Neuro - Dementia

Question 1

What is dementia?

Answer 1

An acquired, persistent decline of intellectual functioning.

Impaired memory and at least on of the following:
Apraxia
Agnosia
aphasia
loss of executive function

Patients will also have impaired ADLs
NO clouding of the sensorium
NO underlying psychiatric disease

Question 2

What are the stats for dementia and MCI

Answer 2

Dementia occurs in 10% of those over the age of 65 and 50% of those over the age of 85.

Mild cognitive impairment is memory impairment with no dementia. 6-25% of these patients will progress to demensia

Question 3

What is delirium?

Answer 3

Acute, transient, potentially reversible confusion state. Disturbed consciousness and altered cognition.

Often a presenting symptom of an illness in the elderly

Question 4

Recall the genetics of Alzheimer disease

Answer 4

Usually sporadic
Early onset associated with chromosome 1, 14, and 21 (related to Down syndrome)
Late onset related to chromosome 19 (apolipoprotein E4 (ApoE4) gene

Amyloid precursor protein gene on chromosome 21
Presenlin-1 protein gene on chromosome 14
Presenilin- 2 protein Chromosome 1

FAD (familial AD) 10% of cases (autosomal dominant)

Question 5

What are the histopaths for the dementias?

Answer 5

AD = NFT (intracellular) and amyloid beta plaques (Neuritic plaques; extracellular). B

Diffuse Lewy: Lewy bodies will be seen diffusely

Frontaltemopral demensia: frontotemporal atrophy

Parkinson disease dimentia
Lewy body pathology

FTD: Pick’s bodies (tau proteins)

Normal Pressure Hydrocephalus: ventriculomegaly out of proportion to sulci enlargment

Binswanger disease: subcortical arteriosclerotic encephalopathy- multiple infarcts of white matter

Question 6

Formulate a workup for dementia

Answer 6

1. H&P
2. Imaging - MRI, CT
3. Laboratory tests - serum electrolytes, glucose, BUN/Cr, Liver Function Test, CBC, Vit B12, Thyroid function test
4. Neuropsychological testing, depression screening
5. Rapid Plasma Reagin (Ab test), HIV, Electroencephalofram, Spinal tap

Question 7

Formulate a workup for delirium

Answer 7

1. H&P: (review medications)
2. Labs: serum electrolytes, glucose, BUN/Cr, LFT, CBC, Calcium, ammonia level, urinalysis, drug screen
3. Pulse oximetry/ ABG
4. Chest x-ray
5. Electroencephalogram

Question 8

What are the pharmocological and nonpharmocological treatments for Alzheimer disease?

Answer 8

Pharmocological:
Cholinesterase inhibitors - 
Donepezil
Rivastigmine
Tacrine
Galantamine

NMDA antagonist -
Memantine

Non-Pharmocological:
Patient education (Simple instructions)
React calmly
Avoid confrontations

Question 9

Differentiate between alcohol withdrawal and Delrium Tremens.

Answer 9

Alcohol withdrawal symptoms include: tremulousness, insomnia, agitation, increase sympathetic activity, hallucinations, nightmares, illusions, formications (crwaling hallucinations), N/V and seizures

Delerium Tremens occurs 42-72 hours after last drink and usually follows seizures that occur within 48 hours of withdrawal. DT does not occur with seizure (e.g think meningitis), more intense tremors with fever, tachycardia, sweating

Question 10

Discuss Wernicke’s encephalopathy

Answer 10

And acute syndrome (K is chronic)
- Thiamine deficicency
Diffuse axona, myelin, neuronal loss
Petechial hemmorhages

Impaired memory (confusion), ataxia and nystagmus

Treatment is IV thiamine

Question 11

Discuss Korsakoff’ syndrome

Answer 11

Chronic condition
Destruction of the mammilary bodies (also thalamus, brain stem and dorsal medial nucleus)
Amnesia. confabulation, impaired insight

Question 12

What is hepatic encephalopathy?

Answer 12

Disturbed sleep, bradykineasia, asterixis, rigidity, hyperactive DTRs

Altered brain function from metabolic abnormalities which are consequence of liver dysfunction.

Ammonia is characterized as a neurotoxin

Treat underlying cause

Question 13

What are the four stages of Hepatic encephalopathy?

Answer 13

I - Euphoria, confusion, sleep disorder
II - Lethargy, confusion, asterixis
III - Marked confusion, slurred sleep. sleepy
IV - Coma

Question 14

Chronic Traumatic Encephalopathy

Answer 14

Degenerative brain disease from a history of concussions

Cognitive impairment, depression, and irrational and impulsive emotional behavior

Question 15

Alzheimer disease

Answer 15

memory loss, advanced age, inability to perform complex tasks

Question 16

Frontotemporal dementia

Answer 16

Behavioral changes, anomia, impaired social conduct.

“Pick’s is a Prick”

Question 17

Creutzfeldt- Jacob disease

Answer 17

Extrapyramidal features, startle induced myoclonus, EEG may have sharp waves or spikes

Question 18

Normal Pressure Hydropcephalus

Answer 18

Dementia, Ataxia, Incontinence

Question 19

Dementia with Lewy Body

Answer 19

Parkinsonian, visual hallucinations, fluctuating cognitive impairment (dementia occurs before, same time, or shortly afterwards; much sooner than PDD)

Question 20

Chronic traumatic encephalopathy

Answer 20

Congnitive impairment, depression, irrational and impulsive emotional behavior

Question 21

Parkinson disease dementia

Answer 21

(TRAP) later will progress to memory impairment, face recognition impairment, and visuospatial impairment

Question 22

Progressive Supranuclear palsy

Answer 22

Cognition, eyes movements (decrease inferior gaze; slow saccades), posture, neck dystonia, typical facial expresion (masked, startled expression, lid retraction)