Trigger - Dementia, D, D Flashcards
what causes increased risk of hemorrhage before sx show
thickened leptomeninges in the spinal cord
seizures, dementia and aphasia
sx of cerebral atrophy
- look for reversible causes
- identify/modify vascular RF
- cog training, exercise
mild cog impairment
cerebral atrophy beginning in the hippocampus and entorhinal cortex. causes widespread shrinking of brain tissue
alzheimers etiology
what is associated with amyloid plaques and neurofibrillary tangles
alzheimers disease
unknown if these cause disease or if these are a result of disease
tau proteins adhering to each other instead of to the microtubules. results in inadequate transfer of info from cell body to axon terminal.
Neurofibrillary tangles
MC in females
alzheimers
assocaited with Apo ε4 gene on chromosome 19 as well as trisomy 21
alzheimers
difficulty learning & recalling info
visuospatial problems
language mpairment
classic triad of alzheimers
depression, apathy and irritability
early behavioral changes in alzheimer’s
late are: agitation and psychotic s/s such as delusions, hallucinations, paranoia
agitation and psychotic s/s such as delusions, hallucinations, paranoia
late behavioral changes in alzheimer’s
early are: depression, apathy, irritability
mild/mod/severe AD?
trouble recalling new names and taking longer time to perform daily tasks
mild.
also see:
longer time to perform daily tasks
recognizing familiar places
paying bills, handling money
recalling new names
word recall
losing or misplasing items
pallning or organizing
remember new reading material
mild/mod/severe AD?
easily lost, difficulty recognizing friends/family, loss of new learning
Mod
also see:
recalling demographics
easily lost
disorientated to place/time
short attention span
disorganized thought processes
choosing appropriate clothing
difficulty recognizing family/friends
repetitive statements
loss of new learning
behavioral changes
psychotic sx
trouble reading, writing
mild/mod/severe AD?
weight loss, increased sleep, trouble swallowing
severe
also see:
absent recognition of family/friend
wt loss
increased sleep
loss of bowel/bladder control
Death often occurs due to a complicating illness (aspiration pneumonia)
increased infections
trouble swallowing
unable to communicate effectively
aspiration pneumonia
MC infection in AD
CT/MRI shows diffuse cortical or cerebral atrophy with a greater degree in the hippocampal area
Alzheimers
remember imaging is NOT DIAGNOSTIC for AD. Alzheimers is usually diagnosed clinically when there is evidence of cog dysfunction that leads to functional impaitment after r/o other causes of dementia
what are the cholinesterase inhibitors
donepezil
glantamine
rivastigmine
aricept
razadyne
exelon
what are the NMDA receptor antagonists
memantine
namzaric ( COMBO DRUG NMDA/cholinesterase inhib)
increases acetylcholine at synapse
cholinesterase inhibitors
donepezil
glantamine
rivastigmine
aricept
razadyne
exelon
SE include N/D and sleep disturbance. TAKE W FOOD
cholinesterase inhibitors
also: severe - bradycardia, AV block, syncope
SE: bradycardia, AV block, syncope. start low go slow, titrate up q 2 months
cholinesterase inhibitors
also see: N/D, anorexia, sleep disturbance
take w food!
inhibits B amyloid production
NMDA receptor antagonists
memantine
SE is dizziness, HA, confusion, constipation
NMDA receptor antagonist
when should you DC cholinesterase inhibitors and NMDA receptor antagonists in an AD pt
once pt is unable to express their needs.
Difficulty of timed activities and executive functions - One-minute semantic test
vascular dementia
less memory impairment than AD but MORE depression
vascular dementia
MRI shows small infarcts (white matter lesions)
vascular dementia
risks include HTN, smoking, DM, statins, antiplatelets
vascular dementia
deposits of alpha-synuclein
lewy bodies
MC in males
DLB
insidious onset of fluctuating cog impairment day to day presenting with delusional misidentification often as 1st symptom
DLB
REM sleep disorder, visual hallucinations, bradykinesia, limb rigidity and flat affecrt
DLB
also HALLMARK = parkinsonism
also HALLMARK = parkinsonism
DLB
SE includes parkinsonism and neuroleptic malignant syndrome
antipsychotics
MRI shows atrophy of basal ganglia structures and dorsal midbrain
DLB
SPECT shows decreased dopamine uptake and perfusion
DLB
MRI shows cortical atrophy with substantia nigra changes
parkinsons disease
fever, AMS, autonomic dysfunction
neuroleptic malignant syndorme
SE of antipsychotics. LIFE THREATENING RXN
MRI shows focal atrophy of frontal, insular and/or temporal cortex
frontotemporal dementia
which FTD variant shows Medial and orbital frontal and anterior insula degeneration
Behavioral variant FTD
which FTD variant shows Anterior temporal degeneration
Semantic variant Primary Progressive Aphasia (PPA)
which FTD variant shows Dominant hemisphere lateral frontal and precentral gyrus atrophy
Non-fluent/agrammatic Primary Progressive Aphasia
Changes in personality, Apathy, disinhibition, compulsivity, loss of empathy, and overeating
Behavioral variant (bvFTD) - MC
Loss of ability to decode/recalling words, object, person-specific
Semantic primary progressive aphasia variant FTD
- Inability to produce words, often with prominent motor speech impairment
- Broca’s area
Primary progressive aphasia (non-fluent/agrammatic variant)
non pharm is first line
if pharm failts use SSRI or trazodone
FTD
abnormal gait, UI, and dementia
normal pressure hydrocephalus
management = ventricular shunting
normal pressure hydrocephalus
diagnosed w MRI showing ventriculomegaly in ABSENCE of sulcal enlargment
normal pressure hydrocephalus
can also dx w high volume LP
identify/tx underlying cuase
eradicate contributing factors
manage s/s
delerium tx
i didnt include meds pros and cons so go look
k will do
