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Brain and Behavior Exam 3 > Lec 57 Dementia and Delirium > Flashcards

Lec 57 Dementia and Delirium Flashcards

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1
Q

What is mild cognitive impairment?

A
  • 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
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2
Q

What are major causes of non-dementia related cognitive impairment?

A
  1. prodromal alzheimers
  2. diabetes
  3. stroke
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3
Q

What is definition of dementia?

A
  • 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
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4
Q

What is course and prognosis of dementia?

A

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
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5
Q

What are risk factors for dementia?

A
  • age
  • female gender
  • vascular
  • environmental (alcohol)
  • genetics
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6
Q

What factors associated with cognitive resilience?

A
  • education
  • social network
  • cognitive stimulating activities
  • regular exervise
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7
Q

What are non-cognitive symptoms of dementia?

A
  • psychotic symptoms
  • socially inappropriate/disinhibiited behaviors [aggression, wandering)
  • sleep disturbance
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8
Q

What are signs of cortical dementia?

A
  • prominent memory impairment (recall AND recognition)
  • language deficiets
  • apraxia
  • agnosia
  • visuospatial deficits
  • lack prominent motor signs
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9
Q

What are causes of cortical dementia?

A

alzheimer’s
Pick’s disease
Creutzfeldt-Jakob
fronto-temporal dementia

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10
Q

What are signs of subcortical dementia?

A

greater impairment in memory recall

  • decreased verbal fluency without anomia
  • bradyphenia [slowed thinking]
  • depressed mood, attention, apathy
  • prominent motor signs
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11
Q

What are some possible causes of subcortical dementia?

A

HIV
parkinsons disease
huntingtons
MS

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12
Q

How do you tell difference between cortical and subcortical dementia?

A

subcortical = decreased mood, motor symptoms, psychiatric, psychosis

cortical = lack prominent motor signs, visuospatial deficits, trouble with memory and language (apraxia/agnosia)

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13
Q

What are some types of mixed dementias?

A

dementia with lewy bodies

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14
Q

What are common etiologies of dementia?

A
  • alzheimers
  • dementia with lewy bodies
  • vascular
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15
Q

What are common themse of neurodegenerative disorders?

A
  • 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
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16
Q

What are characteristics of alzheimers?

A
  • # 1 cause dementia
  • onset usually > 65
  • insidious onset
  • death 8-10 yrs after onset
  • early memory impairment + 1 other deficit
  • functional impairment
17
Q

What are histologic/gross findings of alzheimer’s?

A

widespread cortical atrophy, narrowed gyri, widened sulci
decreased ACh
senile plaques + neurofibrillary tangles

18
Q

What are characteristics of dementia with lewy bodies?

A

2nd most common cause dementia

  • spontaneous parkinsonism
  • recurrent visual hallucinations
  • early dementia [vs PD] with pronounced variations attention and alertness
  • late memory impairment
19
Q

What is neuropathlology of dementia with lewy bodies?

A

alpha synuclein defect = major component of lewy bodies

distribution of lewy bodies in brainstem nuclei and cortex

20
Q

What is vascular dementia?

A

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

21
Q

What are possible etiologies of vascular dementia?

A

stroke, small vessel ischemic disease, hemorrhage, chronic hypoperfusion

22
Q

What is presentation and course of vascular dementia?

A

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

23
Q

What are characteristics of frontotemporal dementia [FTD]?

A
  • 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

24
Q

What is neuropathlology of frontotemporal dementia?

A

spares parietal lobe and posteer 2/3 of superior temporal gyrus

tauopathy = tau containing deposits

pick bodies = spherical tau protein aggregates
fronto-temporal atrophy

25
Q

What are characteristics of Creutzfeldt-Jakob dementia [CJD]?

A
  • rapid progressive dementia
  • occurs usually 60-64 yrs
  • prion disease = familial or infectious
  • fatal in 6-9 months

symptoms: rapid progression dementia, myoclonus, cerebellar sigs, gait abnormalities, psychiatric symptoms

26
Q

What is pathology of CJD?

A
  • spongiform encephalopathy

- prions

27
Q

What are some reversible causes of dementia?

A 
normal pressure hydrocephalus
thyroid dysfunction
dietary [B12 deficiency]
infection [neurosyphilis]
depression
tumor
28
Q

What are characteristics of normal pressure hydrocephalus?

A
  • potentially reversible
    clinical triad: dementia, abnormal gait, urinary incontinence
    = wet, wobbly wacky

idiopathic or secondary to meningitis

treat with CSF removal by LP or shunting

29
Q

What is neuropathology of normal aging?

A
  • change in ninnate immune functions
  • subtle increase blood-CSF barrier and BBB permeability
  • decreased brain volume + weight
  • reduced synapses
  • loss/shrinkage of neurons
  • accumulation lipofuscin pigment in neurons, some neurofibrillary tangles
  • degeneration hippocampus
30
Q

What are pharm treatments for dementia?

A
  • antipsychotics for psychosis + behavioral disturbance
  • anticonvulsants, SSRIs
  • cholinesterase inhibitors
  • NMDA receptor antagonist
31
Q

What is delirium?

A
  • disturbance of consciousness with reduced ability to focus, sustain attention
  • acute onset [hrs to days], fluctuates during day
  • disturbances in arousal [vs normal arousal in dementai]
  • direct physiological consequence of a medical condition [UTI, alcohol withdrawal, morphine]
32
Q

Who gets delirium?

A

epidemin in elderly hospitalized pts

associated with worse outcomes and increase mortality rate

Brain and Behavior Exam 3 (32 decks)

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