Leftovers 2 Flashcards
What is sarcopenia?
Muscle atrophy
What are the 6 PE findings of someone with dementia:
- Slow reactive pupils (small)
- Decreased vibratory sense
- Muscle atrophy
- Increased tone (spasticity)
- Primitive reflexes return
CT scan findings of a dementia brain:
Atrophied with large sulk
Definition of dementia:
Impairment of memory +, one or more cognitive domains AND a decline from the previous level of function (be enough to deal with daily function)
What is apraxia?
Inability to perform purposeful actions
What is agnosia?
Inability to recognize familiar objects
Dementia is NOT a part:
of normal aging
Most potent risk factor for dementia
Age
All of the dementia risk factors (7):
Age Anticholinergic Vit D deficient E4 - cholesterol transport protein Family history SES Sleep
What is Apoliopoprotein E4?
Cholesterol transport protein that promotes the degradation of AB plaques
Common causes and break down of dementia causes:
70% AD - Neurosyphilis used to be the most common
Vascular 15%
Other 15%
What percent of dementia is reversible?
10%
The two proteinpathy dementias:
- AD: Beta-amyloid, tau
- Dementia with lewy: Alpha-synuclein
Neuroinflammation has resulted from:
Excess cytokines
If someone is delirious what are two symptoms they have that dementia does NOT:
- LOC is impaired
- Autonomic hyperactivity is present
What is in the Mini-cog test:
3 item and clock - 0-2 = Dementia; 3-5 = Probably ok
Test to run for neurosyphilis:
RPR
What should you use to image someone with dementia?
MRI with contrast
Who needs a LP for dementia (6): 2C, I, P, 2R
Patients with:
- Cancer
- CNS infection - vasculitis or CT disorders
- Immunosuppression
- Patient under 55
- RPR +
- Rapid dementia
If min-cog., general assessment were positive for dementia, what are the next two steps?
- Mini-mental state exam, Montreal or Saint Louis screening
2. Labs and MRI
If someone has cognitive impaired, do we screen for the apoliopoprotein E4 allele?
Not recommended for the patient but their kids may want it
Amnesic transitional stage has the ____ chance:
Highest; chance of progressive to AD (10%)
Eating how many calories a day can double your risk for AD if 70+?
2,100 - 6,000
Median survival after a diagnosis of Alzheimer’s
4.5 years
What do Alzheimer patients die from?
Pneumonia and CVD
What type of Alzhiemers is most common?
Sporadic - failure in AB clearance mechanisms
What is the mechanism behind familial AD?
1 of 3 genes encoding the amyloid precursor protein, presenilin 1 or 2 is mutated = increase build up of AB in the body
Global pathophysiology of AD (2):
- Abnormal cleavage of APP AND
- Abnormal accumulation of AB that gets deposited into plaques
Neurofibrillary tangles contain what (2)?
- Tau (phosphorylated)
- Ubiqutin
Neurofibrillary tangles are located:
Intracellularly
What proteins are in the neuritic plaques?
Beta-Amyloid and presenilin 1/2 (generated by APP cleavage)
When APP is cleaved it forms (2)
Beta-amyloid and presenilin 1/2
The APOE3 Alzheimer genes are located on what chromosome? Allele significance?
- CH. 19
- APOE4: BAD (45-60% pts. have)
- APOE3: Most common
- APOE2: GOOD, protective
Progression of dementia (5):
- Forget
- Disorient
- Aphasia
- Apraxia
- Gait disorder
Treatment for AD (supplement):
Vitamin E (2000 IU) qd
Four therapies for AD (non-medicinal):
- Exercise
- OT
- Puzzles
- Mental stimulation
Meds for AD treatment:
- Cholinesterase inhibitor (3)
- Memantine
- Aducanumab
Three cholinesterase inhibitors: (DGV)
Donepezil
Galantamine
Vivastigmine
(Done, Gal, Viv)
What is aducanumab directed against?
