Clinical Approach to Dementia (Hon) Flashcards
(26 cards)
What is the definition of dementia?
A decline in memory and at least one other cognitive function/decline in an executive function
What are some infectious causes of dementia?
1) Fungal meningitis
2) Syphilis
3) AIDS
4) CJD
5) Post-herpes simplex encephalitis
What are some toxic/metabolic causes of dementia?
1) Vitamin B12 deficiency
2) Thyroid deficiency
3) Heavy metals
What is the criteria for clinical diagnosis of Alzheimer’s disease?
1) Deficits in 2 or more areas of cognition
2) Progressive worsening of memory and other cognitive function
3) No disturbance of consciousness
4) Onset most often after 65
What is found on CT or MRI of the brain with Alzheimer’s?
Progressive atrophy
What is the main goal of the treatment of Alzheimer’s?
To slow the progression of the disease
What class of drugs are used in the treatment of Alzheimer’s? Name the Drugs
1) Acetylcholinesterase inhibitors; Galantamine, Rivastigmine, Donzepil
2) NMDA receptor antagonist; Memantidine
What is a probably precursor to Alzheimer’s disease?
Mild Cognitive Impairment
What is Mild Cognitive Impairment?
Memory complaint abnormal for age
What should be given to a patient with mild cognitive impairment in order to slow progression to Alzheimer’s?
AChE inhibitor
What is the criteria for probable vascular dementia?
1) Presence of focal sign (hemiparesis, lower facial weakness, Babinski sign, etc.)
2) Evidence of relevant cerebrovascular disease on brain imaging (infarcts, multiple basal ganglia and white matter lesions)
A diagnosis of vascular dementia can be when there is a relation between cognitive problems and vascular events manifested or inferred by the presence of one or more of the following:
1) Onset of dementia within 3 months after a recognized stroke
2) Deterioration in cognitive functions (either abrupt or progressive)
What are some vascular causes of dementia?
1) Multiple infarction
2) Stroke
3) Binswanger’s disease
4) Vasculitis
5) Subarachnoid hemorrhage
What symptoms seen with Diffuse Lewy Body disease?
1) Dementia
2) Parkinsonian symptoms (bradykinesia and rigidity)
3) Prominent psychotic symptoms (generally visual hallucinations)
Lewy Body Disease patients can experience severe, potentially life-threatening adverse reactions if treated with?
Antipsychotic agents
Up to 81% of Lewy Body Disease patients have unexplained periods of?
Increased confusion that last days to weeks and closely mimic delirium
What often presents early in Lewy Body Disease patients?
Bradykinesia, rigidity and falls
How do Lewy Body Disease patients respond to levodopa?
Poor
Parkinson’s disease
1) Where are the Lewy bodies
2) When do psychotic symptoms commonly present?
3) Are resting Tremors present?
4) Is Autonomic dysfunction present?
5) Are Hallucinations present?
6) When do executive dementia occur?
1) Midbrain
2) Later in disease course
3) Yes
4) Sometimes
5) Only in response to anti-parkinsonian drugs
6) Later in disease course
Lewy Body Disease
1) Where are the Lewy bodies
2) When do psychotic symptoms commonly present?
3) Are resting Tremors present?
4) Is Autonomic dysfunction present?
5) Are Hallucinations present?
6) When does Cortical dementia occur?
1) Cortical and Diffuse
2) Earlier
3) No
4) Prominently
5) Yes, in absence of anti-parkinsonian drugs
6) Earlier
What is the most common psychotic symptom of Lew Body Disease?
Visual hallucinations generally of animals and children
Frontotemporal degeneration includes several forms of dementia characterized by?
1) Loss of social skills
2) Personality changes
3) Impairment of intellect, memory, and language
Frontotemporal degeneration usually affects individuals between what ages?
40 and 60
What is the triad of symptoms seen with normal pressure hydrocephalus?
Wet, Wacky, Wobbly:
1) Dementia
2) Gait disturbance
3) Urinary incontinences
