lecture 6

Question 1

describe the difference between dementia and delirium

Answer 1

• Dementia progresses slowly (chronic)

- delirium is sudden change (acute)

Question 2

describe dementia

Answer 2

• syndrome characterized by an impairment in 2 or more intellectual or cognitive functions despite A STATE OF CLEAR CONSCIOUSNESS
• The PERSISTENT and STABLE NATURE OF THE IMPAIRMENT (slow progression) distinguishes dementia from delirium

Question 3

evaluation of demented pt

Answer 3

• start with a comprehensive HandP w documentation of the time line of the problem
• Get an idea of the timeline issues have occured (delirium vs dementia)
• Folstein mini-mental exam
• Lab tests for electrolytes, BUN, Mg, Ca, glucose, TSH, Cr, CBC, B12, folate
• Should CONSIDER HOMOCYSTINE levels (B12)
• neuro imaging
• PET and SPECT scans show hypometabolism

Question 4

describe folstein mini-mental exam

Answer 4

• 30 questions, rough screening test
• 26-30 = ormal score
• some ppl can score incorrectly due to its nature
• Rough screening test

Question 5

Alzheimer’s disease (AD)

Answer 5

• Most common cause of dementia in the industrialized world
• characterized by gradual decline that is STEADY!!!
• Neuritic plaques (AMYLOID) and Neurofibrillary tangles (phosphorylating tau protein)
• Amnesia = initially short term memory
• Agnosia - difficulty recognizing things
• Apraxia = inability to carry out motor function
• Aphasia -= difficulty naming familiar items

Question 6

treatment for alzheimers

Answer 6

• stabilze Ach and glutamate

Question 7

Diffuse Lewy body dementia

Answer 7

• Lewy bodies are intraneuronal inclusions
• characterized by dementia, FLUCTUATING COGNITION (similar to alcoholism), recurrent hallucinations
• similar to parkinsons

Question 8

Vascular dementia

Answer 8

• caused by DECREASED blood flow to brain with significant enough brain damage to cause cognitive impairment
• PRESENTS with STEPWISE DETERIORATION
• History of Hypertension, hyperlipidemia, Atherosclerosis

Question 9

frontotemporal dementia

Answer 9

• Focal atrophy of the FRONTAL and TEMPORAL LOBES
• Characterized by PROGRESSIVE DETERIORATION with PERSONALITY CHANGE and DIS-INHIBITION SYNDROME
• poor personal hygiene, lack of social tact, and hyper sexuality