Dementias, MacIntyre Flashcards
top 3 causes of dementia
alzheimers
vascular
lewy body
majority dementia presents when
> 90 y.o
15-20% >85 y.o
dementia reclassified as
neurocognitive disorders
what is essential in Dx dementia
not due to delirium or other mental Dx
major vs mild dementia
major interferes with ADLs (not independent)
what cognitive domains decline in dementia
complex attention executive function learning/memory language perceptual motor social cognition
what cognitive domains decline in dementia
complex attention executive function learning/memory language perceptual motor social cognition
signs of dementia
aphasia agnosia apraxia progressive onset no clouding of consciousness
which dementia can have clouding of consciousness
lewybody
NT in alzheimers
cholinergic neurons loss
dec Ach
avoid what medsin dementia
anticholinergics!!!
medical workup in dementia
VITAL signs Hx and PE cognitive testing labs neuroimaging when indicated
what labs to order for dementia
CBC, CMP, HIV/Syphilis tests, ammonia, thyroid, B12/Folate, UA, EKG, CXR
differential in dementia
delirium
pseudodementia
benign senescent forgetfullness
medical illness
what are reversible dementias
B12 deficiency folate deficiency tumor infection subdural hematoma NPH
autopsy findings alzheimers
atrophy and enlarged ventricles
risk factors for alzheimers
downs APP female sex head trauma Hx lower education level ApoE alleles
what chromosomes may be assoc with alzheimers
1, 14, 21
what alleles assoc with alzheimers
ApoE e4 increase
ApoE e2 protective
accumulation of what in alzheimer
amyloid plaques and tau tangles
plaqu in alzheimer
APP amyloid B42
tangles in alzheimer
phosphorylated tau
intracell accumulation
clinical signs of alzheimers
behavioral
psychosis! depression, agitation!!!!
sundowning (wander at night)
careful Tx alzhemier because
elderly are sensitive to side effects etc
start low go slow
Tx alzheimer drug classes
ACHEI memantine (NMDA R blocker) antipyschotics valproic acid SSRI
ACHEI used in alzheimer
donepezil
rivastigmine
galantamine
avoid benzos why in alzheimer
inc risk dementia
INC risk for falls!!!
addiction
cannot detox elderly who are addicted
vascular dementia
onset relates to CVA and decline prominent in complex attention and frontal/executive function
demographics vascular dementia
more common in men
abrupt onset step wise decline
clinical signs vascular dementia
dysrhythmia, murmurs, bruits,
risk factors for vascular dementia
smoking, BP, glucose, aspirin
Tx vascular dementia
control risk factors
can try ACHEI
Presentation frontotemporal dementia
insidious onset/gradual progression
behavioral or language types
**overreaction!!
demographics frontotemporal dementia
men>women
usually in 50s
earlier onset
Tx frontotemporal dementia
ACHEI or mood stabilizers(aggression)
Lewy Body dementia overlaps with
PD
signs of lewy body dementia
psychosis (visual hallucinations!!!)
parkinosonian features
fluctuating mental function looks like delirium
paradoxical antipsychotic Tx reaction!!!
what is the paradoxical antipsychotic Tx reaction
inc psychosis and inc side effects with Tx ine lewy body
CJD
prion disease
clonus, ataxia, biomarker evidence
triphasic waves on EEG
Tx supportive, rapidly fatal
Chronic Traumatic Encephalopathy marked by
impulsivity, dysarthria, emotional lability
Tx CTE
ACHEI
valproic acid
sSRI
avoid anticholinergics!
abulia
lack of motivation, seen in HD
what funciton go away first in HD
complex tasks
memory and language later
Tx HD
antipsychotics, ACHEI, mood stabilizers, SSRI
PD accumulates what
alpha synuclein or tau protein in substantia nigra
have lewy bodies
Tx PD
dopaminergic agents—- can cause psychosis!!!
how to distinguish lewy body and PD
PD requires cognitive decline >1 year Dx of PD
dementia from HIV
neurtoxicity of HIV macrophages
dementia in MS
can be seen, multiple lesions everywhere!!
