14 - Dementia Flashcards
(35 cards)
What is dementia?
• An acquired syndrome of decline in memory
and other cognitive functions sufficient to affect
daily life in an alert patient
• Progressive and disabling
• Not an inherent aspect of aging
• Different from normal cognitive lapses
How common is Alzheimer’s disease?
6%‒8% of people ≥65 yr have Alzheimer dementia (AD)
What are the risk factors for dementia?
Definite • Age • Family history • APOE4 allele (gene for AD) • Down syndrome
Possible • Head trauma • Fewer years of formal education • Late-onset major depressive disorder • Cardiovascular risk factors (hypertension, diabetes, hypercholesterolemia, obesity)
What are the factors that protect you from dementia?
Definite: unknown
Possible • NSAIDs • Antioxidants • Intellectual activity • Physical activity • Statin
What is important to ask dementia patients during the history?
Ask both the patient and a reliable informant
about the patient’s:
• Date of onset of current condition and nature
of symptoms
• Medical history
• Current medications & medication history
• Patterns of alcohol use or abuse
• Living arrangements
What do we do in a lab workup for patients presenting with dementia?
• Comprehensive h and p
• lab work: cbc, lytes, bun, creatinine,
calcium, rpr, B12, folate, ALT, AST, free T4,
TSH
• CNS visualization
• Neuropsych testing (mini-mental exam in the office, more testing with a specialist)
What are possible differential diagnoses for a patient presenting with dementia?
** most helpful clinically **
***DEMENTIAS*** • Drugs • Emotional (psychiatric) disorders • Metabolic disorders • Endocrine problems • Nutritional and Neurologic disease • Trauma and Tumor • Infection, ischemia, inflammation • Anemia, arrythmia • Social, Sensory, Spiritual isolation
You can use this for both delirium and dementia
What is the most common cause of dementia in the industrialized world?
Alzheimer’s disease
2nd = Lewy body dementia
What should you examine in dementia patients?
- Neurologic status
- Mental status
- Functional status
What type of testing should you do on your dementia patients?
• Quantified screens for cognition
➢ For example, Folstein’s MMSE, Mini-Cog,
SLUMS, MoCA
• Neuropsychologic testing
When should you consider brain imaging in a patient?
• Onset occurs at age
How do you diagnose dementia?
• It is important to note that we can make the
diagnosis with this approach accurately
greater than 90% of the time.
• The vast majority of diagnoses in patients
with dementia are made up of five clinical
syndromes:
• AD, Diffuse Lewy Body Disease,
Frontotemporal Dementia, Vascular
Dementia, and Normal Pressue
Hydrocephalus.
What is on your differential diagnosis in dementia patients?
• Normal aging • Mild cognitive impairment • Delirium • Depression • Alzheimer disease • Vascular dementia • Lewy body dementia • Other (frontotemporal dementia, alcohol, Parkinson disease, neurosyphilis)
What would you see in normal aging?
• No consistent, progressive deviations on testing
of memory
• Some decline in processing and recall of new
information: slower, harder
• Reminders work—visual tips, notes
• Absence of significant effects on ADLs or IADLs
due to cognition
What is “mild cognitive impairment”
He said its the same thing as early dementia, not a separate diagnosis
He tends to treat this aggressively
Subjective complaint of decline in at least one cognitive
domain: noticeable and measurable
How do you distinguish delirium from dementia?
• Delirium and dementia often occur together in older
hospitalized patients
• The distinguishing signs of delirium are:
➢ Acute onset
➢ Cognitive fluctuations over hours or days
➢ Impaired consciousness and attention
➢ Altered sleep cycles
➢ Search for underlying dementia once delirium cleared
What symptoms often overlap with dementia?
Depression
Discuss the overlap of dementia and depression
The symptoms of depression and dementia often
overlap:
• Impaired concentration
• Lack of motivation, loss of interest, apathy
• Psychomotor retardation
• Sleep disturbance
• Patients with primary depression are generally
unlike those with dementia in that they:
➢ Demonstrate ↓ motivation during cognitive testing
➢ Express cognitive complaints that exceed
measured deficits
➢ Maintain language and motor skills
• ~50% presenting with reversible dementia and
depression progress to dementia within 5 yr
Describe the disease characteristics of Alzheimer’s disease
• Onset: gradual
• Cognitive symptoms: memory impairment core feature
with difficulty learning new information
• Motor symptoms: rare early, apraxia later
• Progression: gradual, over 8–10 yr on average
• Lab tests: normal
• Imaging: possible global atrophy***, small hippocampal
volumes (cannot form new memories)
Describe the disease characteristics of vascular dementia
• Onset: may be sudden (like a stroke)/stepwise
• Cognitive symptoms: depend on anatomy of ischemia,
but dysexecutive syndrome common
• Motor symptoms: correlates with ischemia
• Progression: stepwise with further ischemia
• Lab tests: normal
• Imaging: cortical or subcortical changes on MRI
Rarely PURE vascualr dementia, a lot of times they have many strokes (stepwise decline) and this contributes to dementia, but there is also Alzheimer’s disease present contributing to the Alzheimer’s disease
What is the second most common cause of dementia?
Lewy body disease
Related to Parkinson’s disease
Describe the disease characteristics of Lewy Body dementia
• Onset: gradual
• Cognitive symptoms: memory, visuospatial,
hallucinations***, fluctuations
• Motor symptoms: parkinsonism (shuffling gate, no facial expression)
• Progression: gradual, but usually faster than AD
• Lab tests: normal
• Imaging: possible global atrophy
Usually have some really good days and some really bad days
Describe the disease characteristics of frontotemporal dementia
• Onset: gradual, usually age
How do you stage dementia?
He doesn’t use the “7 steps”
This is what he does:
- Mild
- Moderate
- Severe (need 24 hr/day monitoring)
- Vegetative
