Dementia Flashcards

1
Q

There has been a PROGRESSIVE decline and loss of cognitive function in your PT over time. Their family member describes they are unable to learn new things. What do you suspect Delirium or Dementia? Why?

A

Dementia

Anterograde amnesia, slow onset, with NO impact on attention / arousal which may suggest delirium

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2
Q

Short-term memory is involved with what brain structure?

A

Pre-frontal cortex

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3
Q

Long-term memory is involved with what brain structure?

A

Hippocampus

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4
Q

What is the most common cause of dementia in people 65 or older in the US?

A

Alzheimer’s Dz Dementia

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5
Q

What is the greatest risk factor for Alzheimer’s Dz development?

A

Age

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6
Q

What is the presenting clinical picture for a PT with Alzheimer’s Dz?

A
Memory loss 
      ~~~(short or long term)
Apraxia 
       ~~~(impaired coordination of movements)
Language 
       ~~~(mild aphasia to muteness)
Visual Impairment 
       ~~~(spatial impairment)
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7
Q

What does the diagnostic criteria for Alzheimer’s Dz include?

A

Progression over 6 months
~~~SLOW onset –> DEMENTIA (quick is delirium)
Anterograde Amnesia (cannot make new memories)
Multiple Cognitive Deficits (memory/language)
Not due to another condition
Impairment in functioning

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8
Q

What is the best diagnostic test you can give a PT to determine if mild cognitive impairment is present?

A

Montreal Cognitive Assessment (MOCA)

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9
Q

When administering a Mini-Mental Status Exam what questions should you ask?

What are the associated scores with each category?

A

Orientation

Registration

Attention / Calculation (Serial 7s)

Recall

Language

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10
Q

Your 70 y.o. PT is complaining of recent memory loss and spatial/visual impairment S/Sx… What kind of labs or studies would you consider for this PT?

A
Brain CT or MRI
EEG
CBC (lytes)
TSH
B12
Screen for Depression
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11
Q

When is a lumbar puncture indicated for a PT with suspected Dementia?

A
CNS infxn is likely
PT younger than 55y/o
Reactive Serum Syphilis serology
Rapid progressive dementia
High suspicion of (metastatic cancer, hydrocephalus, immunosuppression, CNS vasculitis)
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12
Q

If imaging were performed on a PT with severe Alzheimer’s Dz; what findings could you expect to see?

A

Amyloid Beta plaques
Neurofibrillary tangles
Hippocampal atrophy
Granular-vascular degeneration of neurons

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13
Q

What kinds of Tx would you consider for a PT with mild-moderate dementia associated with Alzheimer Dz?

A

Cholinesterase Inhibitor (Donepezil, rivastigmine, galantamine) (memantine)

Vitamin E supplementation

Exercise therapy

Cognitive stimulation therapy

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14
Q

How would a vascular dementia PT present if the Middle Cerebral Artery were infarcted/occluded?

A

Aphasia
Confusion
Anosognosia

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15
Q

How would an Anterior Cerebral Artery infarct with dementia present clinically?

A

Frontal Lobe!!
Poor thinking, planning
Decreased initiative

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16
Q

How would a Posterior Cerebral Artery infarct present?

A

Parietal –> vision
Visual distortions
Hallucinations
CORTICAL BLINDNESS!!!!!!!!!

17
Q

What are the two patterns of Frontotemporal Dementia you should be attempting to work through as you assess your PT?

A

Changes in behavior

Problems with language

18
Q

Frontotemporal dementia follows what inheritance pattern? (Appx. 1/4 of the time)

A

Autosomal dominant in 10-25% of PTs

Family Hx in 40% of PTs

19
Q

Frontotemporal disease shares a connection with what other 2 conditions?

A

Lou Gehrig’s Dz (Amyotrophic Lateral Sclerosis)

Motor neuron disease

20
Q

Lewy Body Dementia shares the same protein (alpha-synuclein) anomaly as what Dz?

A

Parkinson’s Disease
Hunched posture
Balance issues
Rigid muscles

21
Q

Lewy Body Dementia differs from the Alzheimer’s Dementia and Vascular Dementia by what abnormal sleep finding?

What other differences might help you differentiate between LBD and Alzheimer’s Dementia?

A

Acting out dreams (impaired REM sleep)

Hallucinations, delusions, and misidentification of people is MORE COMMON in EALRY STAGE LBD than AD

Movement symptoms > in LBD than AD

22
Q

What drugs should be used with EXTREME CAUTION in Dementia w/ Lewy Bodies?

Why should you use extreme caution?

A

Antipsychotic drugs

Altered consciousness
Impaired swallowing
Hallucinations / Delusions
Worsened Parkinson’s symptoms

23
Q

What drug may be prescribed to Tx the altered REM sleep associated S/Sx and acted out dreams observed with Lewy Body Dementia?

A

Clonazepam

24
Q

76 y/o PT presents to your clinic with a Hx of Normal Pressure Hydrocephalus; what S/Sx can you expect to see in this PT?

What is the triad?

A

XS CSF
1. Thinking / Reasoning issues (Dementia)
2. DIFFICULTY WALKING (Gate Apraxia)
~~~Magnetic Gait~~~
3. Loss of bladder control (INCONTINENCE)

25
Q

What are some of the potential causes of Normal Pressure Hydrocephalus?

A

IDIOPATHIC
Hemorrhage
Infxn
Inflammation

26
Q

What clinical study could help in making an accurate diagnosis for a suspected PT with Normal Pressure Hydrocephalus?

A

MRI (looking for ventricular enlargement)

27
Q

What are the uncontrolled spastic movements in the head and arms?

What Dz is this associated with?

A

Chorea movements

Huntington Dz

28
Q

What is spongiform pathology associated with?

A

Creutzfeldt-Jakob Dz (PRNP gene mutation)

29
Q

What is the typical clinical presentation of Frontal Temporal Dementia?

A
Sexually uninhibited
Lack of social tact
Distractibility
Lack of empathy
Personal hygiene neglect
Repetitive / Compulsive behavior
30
Q

What kind of dementia is associated with chronic alcoholism?

A

Korsakoff Syndrome***