Beta-amyloid
What is memantine?
Partial NMDA receptor antagonist
Chemical change in the demented brain
There is cholinergic deficiency (decreased ACh)
Three nerulogical signs and symptoms fo vascular dementia:
- Emotional ability
- Focal motor/sensory deficit
- Abnormal gait
Treatment for vascular dementia (3):
- Manage HTN
- Antiplatelet
- Memantine
Frontotemporal Dementia is seen in what age patients?
(50 - 65) - atrophy in the front/temporal areas
What is the most common indication of Frontotemporal dementia?
Personality or behavioral changes *Memory may not be the first thing to go
What is Primary Progressive aphasia?
Anomia –> Speech simplification –> Mutism
Semantic Dementia definition:
Loss of words and then behavior changes
Frontotemporal dementia treatment (3 A’s)
Atypical antipsychotics, Antidepressants, anxiolytics
What is Normal-Pressure Hydrocephalus?
Ventricles enlarge at the expense of the parenchyma - PSI of CSF is the same
Normal-Pressure Hydrocephalus also has what two names?
- Non obstructive
- Communicating
What two illnesses can cause Normal-Pressure hydrocephalus?
- Meningitis
- Subarachnoid hemorrhage
Two steps of Normal-Pressue Hydrocephalus presentation:
- Gait apraxia
- Urinary incontinence
- Dementia (maybe reversible)
What is: Incontinence sans gene
NPH; person does not care that they are peeing themselves
To diagnose NPH, a CF sample will be:
Normal with normal pressure
What does a CT/MRI show when someone has NPH?
Enlarged ventricles WITHOUT the larger sulk
Treatment for NPH
Centriculoperitoneal shunting
Dementia with Lewy bodies - What do Lewy bodies look like? Where are they located?
Round, eosinophilic, intracytoplasmic neuronal inclusion in the CORTEX and CERBELLUM
A Lewy body is made up of what two proteins?
Alpha-syn. and tau
Dementia with Lewy bodies is like AD and Parkinsons in that…
They have dementia like AD and rigidity (and tremors) like PD
What may be one of the first signs of Dementia with Lewy bodies?
Well formed hallucinations
Do not use ___ in patients with Dementia with Lewy bodies:
Antipsychotics - if must use, only a low dose of quetiapine
Corticobasal Syndrome two characteristics (is there a resting tremor?):
- Dementia
- Progressive asymmetrical and EPS
NO RESTING TREMOR
What four things atrophy with Corticobasal syndrome?
- Parietal
- Basal ganglia
- Insula
- Frontal
What lab finding is hallmark for corticobasal?
Tau positive and glial inclusions
People with Corticobasal syndrome can get what with their extremities?
Limb apraxia - ALIEN HANDS
Can you treat the Parkinson like rigidity in Corticobasal syndrome with Levodopa?
Nope
What are the two cardinal clinical symptoms of Creutz-feldt Jacob disease? (DOUBLE M)
- Mental deterioration
- Myoclonus
What is the gold standard for dx of CJD?
Brain biopsy
How fast do people die with CJD?
1 year - no treamtent
What are three other things that can cause dementia?
- Vitamin B12 def.
- Wilson disease
- Alcoholism
Repetitive TBI can develop what:
Neurofibrillary tangles
What is Dementia Pugillstica?
*No pathology listed
Delayed, progressive, post TBI dementia (boxers)
What are the features of Dementia Pugillstica?
- Happy
- Mentally slow
- Tremor, rigidity, Brady kinesis
What is Chronic Traumatic Encephalopathy? Who gets it?
Neurodegeneration related to football and wrestling
What is CTE related to?
Concussions and sub-concussions
What is a chronic subdural hematoma?
After mild head trauma - HA initially with dementia , hemiparesis and papilledema later
Age of chronic subdural hematoma?
50 - 70
Treatment for chronic subdural hematoma?
Evacuate with surgery
