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becky: neuro MSK > LECTURE 7: DEMENTIA > Flashcards

LECTURE 7: DEMENTIA Flashcards

1
Q

most common neurological medical condition in the hospital

A

deliriium
(15-50% of inpatients, 80% elderly in ICU)
-older pts: one organ
-younger: multi organ

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2
Q

how to treat delirium

A

-eliminate underlying cause
-re-orient (write day/schedule)
-no naps, out of bed in day
-good sleep

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3
Q

dementia characterized by presence of at least 2 of the following:

A

A. impaired:
1. learning/short term memory (temporal)
2. handle complex tasks (frontal)
3. reasoning/abstract thinking (frontal)
4. spatial ability (parietal)
5. language/aphasia (temporal/parietal)

B. significant impairment in social/work

C. decline from PLOF

D. no diff dx (delirium or depression) -hard to diagnose in hospital

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4
Q

what are differential dx of dementia that are REVERSIBLE?

A
  1. depression
  2. medication side effects
  3. poor sleep
  4. hypothyroidism
  5. neurosyphilis
  6. autoimmune encephalitis
  7. normal pressure hydrocephalus
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5
Q

difference between normal pressure hydrocephalus and atrophy on brain scan

A

-NPH:large ventricles
Atrophy: large sulci, shrinking

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6
Q

evaluation of dementia

A

history: what is impaired?
-onset
-time course: why did they stop working?
-progression
-education level
-Observation (behavior? grooming?)
-Mental Status Exam
-Neuro exam: hearing loss? involuntary mvmts?
lab tests, imaging

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7
Q

delirium looks like…

A

acute (hours)
fluctuates (worse at night)
-disrupted sleep wake
-disorganized thinking
-inattention
-drowsiness
-restlessness/agitation/combativeness
-deluisions
-hallucinations

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8
Q

what is normal aging?

A

decrease in attention and ability to learn new information
does not affect IADLs

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9
Q

in dementia, there are typically two lobes involved. List impairments/lobes

A
  1. learning/short term memory: temporal
  2. complex tasks: frontal
  3. reasoning: frontal
  4. spatial ability/orientation: parietal
  5. language/aphasia: parietal and temporal

these things should impair work/social function, decline PLOF

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10
Q

What are causes of dementia?

A
  1. alzheimers
  2. lewy body
  3. frontotemporal
  4. vascular dementia
  5. parkinsons
  6. progressive supranuclear palsy
  7. huntington’s
  8. alcohol related dementia
  9. chronic traumatic encephalopathy
    10: med side effects
    11: prion disease
    12: HIV
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11
Q

What is NPH? (normal pressure hydrocephalus)

A

CSF build up in ventricles!

  1. memory problems
  2. magnetic gait
  3. incontinence
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12
Q

how do you diagnose NPH?

A

DX: gait test, pull lots of CSF out with LP, then gait test again. If it gets better, treat!

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13
Q

how do you treat NPH?

A

VP shunt to pull CSF

gait gets treated but memory doesn’t get better much

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14
Q

MMSE tests…

A

mini mental status exam
total 30
*doesn’t test all lobes

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15
Q

MOCA

A

tests all lobes
1. visuospatial/executive
2. naming animals
3. memory
4. attention
5. language
6. abstraction (banana-orange-fruit)
7. delayed recall
8. orientation

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16
Q

SLUMS exam

A

test for dementia

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17
Q

clock drawing tests what domains?

A

visuospatial
executive
attention
memory

test for dementia

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18
Q

neuropsychological testing includes what?

A

visual-perceptual-spatial functioning
1. copy geom designs
2. identify faces
3. calculations
4. left right discrimination

EXECUTIVE FUNCTIONING:
1. naming fluency
2. alternate numbers and letters in order
3. stroop test (words/colors)
4. repeated hand gestures

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19
Q

what are two predictors of rapid progression of MCI to dementia?

A
  1. medial temporal lobe atrophy in MRI
  2. hypometabolic pattern on FDG-PET
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20
Q

MCI is defined as

A

impairment in 1 or more domain but no dementia or no impairment of ADLs

*also known as pre or prodromal dementia

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21
Q

12-18% of people over 60 years old have

A

MCI

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22
Q

____% of people with MCI per year transition to dementia

A

8-15%

23
Q

most effective tx for dementia/MCI

A

exercise!

