Dementia 4 Flashcards
Functional neuroimaging (PET or SPECT) is not routinely done as a work up for Major NCD…what are the three indications?
- PET scan can help differentiate Alzheimers and FTD in patients who have s/s of both.
- In AIDS patients who have MRI/CT showing circular lesion…SPECT can differentiate between Lymphoma vs Toxoplasmosis.
Lymphoma = increased perfusion Toxoplamosis = decreased perfusion
- PET or SPECT can help dx Lewy Body dementia (see abnormal metabolism in basal ganglia).
In what situations would you consider EEG during a work up of Major NCD?
- Suspect seizure disorder
- Creutzfeldt-Jacob disease (1-2 cycles per second, triphasic sharp waves on a background of electrical depression)
- Suspect metabolic encephalopathy
In what 7 situations would you consider LP as part of a work up for Major NCD?
- Neurosyphilis suspected
- Metastatic Cancer suspected
- Hydrocephalus
- Age <55
- Rapid onset or rapidly progressive
- Immunosuppressed
- CNS vasculitis supsected
What do the following MMSE components test for:
- Orientation
- Repeat 3 words
- 3 word recall
- Serial 7 or WORLD backward
- “No ifs and or Buts”
- Naming pen, watch
- 3 step command
- Orientation - short term memory
- Repeat 3 words - Attention, repetition
- 3 word recall - short term memory
- Serial 7 or WORLD backward - attention
- “No ifs and or Buts” - reputation
- Naming pen, watch - naming
- 3 step command - comprehension
In general there are NO disease modifying agents for Major NCDs…However, for Alzheimers and Vascular dementia…what two things have been shown to be helpful?
- High dose Vitamin E (modestly helpful but increase CV disease risk)
- Managing CV risk factors and lifestyle mod (diet, exercise, DM, smoking, BP, weight loss, better sleep).
What are the 6 Effective Psychosocial intervention for Major Neurocognitive Disorder?
- Behavioral management
- Education of caregiver and staff
- Cognitive stimulation therapy - group based, theme based activities designed to improve cognitive abilities.
- Music therapy
- Multisensory stimulation - massage/touch therapy, tactile, auditory, light therapy
- Caregiver support and training.
What is the most evidence based method for assessing safety to continue driving in Major NCD?
- Clinical Dementia Rating (CDR) Score
- Score of 0.5 modest driving risk
- Score of 1.0 significant driving risk, consider stop driving.
What is the “black box warning” for elderly with psychosis due to Major NCD that are treated with typical or atypical neuroleptics?
Increased mortality (all cause) - 1.7x higher risk of death in antipsychotic group compared to placebo.
After implementing non-phamacologic intervention for Major NCD associated aggression..what medications are helpful if aggression persists?
- Neuroleptics (Haldol not first line, go low dose)
- SSRI (think Celexa)
- Prazosin ( not FDA approved but 2 RCT shows efficacy)
- Mood stabilizers (not supported by evidence)
- BZD (risk of delirium, very low dose, last resort, use one with short t1/2 like Ativan)
family history of Alzheimers disease increases the risk by how much?
2-3X
