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OMS - 2 Neuro Final > Alzheimer's Disease > Flashcards

Alzheimer's Disease Flashcards

(46 cards)

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1
Q

How many people currently have Alzheimer’s disease? Population affected the most?

A
  • About 6 million (1 out of every 8 people)
  • Women account for 2/3

(6 leading cause of death)

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2
Q

Delirium signs and symptoms (4)

A
  1. Impaired consciousness & attention
  2. Acute onset
  3. Fluctuating cognitive function (hours or days)
  4. Alterations in sleep

(Often confused for dementia. Different, but often occur together. Look for underlying cause.)

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3
Q

Define dementia

A

Acquired syndrome of decline in memory and other cognitive functions that affect daily life of an alert patient.

(neurodegenerative)

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4
Q

Dementia is ______ and ______.

A
  • Progressive
  • disabling

(neurodegenerative)

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5
Q

6 examples of typical expected decline with cognition during the aging process (these are not signs of dementia).

A
  1. Speed of processing and nonverbal intelligence
  2. Learning and recall ability
  3. Multitasking
  4. Additional time needed to complete executive tasks
  5. Reaction Time increases
  6. Tip-of-the-tongue phenomenon
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6
Q

What’s the DSM V criteria for evidence of significant cognitive decline from previous level of performance (dementia)?

A
  1. Complex attention
  2. Executive function
  3. Language
  4. Learning / memory
  5. Motor perception
  6. Social cognition

(one or more)

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7
Q

Cognitive deficits that interfere with independence in everyday activities (2 categories).

A
  • ADLs: dress, shower, toilet
  • iADLs: instrumental activities; things you would do on your own or with help (ex: Transportation, cleaning, finances)

(cognitive deficits are not related to delirium and are not explained by a mental disorder i.e. schizophrenia, ADD)

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8
Q

What are the three major risk factors for dementia?

(Alzheimer’s disease, Frontotemporal, Lewy Body Dementia and vascular dementia)

A
  1. Age
  2. Family history (1st degree relative)
  3. Down syndrome
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9
Q

In addition to age, family history and down syndrome what is the genetic risk factor for development of dementia?

A
  • APP
  • PS1 & 2
  • APOE4 allele
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10
Q

What are some possible (not definitive) preventative measures for dementia?

A
  1. NSAIDs
  2. Antioxidants
  3. Level of education and cognition required for work
  4. Exercise
  5. Statins
  6. APOE2*** allele (APOE_4_ allele is a ***risk factor)
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11
Q

What is the most common gene that is related to late onset Alzheimer’s disease?

A

APOE4 gene, chromo. 19

(3 different alleles types 2/3/4, APOE2 = protective)

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12
Q

What is the genetic predisposition for early onset Alzheimer’s disease (before 60 y.o.)?

A
  • APP
  • PS1 & PS2 (presenilin)

(APOE4 is a risk factor for Late AD)

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13
Q

When evaluating a patient for the different types of dementia, what are important pieces of information to gather from a family member?

A
  1. Onset
  2. Family history of dementia
  3. Injuries or Falls
  4. Substance abuse
  5. History of depression
  6. Weakness
  7. Gait changes
  8. Medications
  9. Behavior
  10. Functionality and ADLs & iADLs
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14
Q

Which tests are included in the mental status exam for the different types of Alzheimer’s (5)?

A
  1. MOCA (Montreal Cog)
  2. Mini COG
  3. MSSE (mini mental state)
  4. SLUMs (St. Louis U. Mental Status)
  5. Depression Scale (always needed to r/o a MDD)
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15
Q

How would you evaluate a patient for different types of dementia with a Mini Cog exam?

A

Repeat and remember a chain of words→ draw a clock→ repeat words

(give 3 minutes in between)

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16
Q

How do you score a Mini Cog exam?

A
  • One point for each recalled word (up to 3)
  • Two points for normal clock drawing (0 for ab)

(0-2 points = positive for dementia)

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17
Q

Which items are included on the mini mental state exam (5)?

A
  1. Orientation
  2. Registration
  3. Attention & Calculation
  4. Recall
  5. Language

(unique to MMSE)

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18
Q

Which items are included on the MoCA exam (8)

A
    1. Visuospatial/executive
  2. Naming
  3. Memory
  4. Abstraction
  5. Attention
  6. Language
  7. Delayed Recall

(her fav; must have at least 8th grade edu. Unique to MoCA)

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19
Q

What is included in the lab workup for a patient with possible dementia (5)?

Study These Flashcards
A
  1. CBC/CMP (electrolytes, Kidney fx, LFTs, glucose)
  2. TSH
  3. Vitamin B12
  4. Spinal tap: looking at beta amyloid & tau in CSF
  5. STI: RPR (shyphillis) & HIV in selective population

(ab amyloid would be low; tau high)

20
Q

Which imaging would you order for a patient with possible dementia?

Study These Flashcards
A
  1. MRI (lesions)
  2. FDG-PET: AD or frontotemporal dementia
  3. CT: r/o vascular events

(MRI if young or abrupt, the others are only used in research at the moment)

21
Q

Which type of dementia is have sudden onset?

