Dementias Flashcards
More aggressive management of what seems to be decreasing the likelihood of developing dementia?
Cardiovascular risk factors
What labs are commonly ordered in patients with dementia in order to rule out other etiologies?
TSH, Vitamin B12
What are the symptoms of dementia?
Memory loss Confusion Wandering, getting lost Problem solving difficulty New focal neurological deficits
What diagnostic tests are commonly used for dementia?
MMSE (mini-mental state exam)
MoCA (Montreal cognitive assessment)
CDR (clinical dementia rating)
Formal neuropsychiatric testing
Describe the progression of Alzheimer’s disease
Slowly progressive memory loss and other cognitive decline. Steady rate of progression.
What are the classic pathologic findings of Alzheimer’s disease on post-mortem exam?
Neurofibrillary tangles
Neuritic plaques
Cerebral atrophy
What genetic mutation is associated with Alzheimer’s disease?
APOE E4 mutation
What are the acquired risk factors of Alzheimer’s?
CV risk factors Lower education Sedentary lifestyle Brain trauma Benzodiazepine use
What are the symptoms of Alzheimer’s?
Progressive memory loss despite being alert
Poor short term memory despite good long term
Inability to problem solve
Language difficulties
Sundowning
Personality change
Wandering
Symptoms not explained by delirium or other psychiatric disorder
How is Alzheimer’s diagnosis made?
Clinical diagnosis
Neuropsychiatric testing
Labs to rule out reversible causes
MRI scans NOT helpful except to look for vascular cause of dementia
How is Alzheimer’s treated pharmacologically?
Acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) for mild AD Memantine (NMDA receptor antagonist) for moderate to severe
What is the mean life expectancy for patients with AD after diagnosis?
8-10 years Worse prognosis in: higher age males lower MMSE at dx
What is the second most common type of dementia?
Vascular Dementia - caused by strokes
Describe the progression of vascular dementia.
Abrupt onset followed by stepwise deterioration
What testing should be performed if suspect vascular dementia?
Neuropsychiatric testing
MRI
Blood tests to rule out others and assess cholesterol
Echo of heart and carotids to look for embolic sources
How can you treat vascular dementia?
Cholinesterase inhibitors and Memantine (used despite lack of strong evidence) Treat underlying Physical and Occupational Therapy Caregiver education and support Minimize change in patient's environment
What percentage of people over the age of 65 have mild cognitive impairment?
10-20%
What are the two types of MCI?
Amnestic
Non-amnestic
What can be done in effort to prevent MCI progression?
Control BP, glucose, cholesterol
Stop smoking and EtOH
Diet high in Omega 3 fatty acids
Keep mentally active
What are the other names for blow-induced dementia?
Chronic traumatic encephalopathy
Dementia pugilistica
Who are most susceptible to CTE?
American football players
Soccer players who head the ball
Boxers
Domestic violence survivors
What is the only “treatment” for blow-induced dementia?
Prevention
Helmets
Rest for pts with concussion
Avoid blows to head esp at young age
What are the classic triad signs of normal pressure hydrocephalus?
Dementia
Gait disturbance
Urinary incontinence (not early sign of any other dementia)
Why is it important to keep normal pressure hydrocephalus on your DDx in dementia patients?
~90% of cases per year go undiagnosed and it is treatable!
HTN and large head size increase risk of what type of normal pressure hydrocephalus?
Primary NPH
What causes secondary NPH?
Impaired CSF reabsorption across arachnoid villi due to inflammation and fibrosis caused by SAH, trauma, meningitis or cancer
How should NPH be evaluated?
MRI (look for ratio of ventriculomegaly out of proportion to sulcal enlargement)
LP to test clinical response to removal of CSF
Refer to neurosurgery who may do other more invasive testing
How is NPH treated?
Ventricular shunt placement
What type of dementia causes extreme disinhibition and markedly inappropriate behavior?
Frontotemporal dementia
What is the life expectancy after diagnosis for those with frontotemporal dementia?
6-8 years
How can frontotemporal dementia be treated?
SSRIs (treat psych symptoms)
Atypical anti-psychotics
Typical anti-psychotics NOT effective
Cholinesterase inhibitors (variable results)
What inheritance pattern does Huntington disease follow?
Autosomal dominant
What is the epidemiology of Huntington’s?
Age 35-45
More common in white males
Fatal in 15-20 years
What are the symptoms of Huntingtons?
Progressive chorea
Dementia
Bursts of anger
Antisocial behavior
What chromosomal abnormality causes Huntington’s?
CAG repeat on chromosome 4
What would prompt you to have Creutzfeldt-Jakob disease (Bovine Spongiform Encephalitis) high on your DDx?
Abnormality in almost every area of the neurologic system
What is the treatment for CJD?
None really. Symptomatic, supportive and psychological care for patient and family
