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Neurology > Lecture 12: Dementia > Flashcards

Lecture 12: Dementia Flashcards

1
Q

Dimentia: Essentials of Dx

A
  • progressive intellectual decline
  • not due to delirium or psychiatric dz
  • age = main risk factor
  • other risk factors = fam hx and vascular dz
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2
Q

Dimentia: General Considerations

A
  • progressive decline in intellectual fxn that is severe enough to compromise social and occupational fxn
  • typically begins after 60 and prevalence doubles evert 5 yrs
  • 85 and older: 50% with dementia
  • most dementia is acquired or as result of another disorder (stroke)
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3
Q

Risk Factors for Dimentia

A
  • Fam hx
  • DM
  • other vascular dz risk factors
  • significant head injury
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4
Q

Delirium

A
  • acute confusional state that often occurs in response to an identifiable trigger such as: drugs, intoxication, withdrawal, med side effects, infxn, met. disturbances, sleep deprivation or other neuro dz
  • fluctuating levels of arousal
  • improves after removal or tx of precipitating factor
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5
Q

Signs/Sx’s of Dementia

A
  • Short term memory loss
  • word difficulty
  • visual spatial dysfxn
  • executive dysfxn
  • apathy
  • apraxia
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6
Q

Short term memory Loss

A
  • repeating questions/stories and diminished ability to recall details of recent convos or events
  • sue to pathologic changes in hippocampus
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7
Q

Word difficulty

A
  • difficulty recalling names of ppl, places, or objects
  • low frequency words first affected
  • speech laden with pronouns and circumlocutions
  • pathology at temporoparietal jxn of L hemisphere
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8
Q

Visual spatial dysfxn

A
  • poor navigation and getting lost in familiar places
  • impaired recognition of previously familiar places
  • trouble discerning objects against a background
  • R parietal lobe is affected
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9
Q

Executive Dysfxn

A
  • easy distractibility
  • impulsivity
  • mental inflexibility, concrete thoughts
  • slow processing speed
  • poor planning, organization or impaired judgement -due to areas of frontal or subcortical areas
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10
Q

Apathy

A

-indifference

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11
Q

Apraxia

A
  • loss of learned motor behaviors

- due to dysfxn of frontal or parietal lobes (especially L parietal)

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12
Q

Hx questions : dementia

A
  • establish risk factors
  • document pt’s current capacity to perform basic ADLs and IADLs
  • note extent go decline from premorbid level of fxn
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13
Q

PE dementia

A

MMSE

Montreal Cognitive Assessment

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14
Q

Montreal Cognitive Assessment

A
  • takes longer but slightly more sensitive
  • 26 and greater is normal: consider rechecking in 6 mnths-1 yr
  • 25 and below: needs full cognitive eval
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15
Q

Imaging: dementia

A
  • indicated for a new progressive cognitive complaint
  • exclude occult CV dx, tumor or other structural abnormalities
  • MRI is preferred method
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16
Q

Labs

A
  • any pt with cog impairment: measure B12, T4, TSH
17
Q

Alzheimer’s Dz facts

A
  • most common dementia 60+
  • up to 50% have it in 80s
  • not really genetic, more epidemic
18
Q

Alzheimer’s Risk Factors

A
  • age
  • low education
  • uncontrolled DM
  • fam hx
  • APOE genotype
  • mutations: APP gene on chrom 22; Presinillin 1 on chrome 14; Presinillin 2 on chrom 1
19
Q

AD Signs/Sx’s

A
  • short term memory impairment
  • 2 or more cognitive domains involved
  • animal fluency worse than letter fluency
  • some fxnl impairment in real life
  • variable deficits of executive fxn, visuospatial fxn and lang
20
Q

AD Dx

A
  • stage with MMSE, but don’t test unless symptomatic
  • F/u every 6 mnths
  • MRI shows atrophy in hippocampus
21
Q

Vascular Dementia: facts

A
  • 2nd most common

- pathophysiology: multiple ischemic attacks

22
Q

VD signs/sx’s

A
  • stepwise or progresive accumulation of cognitive deficits in association with repeated strokes
  • sx’s depend on localization of stroke
23
Q

VD Risk Factors

A
  • smoking
  • DM
  • HTN
  • Hypercholesteremia
24
Q

VD: 2 types

A
  • Multiple Infarct Dementia: medium large vessel; stepwise deterioration; strokes on MRI
  • Subcortical Dementia: small vessel dz; gradual decline; no memory problem; letter fluency worse than animal; MoCA worse than MMSE; lacunas and other white matter changes on MRI
25
Q

VD tx

A
  • prevent vascular events

- Afib: anticoags

26
Q

Frontotemporal Dementia: pathology

A
  • defined by protein found in intraneural aggregates
  • Peak incidence in 6th decade
  • familial cases due to mutations in specific pros
27
Q

FTD types

A

1) Behavioral variant FTD
2) Semantic Dementia
3) Progressive Nonfluent Aphasia

28
Q

Behavioral Variant FTD

A
  • deficits in empathy, social compartment insight, abstract thought and executive fxn
  • behavior is disinhibited, impulsive and ritualistic with prominent apathy
  • decrease/increase in sex or sweet/fatty foods
  • preservation of memory
  • Focal R frontal atrophy
29
Q

Semantic Dementia

A
  • deficits in word finding, single word comprehension, object and category knowledge and face recognition
  • behaviors: rigid, ritualistic and may be similar to behavioral variant
  • focal asymmetric temporal pole atrophy
30
Q

Progressive nonfluent aphasia

A
  • speech is effortful with dysarthria, phonemic errors, sound distortions and poor grammar
  • focal extrapyrimidal signs and apraxia of R arm and leg common
  • Focal L frontal atrophy
31
Q

Corticobasal Degeneration

A
  • unilateral ideomotor apraxia, agraphthesia astereognosis
  • Alien hand syndrome
  • myoclonic jerks
  • Gait: preserved until late
32
Q

Lewy Body Dementia

A
  • cog dysfxn with prominent visuospatial and executive deficits
  • psych disturbances with anxiety, hallucinations and fluctuating delirium
  • Parkinsonism motor deficits
  • less problems with memory
33
Q

Prion Disorders: pathophys

A
  • rare
  • caused by infectious proteins called prions
  • induce conformation change of normal brain protein into abnormal isoform that causes neuronal vacuolation, reactive proliferation of astrocytes and microglia and deposition of B amyloid plaquea
34
Q

Prion Disorders: sx’s

A
  • myoclonic fasciculations, ataxia, visual disturbances, pyramidial and extrapyrimdial sx’s
  • specific EEG: slow waves and high voltages
35
Q

Wernecke’s Encephalopathy

A
  • due to alcoholism, poor dietary intake of thiamine
  • anorexia, muscle cramps, parasthesis, irritability
  • hrt failure and peripheral nerve d/o
  • give Thiamine
36
Q

Vit. B12 Deficiency

A
  • macrocytic anemia, megaloblastic blood smear, low serum Vit. B12 levels
  • anemia, mucosal cell changes, parasthesias of peripheral nerves
  • pale, icteric, sallow, decrease vibration and position sense, memory disturbance
  • give Vit. B12
37
Q

Pellegra (aka Nicotinic Acid deficiency)

A
  • due to alcoholism and nutrient drug interactions
  • anorexia, weakness, irritability, mouth soreness, glossitis, stomatitis, wt loss
  • advanced: dermatitis, diarrhea, dementia
  • give oral niacin

Neurology (12 decks)

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