dementia

Question 1

alziehmers is the ____

Answer 1

most common cause od dementia

Question 2

Vascular dementia is ___

Answer 2

lewy n

Question 3

What infections can cause dementia

Answer 3

HIV, Syphilus, hydrocephalus

Question 4

whats the difference between NPH and non NPH type

Answer 4

NPH has brain matter pushed against brain wall

Question 5

alziehmers is always ___ over what time frame

Answer 5

progressive, months and years.

Question 6

alziemers is often preceeded by

Answer 6

MCI (mild cognitive impairment)

Question 7

alzheimers is a disease of ____ and ___

Answer 7

function and quality of life.

Question 8

Clinical stages of AD

Answer 8

early, middle, late

Question 9

alzheimers diagnosis

Answer 9

Currently no specific, single definitive test
• R/O other disorders
• “Rule in” by characteristic presentation and
course
• Use of rating scales (MMSE, MOCA, clock,
SLUMS), more so MMSE and MOCA
• Pathology: plaques and tangles
• Amyloid and tau
• Amyloid hypothesis

Question 10

What is the amyloid hypothesis

Answer 10

that amyloid is the major cause of AD

Question 11

A person must have these two proteins?

Answer 11

plaques and tangles (amyloid and tau

Question 12

ADLS

Answer 12

activities of daily living

Question 13

What ADLS lost first in AD

Answer 13

instrumental

Question 14

what adls lost second in AD

Answer 14

Basic ADLs lost in 2nd and 3rd stages:
dressing, bathing, grooming, toileting
Basic ADLs lost in 2nd and 3rd stages:
dressing, bathing, grooming, toileting

Question 15

Alzheimer’s Disease-Stages

Answer 15

Early/mild–short term memory loss (STM) loss, anxiety, depression
• Middle/moderate—sleep problems, speech and language issues,
psychosis, agitation, need for supervision
• Late/severe—24 a day care. Wandering,
yelling, severe speech problems

Question 16

Vascular Dementia

Answer 16

• “Multi-infarct dementia”
• Uneven progression
• Vascular lesions
• Sub-cortical changes: white matter disease (scaring in cortex if stroke, white matter effected/myelin requires vascular)

Question 17

Frontotemporal Dementias

Answer 17

Pick’s disease-tau inclusion bodies. NOT amyloid. Frontal temporal lobe involved. More atrophy in this area is somewhat of a give away.
• “tauopathy”
• Primary progressive aphasia aka PPA (speach and language problems come first in this kind)
• Changes in personality, executive
function, judgment early in course, and social
• Speech and language problems
• Progression to memory loss

Question 18

lewy body dementia give away

Answer 18

hallucinations

illusions (misperception)

Question 19

illusions characteristic of

Answer 19

lewy body deliruim, alcohol.

Question 20

Lewy Body Dementia

Answer 20

• Overlaps with PD and sometimes with AD
• Fairly sudden onset
• Early psychosis—visual hallucinations
• Parkinsonian symptoms
• Fluctuation; delirium like symptoms
• Often intolerant to antipsychotics
• “Lewy Body”: a-synunclein intracellular inclusion (protein that's specific);
diffuse or localized
• Parkinson’s dementia-develops long after motor
symptoms; loss of logic and reasoning

Question 21

parkinsons

Answer 21

also alpha synuclein

Question 22

what is a common theme in early demensias

Answer 22

proteins

Question 23

AD vs Lewy body vs Parkinsons

Answer 23

Lewy body is acute onset (dreams that are strange), Parkinsons

Question 24

Behavioral and Psychiatric

Symptoms of Dementia (BPSD)

Answer 24

Speech and language changes
• Circadian rhythm disturbances (“sundowning”)
• Inappropriate vocalizaton
Wandering
• Shadowing(following people)
• Agitation/aggression
• Catastrophic reaction (change in ruitine is a big deal)
• Mood lability
• Delusions—paranoia, other psychotic symptomsexit seakers (try to leave). perception effected by the illness.

Question 25

Dementia Treatment

Answer 25

supportive, not currative, does not change outcome. Cholinesterase inhibitors: (increase Ach for memorry processing), short run improvement. vegal nerve causese the side effects Aricept (Donepezil most common), Razadyne (Galantamine), Exelon (Rivastigmine) • CI—supportive but not curative • Namenda (Memantine)—also supportive— mostly mid to late disease. Blocks MMDGA (progrutimate reactors)

Question 26

Psychiatric medications in | dementia

Answer 26

Off label means higher need for informed consent ``` No specific psychiatric medication approved for dementia • “Off-label” uses • Need for informed consent • Commonly used: atypical antipsychotics, mood stabilizers (valproate), benzodiazepines (lorazepam), SSRI< SNRI, trazodone ``` NOT Lithium

Question 27

Controversies in Use of | Antipsychotics in Dementia

Answer 27

``` BBW, use when lack of other alternatives. Monitor closely. Older & more frail = high index of suspicion of side effects. Atypical antipsychotics-”black box warning” by FDA because of increased morbidity and mortality • Limited efficacy • Lack of good alternatives • Individual patients may respond well ```

Question 28

Meds for BPSD

Answer 28

``` Target symptom approach • Empirical, variable • Avoid polypharmacy (use one) • Low dose and duration • Avoid anticholinergics (antagonize disease, benadril etc) • Initially consider non-pharmacologic measures • Consider delirium and pain (may not be able to verbalize) ```

Question 29

dementia vs AD

Answer 29

dementia related to systemic condition Cognitive disturbance usually related to systemic condition(s)—illness, drugs, drug withdrawal • At risk-elders, children, CNS disorders, previous episodes, malnourished, multiple organ system illness (if other issues risk higher for delirum) • Relatively short time course • Altered sensorium (aka not in touch with reality)

Question 30

Delirium

Answer 30

``` Cognitive fluctuation, confusion, psychosis, lucid intervals • sleep/circadian rhythm disturbance • Agitated and withdrawn types • Comorbidity with dementia • Possible sequelae ```

Question 31

Delirium type of hallucination

Answer 31

audtiory: drugs Visual: medical or neuro proviking psych (delirum, demensia)

Question 32

Delirium symptoms

Answer 32

``` Cognitive fluctuation, confusion, psychosis, lucid intervals • sleep/circadian rhythm disturbance • Agitated and withdrawn types • Comorbidity with dementia • Possible sequelae ```

Question 33

Delirium Treatment

Answer 33

``` Address underlying conditions • Normalize environment • Small doses of antipsychotics • Limit benzodiazepines • Protection from impaired judgment • Minimize restraints ```

Question 34

prolonged delirium has a ___ mortality rate

Answer 34

higher

Question 35

goals of interview

Answer 35

gaoal: rapor, relationship, level of cognitive impariment and addresss (not patronizing)

Question 36

testing?

Answer 36

memory using scale using mocha, maybe a simple memory test of three workd memory test, and clock test. may also assess mood and suicidal thinking. Older people as a group (olde men higher risk for suicide, women more likely to use pills and survive and men use guns) social isolation, sense of hopelessness, chronic pain.

Question 37

anmestic disorder

Answer 37

dsm5 its a part of major neurochognitive diorser caused by doc. short term memory (drug, thryamin deficcienty or trauma brain injruy) anemesia (in this cause used retrograde amnesia and other anmesia).

Question 38

death dying and grief

Answer 38

dsm5 bereivment inclusion (6 months of other death).