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Mental Health > Dementia > Flashcards

Dementia Flashcards

1
Q

DSM-5 criteria for major neurocognitive impairment

Dementia

A

A) evidence of significant cognitive decline from a previous level of performance in one or more of the following cognitive domains:

  • learning and memory
  • language
  • executive function
  • complex attention
  • perceptual-motor
  • social cognition

B) cognitive deficits interfere with independence in everyday activities. At a minimum, assistance should be required with complex instrumental activities of daily living
- I.e: paying bills, managing meds, etc.

C) the cognitive deficits do not occur exclusively in the context of delirium

D) cognitive deficits are not better explained by another mental disorder

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2
Q

Main types of dementia

A

Alzheimer’s dementia
- MOST common

Lewy body dementia

Frontotemporal dementia (picks disease)

Vascular dementia
- 2nd most common

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3
Q

When to ask for dementia?

A

Ask if patients present for care with subjective memory complaints or if a Family member/friend reports concerns

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4
Q

How to ask about activities of daily living vs instrumental activities of daily living

A

IADLs: Difficulty with?

  • balancing checkbook
  • preparing meals
  • getting to appointments on time
  • taking medications every day

ADLs: difficulty with

  • eating meals
  • getting dressed
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5
Q

What are the cognitive domains of dementia testing

A

Executive function

Language

Complex attention

Learning and memory

Perceptual-motor

Social cognition

all are tested with the MOCA test

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6
Q

What labs are needed for dementia

A

CBC

CMP

LFTs

TSH

B12/folate and vitamin D

RPR and HIV testing

Head imaging (CT or MRI)

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7
Q

Alzheimer’s disease key features

A

most common form of dementia

MOCA findings

  • predominant defect in delayed recall and orientation
  • very quickly forgets short term conversations

Histopathology
- diffuse neuritic plaques with extracellular amyloid deposition and intracellular neurofibrillary tangles

Course:
- progresses to death in around 10 years of diagnosis

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8
Q

Alzheimer’s clincial features

A

declarative episodic memory is almost always first to go

hippocampus and medial temporal lobes are degraded first

Pathways that mediate procedural memory and motor learning are spared

May also present with

  • executive dysfunction
  • insight into deficits
  • MRI = reduced hippocampus volume
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9
Q

what is the Risk of developing dementia

A

Roughly doubles every 10 years once somebody hits 60 yrs

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10
Q

Alzheimer’s disease causes/risk factors/prognosis

A

Likely due to amyloid/tau beta peptide build ups due to decrease clearance or overproduction
- exact is unknown

mutations in apolipoprotein E confer increased risk

Acquired risk factors:

  • HTN
  • dyslipidemia
  • diabetes
  • CVA
  • Atherosclerosis
  • TBI
  • certain meds
  • sedentary lifestyle
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11
Q

Alzheimer’s treatment

A

Early AD

  • acetylcholinesterase inhibtors
  • donepezil/galantamine/rivastigmine*

Late or severe AD

  • memantine added to acetyl inhibitors
  • add vitamin E also as supplementation

Very late stage AD with behavioral disturbances

  • consider using SSRI or trazodone in addition
  • try to not use antipsychotics (increases seizure and stroke risks)

DOESNT cure, only slows

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12
Q

Lewy body dementia general clinical features

A 
Parkinsonism features with: 
- cognitive impairment 
- visual hallucinations 
- sleep disorders 
- dysautonomia (orthostatic hypotension)
- antipsychotic sensitivity 
(NEVER give high efficacy antipsychotics) 
*if need to use quatepine or risperidone*

very challenging to differentiate from delirium

** if able to neuro biopsy, will show eosinophilic cytoplasmic inclusions (Lewy bodies)**

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13
Q

Neuroimaging between Lewy body and Alzheimer’s

A

Lewy body

  • mammillary bodies are preserved
  • hippocampus is preserved
  • temporal lobes are preserved
  • SPECT scan findings will show occipital lobe hypoperfusion

Alzheimer’s

  • mammillary bodies are degraded
  • hippocampus is degraded
  • temporal lobes are degraded
  • SPECT scan findings will show hippocampus and temporal lobe hypoperfusion
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14
Q

Treatment of Lewy body dementia

A

Control vascular risk factors

Maybe try Acetylcholinesterase Inhibtors (not the greatest effects though)

Levodopa and amantadine dont work well for Parkinsonism symptoms

NEVER GIVE ANTIPSYCHOTICS

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15
Q

Parkinson’s psychosis

A

Motor symptoms will present first and have a history before psychosis presents
- also take s time to develop (compared to delirium)

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16
Q

Frontotemporal dementia (FTD)

picks disease

A

Presents with: (usually around the same time altogether)

  • disinhibition
  • apathy/loss of empathy
  • hyperorality
  • compulsive behaviors

MOCA findings = executive function is high dysregulated (affects prefrontal lobes)

can have a younger onset as early as 30 yrs old

17
Q

Picks disease treatment

A

Focus on safety and driving first
- establish how they are gonna be able to get around

Speech therapy

NO medications have been known to work well

really not much definitive care, just supportive

18
Q

Vascular dementia

A

Often seen in CNS vascular disease processes and is the 2nd most common type of dementia

Symptoms vary since it can affect any lobe of the brain

  • will show stepwise progression of symptoms though
  • usually starts off with discrete cognitive dysfunctions,and then keep progressing slowly getting worse and worse. The whole thing is often very discrete until it gets really bad.

MRI imaging shows various periventricular lesions due to infarcts throughout the brain

19
Q

Risk factors for vascular dementia

A

Age

HTN

Diabetes

Sedentary lifestyle

A fib

CAD

Smoking

BMI super high or low

20
Q

High yield symptoms to help differentiate dementias clincially

A

rapid forgetting of short time/declarative memory = AD

Parkinsonism symptoms = Picks disease or Lewy body dementia

Aphasia out of proportion in the absence of a known stroke = PPA in conjunction with picks disease

Gait disturbances with urinary incontinence = normal pressure hydrocephalus

Rapidly progressive dementias in younger patients = usually rare/more lethal dementias

21
Q

Easiest ways to differentiate delirium from dementia

A

Delirium

  • acute onset (hrs- days)
  • attention and orientation are impaired
  • level of consciousness can be impaired
  • speech/language = incoherent and disorganized
  • memory of past events = fluctuates but usually impaired

Dementia

  • usually chronic onset (months-years)
  • attention and orientation are preserved
  • level of consciousness is NEVER IMPAIRED
  • speech/language = usually coherent but may struggle with remembering the word to use
  • memory of past events = intact except in late stages (only recent memories are impaired)

Mental Health (46 decks)

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