Dementias Flashcards
Dementia decreasing in USA w/
Cardio risk factor management
Dementia
Types
- Alzheimer’s
- Vascular dementia
- Parkinson’s associated dementia
*other - lewy bodies, chronic ETOH abuse, frototemporal
Acute Onset Stepwise Risk Factors Frontal deficits Neuro Signs Gait Imaging
Vascular dementia
Gradual onset
Memory Loss
Normal exam
Alzheimer’s Dz
Parkinsonism Hallucinations Fluctuations Frontal deficits Visuospatial
Parkison’s w/ dementia
Lewy bodies
Behavior
Frontal deficits
Family Hx
Young onset
Frontotemporal dementia
Dementia
Hx
- Hx - ask informant
- memory loss?
- confusion?
- wandering? RISK
- Difficulty problem solving?
- new focal neuro s/s
- New Meds? Substances?
- Family Hx of CV/dementia
Dx tests
- 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
Physical Exam
- other Underlying dz? S/s
- Evidence of Self neglect?
- Evidence abuse?
Labs
TSH
B12
*rarely help
Alzheimer’s Dz
Path
Neurofibrillary tangles
Neuritic plaques
Cerebral atrophy
Alzheimer’s Dz
Who?
- Old
- APOE E4 mutation
- FH - esp. AA
Alzheimer’s Dz
Risk Factors
- CV
- Low education
- Sedentary
- Brain trauma
- Benzo use
- progressive memory loss
- short term BAD
- long term GOOD
- sundowning - worse at night
- language difficulty
- wandering
S/s
Alzheimer’s Dz
*NOT DELIRIUM = sudden onset
Alzheimer’s Dz
Dx
- Hx
- MRI not helpful
- labs- rule out reversible causes
Alzheimer’s Dz
Rx Tx
Mild vs. Severe
- MILD = AchE blockers
- Donepezil
- Galantamine
- Rivastigmine
*SEVERE = Memantine
NO HELP REALLY
NO BENZOS/Sedatives to sleep = Quicker death
Alzheimer’s Tx
Non-Pharm Tx
- treat all other conditions
- routines for daily living to MINIMIZE DISTRESS
- Minimize Care-giver/environment changes
Alzheimer’s Dz
Prognosis
8-10 years from Dx
*Worse= age, male, low MMSE at Dx
From strokes
- Abrupt onset
- stepwise deterioration
- PE = stroke-like
- MRI/CT = stroke
- risk factors (stroke risks) : CV, DM, smoking
Vascular Dementia
Vascular Dementia
Tests
- Hx/ PE
- Neuropsychatric testing
- MRI
- blood tests = other cause, cholesterol
- Cardio/Carotid Echo = embolic sources?
Vascular Dementia
Tx
Rx= AchE blocker/Memantine
- PT/OT
- routines/minimize environment changes
Vascular Dementia
Prognosis
Prevent strokes!
Memory Cognitive Impairment
Types
- Amnestic = MC, forgetfulness
- Non-amnestic = problem w/ executive function, language, visuospatial function)
10% PROGRESS TO ALZHEIMER’S
Mild Cognitive Impairment
History
IMPAIRING JOB/LIFE?
- med/psyc Hx
- FH dementia?
- how have abilities / behavior changed?
Mild cognitive impairment (MCI)
Work-up
- rule out reversible causes (meds, depression, toxins, etc.)
- GET BASELINE FUNCTIONING (mmse/full neuropsyc if suspicious)
- repeated blows to the head
* football players
Blow-Induced Dementia (CTE)
- MUST PREVENT
- PREVENT from YOUNG AGE
S/s TRIAD:
Dementia
Gait disturbance
Urinary Incontinence (ONLY THIS)
Normal Pressure Hydrocephalus
Normal Pressure Hydrocephalus NPH
Path
1ary vs. 2ary
Primary = not understood, HTN, Large head
Secondary = CSF can’t reabsorb across arachnoid villi
Gait = block turning, short steps
Urinary = beginning-urgency, changing?
cognitive disturbance = psychomotor slowing, DOWN executive function/attention, apathetic (NOT LIKE ALZHEIMERS)
Signs?
Normal Pressure Hydrocephalus NPH
NPH vs. Alzheimer’s
Affect
FLAT in NPH
Normal Pressure Hydrocephalus
Dx
- MRI = ventriculomegaly w/ normal sulci depth
- LP = 30-50cc CSF removal improves gait/cognitive
- neurosurgeons - other tests
Normal Pressure Hydrocelphalus NPH
Tx
Ventricular Shunt (to stomach/atrium)
- need shunt revisions over time
- prognosis - death w/ fall usually
- rare
- extreme disinhibition, inappropriate behavior
- police arrest
- refuse help, deny problem
S/s?
Frontotemporal Dementia
6-8 yrs left
Frontotemporal Dementia
Tx
SSRI = decrease disinhibition
Atypical Anti-psycs
- Olanzapine
- Quetiapine
(typical make worse! (Risperidone)
Huntington Dz
Path
Expanded CAG repeate on Chrom 4, auto-dom
Progressive chorea
dementia
Anger bursts
Antisocial Behavior
S/s?
Huntington Dz
Huntington Dz
Dx
History
Physical
Genetic testing
Abnormalities in ALMOST EVERY Neuro System
S/s?
Creutzfeldt-Jakob Dz
Alzheimer’s Dz
Dx
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
