DDx: Dementia Flashcards Preview

08 NEUROLOGY > DDx: Dementia > Flashcards

Flashcards in DDx: Dementia Deck (14):
1

Differenial Diagnosis of Dementia:

Alzheimer disease

Mild Cognitive Impairement

Frontotemporal dementia

Dementia with Lewy bodies

Vascular dementia

Normal pressure hydrocephalus

Potentially Reversible Causes of Dementia:

Nutritional

Inflammatory and autoimmune

Infectious

Endocrine

Structural

Toxic/metabolic

Psychiatric

2

Alzheimer disease

Most common cause of dementia (60%-80% of cases). The result of structural neuronal changes with pathologic features including deposition of insoluble, neurotoxic β-amyloid protein in extracellular parenchymal plaques and intracellular accumulation of neurofibrillary tangles composed of abnormal tau protein.

The onset of Alzheimer disease is insidious. Persistent forgetfulness is the hallmark of Alzheimer disease. As the disease progresses, memories are lost and problems with word-finding ability become apparent. The ability to perform complex mental operations, such as reading or calculating, or to execute multistep tasks, such as planning a meal or shopping, declines. Visuospatial impairment and apraxia develop, with patients losing the ability to dress themselves, perform complex motor actions, or use tools, such as a television remote control or a telephone.

Tx: Cholinesterase inhibitor (Donepezil)

The N-methyl-D-aspartate receptor antagonist memantine is the only drug approved by the Food and Drug Administration as first-line treatment of moderate to advanced Alzheimer disease. 

Non pharmacologic: Cognitive stimulation included a range of activities designed to stimulate thinking, concentration, and memory. Cognitive stimulation was associated with improved cognitive function immediately after treatment. Quality of life also improved, but there was no impact on mood, overall functional level, or caregiver outcomes.

3

Mild Cognitive Impairment

Mild cognitive impairment (MCI) describes a loss of cognitive ability that exceeds the expected age-related memory loss but does not interfere significantly with daily activities. The boundary between MCI and dementia is unclear, although 10% to 15% of patients with MCI will meet the criteria for dementia within 1 year. 

There are universal age-related declines in cognition that chiefly affect memory, learning, and problem solving beginning around age 40 years, and these changes may be noticeable to patients. 

4

Frontotemporal dementia

 

Progressive neuropsychiatric disorder characterized by early behavioral and personality changes that range from apathy to social disinhibition. Patients may fail to change their clothes, brush their teeth, pursue their former interests, or initiate many of their previous activities that constituted a normal day. They may fixate, in a seemingly idiosyncratic fashion, on a particular activity, such as going to the bathroom, sorting through a wallet, hoarding magazines, or watching television. Some patients have greater disinhibition and emotional lability (crying or laughing inappropriately).

Disproportionate atrophy of the frontal and anterior temporal brain regions.

 

5

Dementia with Lewy bodies

Characterized by parkinsonism that is responsive to dopaminergic therapy, visual hallucinations, and/or fluctuating cognition. The characteristic cognitive profile of dementia in patients with dementia with Lewy bodies includes impaired learning and attention, psychomotor slowing, constructional apraxia, and more profound visuospatial impairment but less memory impairment than in similarly staged patients with Alzheimer disease.

Intraneuronal Lewy body inclusions in the cerebral cortex.

 

 

 

6

Vascular dementia

Consequence of progressive ischemic brain injury; stepwise deterioration

7

Normal pressure hydrocephalus

Triad of cognitive decline, gait impairment, and urinary incontinence in the setting of normal CSF pressure.

8

Potentially Reversible Causes of Dementia

Nutritional

Vitamin B12 deficiency, thiamine deficiency

9

Inflammatory and autoimmune

SLE, CNS vasculitis, sarcoidosis, granulomatosis with polyangiitis, paraneoplastic disease

10

Infectious

Brain abscess, chronic meningitis, HIV, CNS Whipple disease, syphilis, viral encephalitis (CMV, HSV)

11

Endocrine

Hypothyroidism, hyperthyroidism, hypoparathyroidism

12

Structural

Hydrocephalus, brain tumor, subdural hematoma, postconcussive syndrome

13

Toxic/metabolic

Drugs, heavy metal exposure

14

Psychiatric

Depression, catatonia, schizophrenia