Study These Flashcards
A

Vascular Dementia

(the other types are typically gradual, may also be stepwise or build over time, a lot of the time it is mixed)

22
Q

What is a clinical features that Alzheimer Disease, Lewy Body Dementia, Vascular Dementia & Frontotemporal Dementia all have in common?

Study These Flashcards
A

normal lab findings

23
Q

Clinical features of Alzheimer disease

Study These Flashcards
A
  1. Memory impairment with difficulty in learning new information
  2. Rarely has motor issues but can lead to apraxia
  3. Confusion, agitation, paranoia, loss of memory
  4. Difficulty w/ADL/iADLs
24
Q

Which two types of dementia have Global atrophy on Imaging?

Study These Flashcards
A
  1. Alzheimer disease (also has small hippocampal vol.)
  2. Lewy Body dementia
25
Clinical features of Lewy Body dementia (6)
1. ***_Motor changes followed by memory loss_*** 2. ***_Hallucinations (visual)_*** 3. Parkinsonian-like 4. Fluctuations of confusion 5. ANS malfunction 6. REM sleep disorder (sensitive to neuroleptic drugs)
26
Clinical features of vascular dementia include ______ deficits (2).
1. Motor deficits 2. cognition deficits (depend on ischemia) (step-wise decline w/platues until the next infarct)
27
Image findings for vascular dementia
Cortical or subcortical damage on an MRI
28
Frontotemporal dementia has a loss of ______ and is correlated with \_\_\_\_\_.
* Executive function (disinhibition, apathy, behavior change) * ALS (usually no motor deficits)
29
Image findings for frontotemporal dementia
Atrophy of the frontal and temporal lobes (order FDG-PET scan - uptake of glucose)
30
Pathology of Alzheimer disease
Abnormal beta amyloid Aβ protein processing leading to amyloid plaques (extracellular) → Inflammation, neuronal degeneration, and apoptosis→Neurofibrillary tangles (intracellular phosphorylated tau protein)→Decreased glucose metabolism in brain
31
Pathology of Lewy Body formation and Parkinson with dementia
alpha-synuclein (2nd most common neurocognitive diz)
32
AchE inhibitors are commonly used to treat **which types of dementia**?
1. Lewy Body 2. Alzheimer 3. Vascular (only if mixed w/AD) (not frontotemporal! it could make it worse!)
33
Which **AchE inhibitor** is used to treat Alzheimer, Lewy Body and vascular dementia?
1. Donepezil 2. Galantamine 3. Rivastigmine ## Footnote ***_(do not use for frontotemporal, it may make it worse)_***
34
In addition to AchE inhibitors, what medication might be prescribed for Alzheimer disease?
NMDA Antagonist | (prevents excitotoxicity)
35
Pharmacologic treatment of Lewy Body dementia (4)
1. AchE Inhibitors 2. Antipsychotics 3. Levodopa Carbidopa 4. SSRIs (same for vascular dementia, with the addition of BP control, antiplatelet, DM & cholesterol control)
36
What is the pharmalogic treatment for frontotemporal dementia?
1. Antidepressants 2. Antipsychotics ## Footnote ***_(do NOT give AchE inhibitors, it may make it worse)_***
37
Korsakoff Syndrome symptoms
* Anterograde and retrograde memory loss * Apathy * Confabulation * Long-term memory is preserved (late neuropsychiatric manifestation of Wernicke's encephalopathy)
38
The vast majority of treatment for dementia is ***_NON-PHARMACOLOGIC (7)_***
1. Enhance quality of life 2. Maximize functional performance 3. Improve cognition, mood, behavior 4. Caregivers 5. Safety modifications 6. Regular appointments 7. Education for family
39
Mild Cognitive Impairment
* This is a prodromal form of dementia and a HUGE risk factor in developing AD * Some memory loss, but very functional & non-demented (test memory every year)
40
Criteria for Mild Cognitive Impairment (4)
1. Change in cognition 2. Impairment in one or more cognitive domains 3. Preservation of independence in functional abilities 4. Non-demented ## Footnote **(high risk for developing AD)**
41
How do AchE inhibitors help dementia?
Slow breakdown of acetylcholine → modest delay in cognitive decline
42
Side effects of AchE inhibitors
Side effects: GI side effects common (diarrhea), syncope, falls
43
New treatment for dementia. How does it work?
* Aducanumab * Monoclonal antibodies against amyloid beta (must catch them before memory loss to be effective)
44
Memantine (Namenda) MOA
reduces glutamate-mediated excitotoxicity (neuroprotective) (moderate-severe only. side effect: constipation)
45
Vascular Dementia tx (7)
1. stop smoking 2. blood pressure control 3. cholesterol control 4. anti-platelet tx 5. diabetes control 6. exercise 7. healthy diet ***_(the only demential you can stop)_***
46
Lewy Body tx (4)
1. **AchE inhibitor**: memory & hallucinations 2. **Quetiapine** if hallucinations not treated 3. **SSRI**: depression is common 4. **levodopa/carbidopa**: motor fxn (levodopa/carbidopa may exacerbate psychiatric sx)

OMS - 2 Neuro Final (36 decks)

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