Lec 57 Dementia and Delirium Flashcards
What is mild cognitive impairment?
- impaired cognition in one or more domains [executive function or memory or language]
- no significant functional impairment, not as bad as dementia
- may be prodromal state for dementia (10-15%/yr develop it)
- 1/3 improve
What are major causes of non-dementia related cognitive impairment?
- prodromal alzheimers
- diabetes
- stroke
What is definition of dementia?
- clinical syndrome
- insidious onset, progressive cognitive impairment in multiple domains: memory impairment + aphasia or apraxia or agnosia or disturbance executive functioning
- no impairment in consciousness, does not occur during delirium
- significant impairment in social or occupational function
- small % may be reversible
What is course and prognosis of dementia?
depends on etiology of dementia
- duration 6 mos to 15 yrs
- neuropsychiatric symptoms worsen with progression
- eventually leads to death
- modifying vascular risk factors can improve course
What are risk factors for dementia?
- age
- female gender
- vascular
- environmental (alcohol)
- genetics
What factors associated with cognitive resilience?
- education
- social network
- cognitive stimulating activities
- regular exervise
What are non-cognitive symptoms of dementia?
- psychotic symptoms
- socially inappropriate/disinhibiited behaviors [aggression, wandering)
- sleep disturbance
What are signs of cortical dementia?
- prominent memory impairment (recall AND recognition)
- language deficiets
- apraxia
- agnosia
- visuospatial deficits
- lack prominent motor signs
What are causes of cortical dementia?
alzheimer’s
Pick’s disease
Creutzfeldt-Jakob
fronto-temporal dementia
What are signs of subcortical dementia?
greater impairment in memory recall
- decreased verbal fluency without anomia
- bradyphenia [slowed thinking]
- depressed mood, attention, apathy
- prominent motor signs
What are some possible causes of subcortical dementia?
HIV
parkinsons disease
huntingtons
MS
How do you tell difference between cortical and subcortical dementia?
subcortical = decreased mood, motor symptoms, psychiatric, psychosis
cortical = lack prominent motor signs, visuospatial deficits, trouble with memory and language (apraxia/agnosia)
What are some types of mixed dementias?
dementia with lewy bodies
What are common etiologies of dementia?
- alzheimers
- dementia with lewy bodies
- vascular
What are common themse of neurodegenerative disorders?
- selective degeneration of subpopulation of neurons
- often with onvolvement cortical-cortical projections
- visible atrophy or alteration of structures on imaging
- often abnormal accumulation of proteins/lipoproteins in neurons
- slow insidious onset and progression
What are characteristics of alzheimers?
- # 1 cause dementia
- onset usually > 65
- insidious onset
- death 8-10 yrs after onset
- early memory impairment + 1 other deficit
- functional impairment
What are histologic/gross findings of alzheimer’s?
widespread cortical atrophy, narrowed gyri, widened sulci
decreased ACh
senile plaques + neurofibrillary tangles
What are characteristics of dementia with lewy bodies?
2nd most common cause dementia
- spontaneous parkinsonism
- recurrent visual hallucinations
- early dementia [vs PD] with pronounced variations attention and alertness
- late memory impairment
What is neuropathlology of dementia with lewy bodies?
alpha synuclein defect = major component of lewy bodies
distribution of lewy bodies in brainstem nuclei and cortex
What is vascular dementia?
cognitive decline due to ischemic or hemorrhagic injury
- defined by focal neurological symptoms + cerebrovascular disease on neuroimaging at time of clinical
overlap in risk factors and pathophysiology of AD (vascular disease, age, vascular risk factors)
variable symptoms depending on location
What are possible etiologies of vascular dementia?
stroke, small vessel ischemic disease, hemorrhage, chronic hypoperfusion
What is presentation and course of vascular dementia?
variable onset and course
onset acute = large or strategic vascular event
onset insidious = smaller subcortical or small vessel infarct
course may be static or stepwise decline
What are characteristics of frontotemporal dementia [FTD]?
- onset age 45-65 [earlier than AD]
- may be familial
- insidious onset, gradual progression
- diagnosis to death = 3-5 yrs
symptoms = dementia, aphasia [progressive deterioration of language], parkinsonian aspects, change in personality
What is neuropathlology of frontotemporal dementia?
spares parietal lobe and posteer 2/3 of superior temporal gyrus
tauopathy = tau containing deposits
pick bodies = spherical tau protein aggregates
fronto-temporal atrophy
