[CLMD] Dementia [Hon]

Question 1

What is the DSM-IV definition of Dementia?

Answer 1

“A decline in memory and at least one other cognitive function”

(…Aphasia, apraxia, agnosia or a decline in an executive function such as planning, organizing, sequencing or abstracting)

“This decline impaires social or occupational functioning in comparison with previous functioning”

Question 2

What is the prevalence of dementia in patients over the age of:

65?

85?

Answer 2

More than 10% = 65yo

More than 30% = 85yo

Question 3

What is the most common DEGENERATIVE cause of dementia?

Answer 3

Alzhemier’s Disease

(80%)

Question 4

What is the second most common DEGENERATIVE cause of dementia?

Answer 4

Lewy body disease

Question 5

What are the remaining 7 DEGENERATIVE potential causes of dementia?

(don’t worry you don’t need to know all of them, just be familiar with the names)

Answer 5

• Parkinson’s disease
• Frontotemporal lobar degeneration
• Progressive supranuclear palsy
• Corticobasal degeneration
• Multiple systems atrophy
• Huntington’s disease
• Olivopontocerebellar degeneration

Question 6

Overall, what are the (8) categories of causes of dementia?

Answer 6

Degenerative

Vascular

Infectious

Psychiatric

Toxic/metabolic

Traumatic

Tumors

Other

Question 7

What are examples of vascular causes of dementia?

Answer 7

Multiple infarction

Single stroke

Binswanger’s disease

Vasculitis

Subarachnoid hemorrhage

Question 8

What are examples of infectious causes of dementia?

Answer 8

Fungal meningitis

Syphilis

AIDS dementia

Creutzfeldt-Jakob disease

Post-herpes simplex encephalitis

Question 9

What are examples of psychiatric causes of dementia?

Answer 9

Depression

Alcohol use

Drug-related disorder

Personality disorder

Anxiety disorder

Question 10

What are examples of toxic/metabolic causes of dementia?

Answer 10

Vitamin B12 deficiency

Thyroid deficiency

System failure: liver, renal, cardiac, respiratory

Heavy metals

Toxins

Question 11

What are examples of traumatic causes of dementia?

Answer 11

Subdural hematoma

Closed head injury

Open head injury

Chronic Traumatic Encephalopathy (CTE)

Anoxic brain injury

Question 12

What are examples of tumor causes of dementia?

Answer 12

Astrocytoma/glioblastoma

Lymphoma

Metastatic tumor

Question 13

What are examples of OTHER causes of dementia?

Answer 13

Symptomatic hydrocephalus

Question 14

What is argueably the most important aspect of an evaluation of a patient with dementia?

Answer 14

HISTORY

*Preferably obtained from the patient AND from spouse or other family members, caregivers, etc*

Question 15

What may you want to consider if you are interviewing both the patient with dementia and a family member about the patient’s history?

Answer 15

Separate interviews

Question 16

What are specific subjects to ask about in the history of a dementia patient?

Answer 16

PATIENT DIFFICULTIES

• Memory?
• Progression?
• Functioning of pt?
• Safety? (guns in house?)
• Head injury?
• Family hx of dementia?

Question 17

What is the standardized examination to perform on a dementia patient?

Answer 17

Mini-Mental State Examination

Question 18

What laboratory studies are recommended in all cases of dementia?

Answer 18

CBC

Chemistry panel

Sed rate

Thyroid function studies

B12 level

RPR

CT or MRI of the head

Question 19

What are the selective tests recommended for:

• Creutzfeldt-Jakob, Encephalitis
• Cancer, infection, vasculitis, NPH

Answer 19

EEG = Creutzfeldt-Jakob, Encephalitis

LUMBAR puncture = Cancer, infection, vasculitis, NPH

Question 20

What is the criteria for clinical diagnosis of Alzheimers disease?

Answer 20

Deficits in 2 or more areas of cognition

Progressive worsening of memory and other cognitive function

No disturbance in consciousness

(Dementia established via MMSE)

Question 21

What are examples of laboratory supportive findings for Alzheimer’s disease?

Answer 21

Normal lumbar puncture

EEG: normal/mild generalized slowing

Progressive atrophy documented by MRI or CT brain

Question 22

What is the main goal of treatment for Alzheimer’s disease?

Answer 22

Slow the progression of the disease

Question 23

What is the primary category of drug used to treat alzheimers?

Answer 23

Acetylcholinesterase Inhibitors

Question 24

What are the (3) primary acetylcholinesterase inhibitors used to treat Alzheimer’s disease?

Answer 24

Donepizil

Rivastigmine

Galantamine

Question 25

What is an additional category of drug that has shown some efficacy in treating **Alzheimer's disease?**

Answer 25

NMDA receptor antagonist - **Memantine**

Question 26

What is a **mild cognitive impairment (MCI)?**

Answer 26

Memory complaint; typically noted **by the patient** Tested abnormal memory for age, yet does **NOT** meet the criteria for dementia

Question 27

How do you manage a patient with **mild cognitive impairment?**

Answer 27

MCI is probably a precursor to Alzheimer's disease Patients with MCI are 5x more likely to develop AD Therefore: **Treat with AchEI medications**

Question 28

What is the **primary finding** for probable **vascular dementia?**

Answer 28

**Focal signs** on neuro exam (Hemiparesis, lower facial weakness, babinski sign, sensory deficit, hemianopia etc)

Question 29

What is the **tetrad** of symptoms of **diffuse lewy body disease?**

Answer 29

- Dementia - Parkinsonian symptoms - Promnent psychotic symptoms (hallucinations) - Extreme sensitivity to antipsychotic agents

Question 30

Compare **diffuse lewy body disease** to **alzheimer's disease**

Answer 30

Diffuse lewy body disease: - progresses more rapidly than AD - symptoms generally vary a great deal more day to day than AD

Question 31

Most patients with **diffuse lewy body disease** experience severe, potentially life-threatening adverse reactions if treated with \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 31

Most patients with **diffuse lewy body disease** experience severe, potentially life-threatening adverse reactions if treated with **ANTIPSYCHOTIC AGENTS**

Question 32

Lewy bodies are located in the __________ for parkinsons disease

Answer 32

Lewy bodies are located in the **Basal ganglia** for parkinsons disease

Question 33

What are the features of **frontotemporal degeneration?**

Answer 33

Slow progressive deterioration of: Social skills Changes in personality Impairment of **intellect, memory and language**

Question 34

What is the **triad** of **normal pressure hydrocephalus?**

Answer 34

Dementia Gait disturbance Urinary incontinence

Question 35

What is the most likely feature of **normal pressure hydrocephalus** to be reversed with shunting?

Answer 35

GAIT

Question 36

What does **CADASIL** disease stand for?

Answer 36

Cerebral autosomal dominant subcortical infarcts and leukoencephalopathy

Question 37

Age of onset for **CADASIL?**

Answer 37

40-50 yo

Question 38

What is the pathophys of **CADASIL's Disease?**

Answer 38

Hereditary stroke disorder (Progressive degeneration of smooth muscle cells in blood vessels)

Question 39

How does **CADASIL's disease** typically manifest?

Answer 39

"Migraine" headaches TIAs Strokes