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Neurology > Dementias > Flashcards

Dementias Flashcards

1
Q

Dementia decreasing in USA w/

A

Cardio risk factor management

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2
Q

Dementia

Types

A
  • Alzheimer’s
  • Vascular dementia
  • Parkinson’s associated dementia

*other - lewy bodies, chronic ETOH abuse, frototemporal

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3
Q 
Acute Onset
Stepwise
Risk Factors
Frontal deficits
Neuro Signs
Gait
Imaging
A

Vascular dementia

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4
Q

Gradual onset
Memory Loss
Normal exam

A

Alzheimer’s Dz

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5
Q 
Parkinsonism
Hallucinations
Fluctuations
Frontal deficits
Visuospatial
A

Parkison’s w/ dementia

Lewy bodies

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6
Q

Behavior
Frontal deficits
Family Hx
Young onset

A

Frontotemporal dementia

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7
Q

Dementia

Hx

A
  • Hx - ask informant
  • memory loss?
  • confusion?
  • wandering? RISK
  • Difficulty problem solving?
  • new focal neuro s/s
  • New Meds? Substances?
  • Family Hx of CV/dementia
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8
Q

Dx tests

A
  • Mini-Mental Status exam
  • Montreal Cognitive Assessment (MoCA)
  • Clinical Dementia rating (CDR)
  • Focal Neuropsyc testing for specific domains
    • recent memory, language, executive function, visual/auditory memory
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9
Q

Physical Exam

A
  • other Underlying dz? S/s
  • Evidence of Self neglect?
  • Evidence abuse?
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10
Q

Labs

A

TSH
B12
*rarely help

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11
Q

Alzheimer’s Dz

Path

A

Neurofibrillary tangles
Neuritic plaques
Cerebral atrophy

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12
Q

Alzheimer’s Dz

Who?

A
  • Old
  • APOE E4 mutation
  • FH - esp. AA
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13
Q

Alzheimer’s Dz

Risk Factors

A
  • CV
    • Low education
    • Sedentary
    • Brain trauma
    • Benzo use
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14
Q
  • progressive memory loss
  • short term BAD
  • long term GOOD
  • sundowning - worse at night
  • language difficulty
  • wandering

S/s

A

Alzheimer’s Dz

*NOT DELIRIUM = sudden onset

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15
Q

Alzheimer’s Dz

Dx

A
  • Hx
  • MRI not helpful
  • labs- rule out reversible causes
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16
Q

Alzheimer’s Dz

Rx Tx

Mild vs. Severe

A
  • MILD = AchE blockers
  • Donepezil
  • Galantamine
  • Rivastigmine

*SEVERE = Memantine

NO HELP REALLY

NO BENZOS/Sedatives to sleep = Quicker death

17
Q

Alzheimer’s Tx

Non-Pharm Tx

A
  • treat all other conditions
  • routines for daily living to MINIMIZE DISTRESS
  • Minimize Care-giver/environment changes
18
Q

Alzheimer’s Dz

Prognosis

A

8-10 years from Dx

*Worse= age, male, low MMSE at Dx

19
Q

From strokes

  • Abrupt onset
  • stepwise deterioration
  • PE = stroke-like
  • MRI/CT = stroke
  • risk factors (stroke risks) : CV, DM, smoking
A

Vascular Dementia

20
Q

Vascular Dementia

Tests

A
  • Hx/ PE
  • Neuropsychatric testing
  • MRI
  • blood tests = other cause, cholesterol
  • Cardio/Carotid Echo = embolic sources?
21
Q

Vascular Dementia

Tx

A

Rx= AchE blocker/Memantine

  • PT/OT
  • routines/minimize environment changes
22
Q

Vascular Dementia

Prognosis

A

Prevent strokes!

23
Q

Memory Cognitive Impairment

Types

A
  • Amnestic = MC, forgetfulness
  • Non-amnestic = problem w/ executive function, language, visuospatial function)

10% PROGRESS TO ALZHEIMER’S

24
Q

Mild Cognitive Impairment

History

A

IMPAIRING JOB/LIFE?

  • med/psyc Hx
  • FH dementia?
  • how have abilities / behavior changed?
25
Q

Mild cognitive impairment (MCI)

Work-up

A
  • rule out reversible causes (meds, depression, toxins, etc.)
  • GET BASELINE FUNCTIONING (mmse/full neuropsyc if suspicious)
26
Q
  • repeated blows to the head

* football players

A

Blow-Induced Dementia (CTE)

  • MUST PREVENT
  • PREVENT from YOUNG AGE
27
Q

S/s TRIAD:

Dementia
Gait disturbance
Urinary Incontinence (ONLY THIS)

A

Normal Pressure Hydrocephalus

28
Q

Normal Pressure Hydrocephalus NPH

Path
1ary vs. 2ary

A

Primary = not understood, HTN, Large head

Secondary = CSF can’t reabsorb across arachnoid villi

29
Q

Gait = block turning, short steps

Urinary = beginning-urgency, changing?

cognitive disturbance = psychomotor slowing, DOWN executive function/attention, apathetic (NOT LIKE ALZHEIMERS)

Signs?

A

Normal Pressure Hydrocephalus NPH

30
Q

NPH vs. Alzheimer’s

Affect

A

FLAT in NPH

31
Q

Normal Pressure Hydrocephalus

Dx

A
  • MRI = ventriculomegaly w/ normal sulci depth
  • LP = 30-50cc CSF removal improves gait/cognitive
  • neurosurgeons - other tests
32
Q

Normal Pressure Hydrocelphalus NPH

Tx

A

Ventricular Shunt (to stomach/atrium)

  • need shunt revisions over time
  • prognosis - death w/ fall usually
33
Q
  • rare
  • extreme disinhibition, inappropriate behavior
  • police arrest
  • refuse help, deny problem

S/s?

A

Frontotemporal Dementia

6-8 yrs left

34
Q

Frontotemporal Dementia

Tx

A

SSRI = decrease disinhibition

Atypical Anti-psycs

  • Olanzapine
  • Quetiapine

(typical make worse! (Risperidone)

35
Q

Huntington Dz

Path

A

Expanded CAG repeate on Chrom 4, auto-dom

36
Q

Progressive chorea
dementia
Anger bursts
Antisocial Behavior

S/s?

A

Huntington Dz

37
Q

Huntington Dz

Dx

A

History
Physical
Genetic testing

38
Q

Abnormalities in ALMOST EVERY Neuro System

S/s?

A

Creutzfeldt-Jakob Dz

39
Q

Alzheimer’s Dz

Dx

A

Dementia

  • function at work impaired
  • function decline
  • No psyc disorder
  • Hx from patient AND informant

Cognitive Impairment (2+)

  • acquire/remember new info
  • Reasoning/complex task/judgement
  • visuospatial abilities
  • language
  • Personality/behavior

Neurology (20 decks)

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