24
Q

early alzheimers looks like

A

-short term memory loss
-word finding difficulties
-mild executive dysfunction
-mild visuospatial deficits

25
Q

later alzheimers looks like

A

-all memory impaired
-behavioral changes
-sleep/eating disturbed
-hallucinations

26
Q

end stage alzheimers looks like

A

mute, aspiration risk, ned bound, incontinence
*risk of bed sores, infection, DVT, pneumonia, malnutrition

27
Q

what is the most common neurodegenerative disorder and 6th common cause of death in US?

A

ALZHEIMERS
*90% is sporatic
*70% of dementia cases

28
Q

risk factors for alzheimers

A
  1. head trauma
  2. women
  3. lower education
  4. ApoE e4 gene
  5. other genes: presenilin 1 and 2, APP gene
29
Q

what are modifiable risk factors for alzheimers?

A

HTN, cholesterol
DM, high BMI
smoking
metSyn
inactive
obstructive sleep apnea
hyperhomocysteinemia

30
Q

pathology of alzheimers/how to diagnose?

A
  1. tau (neurofibrillary tangles)
  2. amyloid beta (senile plaques)
  3. cerebrovascular amyloid

atrophy with neuron loss!

31
Q

what are the 2 CSF biomarkers for alzheimers?

A
  1. amyloid beta, tau
32
Q

On the MOCA, person with alzheimers looks like ____vs vascular dementia

A

difference: attention!
both: problems with visual/spatial, delayed recall

33
Q

vascular dementia 2 types

A
  1. multi-infarct
  2. SUBCORTICAL diffuse white matter disease/subcort leucoencephalopathy, binswanger disease
34
Q

subcortical dementia presents with

A

ATTENTION
concentration deficits
psychomotor slowing

35
Q

what to lab test to diff dx dementia/reversible causes

A

– HIV, tests for syphilis
– thyroid, liver function tests
– Kidney function
– B12, folate
– ANA (test for lupus), rheumatoid factor

– paraneoplastic antibodies (not routine) – Heavy metal screen (not routine)
– Thiamine levels (not routine)

36
Q

what 3 imaging do they do for alzheimers?

A
  1. MRI
  2. FDG-PET
  3. Amyloid PET
37
Q

what medications are given to treat cholinergic deficiency in Alzheimers?

A

Cholinesterase inhibitors
1. Donepezil (Aricept)
2. Galantamine (Razadyne)
3. Rivastigmine (Exelon)

38
Q

NMDA partial antagonist for Alzheimers

A

Memantine (Namenda)

39
Q

what medication approved in 2023 can slow cognitive decline by 27% over 18 months in EARLY STAGE ALZEIMERS?

A

Lecanemab: IV medication every 2 weeks

40
Q

how to best manage alzheimers

A
  1. caregiver/supervision
  2. quiet, familiar environment
  3. treat depression
    4.behavior/hallucinations: give benzos or antipsych
41
Q

Lewy Body Dementia presents with

A
  1. attention
  2. executive function
  3. visuospatial
    (less memory)
    +
    2 or more of
  4. fluctuations
  5. visual hallucinations
  6. spontaneous
  7. parkinsonism
  8. REM sleep behavior disorder
42
Q

2 parts of brain affected by lewy body

A

visuospatial/executive: parietal and occipital
attention: parietal
*PARIETAL AND OCCIPITAL

43
Q

2nd most common cause of alzheimers

A

frontotemporal lobe dementia

44
Q

frontotemporal lobe dementia symptoms

A

low attention, perseveration, flirty
-frontal release signs
-hyperreflexia
-no weakness
-memory is fine

45
Q

types of FTD

A
  1. behavioral variant
  2. primary prog aphasia
  3. FTD associated with motor neuron disease
46
Q

what does the brain of someone with bvFTD look like?

A

atrophy in frontal, temporal lobes
proteins: tau, TDP-43, ubiquitin

47
Q

behavioral changes in FTD

A
  1. disinhibition
  2. no empathy
  3. apathy
  4. hyperorality (oral)
  5. perseverative/compulsive
48
Q

what is athetosis

A

writhing movmenets preventing stable posture

49
Q

what is ballism

A

violent mvmt at joint

50
Q

what is dystonia

A

contractions causing twisting/abnormal postures

51
Q

myoclonus

A

repeated non-rhythmic brief shock like JERKS

52
Q

what is sterotypy

A

repetitive simple movements, can be suppressed

53
Q
A

becky: neuro MSK (14 decks)

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