Disturbed attention and reduced awareness (altered consciousness) +1 other cognitive domain disturbance
- Develops over a short period of time
- Fluctuates in severity
- Evidence of a direct causal factor (medical condition, subtance, etc)
- *Differs from DLB due to sudden onset and NO parkinsonism
Major Neurocognitive Disorder
- Significant decline in performance, 2 SD below norms
- Interferes with IADLs
Vascular
Age, onset, symptoms, imaging
- Typically following a stroke or other cerebrovascular event, so likely stepwise but can also be gradual
- Cognition: decline in complex attention, speed of processing, and executive functioning
- Able to learn, but rapid forgetting, but able to recognize (better recall with cues)
- Retrieval deficit
- Imaging typically demonstrates infarcts or hemosiderin deposits; extensive white matter lesions (small vessel disease or subcortical ischemic changes); two or more lacunes outside the brain stem
- Age: 60’s+
Lewy Body Dementia
Age, onset, symptoms, imaging
- Insidious onset and gradual progression
Symptoms:
* Frequent cognitive fluctuations in early disease; pronounced variations in attention and alertness
* Recurrent visual hallucinations
* Parkinsonian features and gait imbalance following cognitive decline
* REM sleep disorder
- Cognition: impaired attention, executive function, and visuoperceptual ability
- Preserved learning and memory
- Differs from delirium due to insidious onset and parkinsonism
- Imaging: Preservation of medial temporal volume relative to AD
- Age: 70’s
Parkinson’s
Age, onset, symptoms, imaging
- Insidious onset, gradual progression
- Requires diagnosis of Parkinson’s for 1 year before cognitive impairment can be due to PD
- Otherwise, could be diagnosed with DLB
- Cognition: reduced attention, executive dysfunction, slowed information processing, and memory and visuospatial deficits
- Intact language skills
- MOTOR SYMPTOMS: Rigidity, tremor, bradykinesia (slowness); and cogwheeling, gait change, and postural instability
□ Age: 50+; more common in men
Frontotemporal Dementia
Behavioral Variant
* ****Disinhibition
* Apathy or intertia/amotivation
* Loss of sympathy or empathy
* Perseverative, stereotyped, or compulsive behavior
* Imaging: bilateral frontal lobe atrophy and anterior temporal lobe atrophy
* Decline in executive functioning
Language Variant
* **Primary Progressive Aphasia; three variants: semantic, agrammatic, logopenic
Age: 50’s
Primary Progressive Aphasia
- Type of FTD
Semantic Variant - **Difficulty finding nouns, understanding, reading
- Imaging: bilateral middle, inferior, and anterior temporal lobe atrophy
Agrammatic/Nonfluent Variant
* Telegraphic speech, incorrect pronounciation
* Imaging: left posterior frontal-insular atrophy (Broca’s)
Logopenic Variant
* ****Primarily word-finding difficulties
* Imaging: left temporoparietal dysfunction, often caused by AD
TBI
Impact to head or other mechanism of rapid movement or displacement of the brain with one or more of the following:
* Loss of consciousness
* Posttraumatic amnesia
* Altered mental state: disorientation and confusion
* Focal neurological signs
Mild TBI
- Depression, irritability, fatigue, headache, photosensitivity, sleep disturbance; all tend to resolve in weeks following mild TBI
- LOC duration less than 30 min
- PTA (densely impaired new learning): less than 1 day
- Altered consciousness: less than 1 day
- GCS: 13-15
- Normal CT or MRI (if abnormal, it’s considered a complicated mild TBI)
Hungtinton’s
- Insidious onset, gradual progression
- Cognition: difficulties with executive function (processing speed, planning, organization)
- Cognitive & behavioral changes precede the emergence of typical motor abnormalities of bradykinesia (slowing) and chorea (involuntary jerking)
- Age: 35-45 years old
Prion
- Prion = transmissible misfolded proteins called prions
- Insidious onset, rapid progression
- Motor features of prion disease (myoclonus (sudden twitches) or ataxia)
- Creutzfeldt-Jakob disease
Multiple Sclerosis
- Cognitive: slowed processing speed, reduced attention, poor executive functioning, some memory problems
- Imaging: lesions around corpus callosum
Korsakoff’s
- Long history of drinking
- Thiamine deficiency
- Impaired memory, executive functioning, attention
- Intact visuospatial and language skills
Cerebral Amyloid Angiopathy
- Imaging: lots of small spots of amyloid build up in blood vessels
- Similar cognitive profile to vascular
- Differs from AD in that it has more pronounced visuospatial and executive functioning deficits early on
