cholinesterase inhibitor - raise ACh levels - may help symptoms donepezil rivastigmine galantamine memantine $$$

Dementias - Cohen Flashcards by Matt Stanton

risk fx dementia

aging

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dementia

develop multi cognitive defects sufficient to cause impairment in occupational and social fxn

progressive and likely irreversible decline

not temporary (like delirirum)

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MC cause of dementia

alhzeimers

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beta-amyloid plaques

alzheimers

AB42

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tau tangles

alzheimers - microtubules inside neurons

phosphorylated tau

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down syndrome

almost all get alzheimers - so chromosome 21 may play a role

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alzheimers

see loss of ACh

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beta-amyloid

AB42

produced from APP by secretases

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alzheimers epidemiology

older - >80yo in 10-25%

more common in women

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homozygous at E4 allele of apoE

more prone to alzheimers

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alzheimers clinical course

begins - loss of memory
speech restricted to simple phrases
trouble day to day affairs
visuospatial decline - get lost
gait disorder
depression, bored, lack social inhibition

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apraxia

loss of simple actions/certain tasks
-loss of connections between cortical sites

in alzheimers

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mild alzheimers

safe at home, some help with activities, not a threat

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moderate alzheimers

kept at home with great effort

-full or nearly full time caregiver

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severe alzheimers

must go to nursing home - round clock supervision

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diagnosis of alzheimers

clinical diagnosis

possible diagnostic test - inject PiB (pitt compound) and use PET scan to see amyloid deposition in brain

CSF levels of beta-amyloid decrease and tau increase

MRI - atrophy medial temporal lobe

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tx of AD

cholinesterase inhibitor

raise ACh levels
may help symptoms

donepezil**
rivastigmine
galantamine
memantine $$$

donepezil

most widely used tx for AD - fewest adverse effects

-taken once daily

memantine

antagonist of glutamate

prevent cell death from glutamate activity

tx of AD - but $$$

mild cognitive impairment

mild AD
-still fxn in social and job roles

lots progress to AD

lewy body disease

fluctuating dementia

wild and crazy

decreased facial animation, slow, imbalance, tremor
-mild/moderate parkinsonian sx

EARLY dementia and agitation

more common in men

dementia fluctuating, visual hallucinations, parkinsonism

lewy body dementia

bad response to antipsychotic

lewy body dementia

tx of lewy body dementia

may improve with AChE drugs

lewy bodies

contain protein alpha-synuclein

clinical course of lewy body disorder

rapid decline -death 5-7 years psychotic behavior that fluctuates -with visual hallucinations

diagnosis of lewy body disorder

clinical diagnosis AChE tx somewhat effective

prior strokes with step like downhill course

multi-infarct dementia seizures common likely CAD, PVD, or carotid stenosis - seen on U/S

risk fx for multi-infarct dementia

HTN, diabetes, hyperlipidemia

tx of multi-infarct dementia

control risk fx - aspirin and anti-coags

fronto-temporal dementia

family of multi disorders -early age of onset 50-60yo decline in behavior and speech incrased tau protein, TDP43, and ubiquitin

increased tau, TDP43, and ubiquitin

seen in fronto-temporal dementia

behavior dominant FTD

most patients personality change - obsessed with certain subject - sing song over and over - over eat, over drink - occasional become weak no hallucinations

language predominant form of FTD

progressive aphasia left frontal and temporal lobe - more atrophy mute in few years

tx of FTD

antidepressant somewhat help

creutzfeldt jakob disease

prions | -proteins

rapid dementia over 1 year with myoclonic jerks

CJD spongiform brain EEG - triphasic waves - diffuse periodic wave pattern

14-3-3 in CSF

CJD

prion path

change in shape of proteins

normal pressure hydrocephalus

gait disturbance incontinence dementia have large lateral ventricles see normal P on spinal tap

tx of NPH

shunting

diagnosis of NPH

remove 30cc from CSF with lumbar pucture - symptoms better