Dementia Flashcards
What are the various types of dementia and frequencies?
- Alzheimer’s 60-80% (May be up to 85%)
- Lewy Body Dementia 5-10%
- Vascular Dementia 5-10%
- Frontotemporal Dementia 5-10%
- Others: Parkinson’s, Huntington’s
*May have mixed dementias
What are possible etiologies of memory loss?
- Neurodegenerative causes
- Secondary causes: depression, medications (anticholinergic side effects), multiple comorbidities
What is mild cognitive impairment?
Not part of normal aging
-Deficit in 1 of 4 areas of cognition (language, spacial ability, learning/memory, executive control)
- S/S: memory complaints, abnormal memory for age, no functional disability, normal general cognitive function
- Increases risk for developing AD
What are some examples of cognitive Impairment screening tools?
-Mini-Mental Status Exam (MMSE): Standardized, well-studied, tracks progress and decline, quantifies cognitive function 30 Components Scoring: 22-24: Mild 15-21: Moderate <15: Severe
Mini-Cog:
Uncued 3-item recall test with clock-drawing test (CDT)
What follow-up is required for positive screens for cognitive impairment?
Refer for neurological evaluation
Refer for neuropsychological evaluation
Diagnostic imaging and labs
What would signify a non-AD dementia diagnosis?
- Rapid onset
- Rapid progression
- Non-memory presentation
- Onset <50yo
Lewy Body Dementia
Characteristics
-Late-onset (75-80yo)
-Fluctuating cognitive impairment, recurrent visual hallucinations, parkinsonism, depression
Duration: 6 years
Dementia
Diagnostic Tests
Imaging and Labs
Structural neuroimaging: non-contrast CT or MRI
Screen for depression, B12 deficiency, hypothyroidism
Genetic markers not approvied
Alzheimer’s Disease
Characteristics
- Progressive, neurodegenerative disorder
- Average life span following diagnosis depends on age at dx, typically 7-10 years
- Amnesia, aphasia, apraxia, agnosia
- Difficulty with memory, recall, language, psychomotor function.
- Personality changes, irritability, hallucinations, agitation
- Incontinence, dysphagia
Alzheimer’s Disease
Etiology
Etiology unknown:
Amyloid Hypothesis: Abnormal processing of amyloid precursor protein (APP), increases in beta-amyloid creates plaques
Alzheimer’s Disease
Risk Factors
- Cardiovascular disease: heart disease
- Increased homocysteine levels
- APOE-e4 (cholesterol carrying protein) susceptibility gene for AD, affects age of onset of disease
- Aging
- Genetics
- Female gender
- Possibly depression
- Possible hypothyroidism
Screening for Depression in Older Adults with dementia considerations
Screen older adults using
- Single question
- Geriatric depression scale (GDS)
- Cornell Depression in Dementia Scale
What is the BEERS list?
- Meds to avoid in patients >65yo
- Anticholinergics
- Some may induce dementia like symptoms - decreased cognitive function
Vascular Dementia
Criteria/Characteristics
- Evidence of 2 or more strokes by history, neurologic signs, or imaging or single stroke with a clear temporal relationship to onset of dementia
- Evidence of at least 1 infarct outside the cerebellum by CT or T1-weighted MRI
Silent brain infarcts increase risk
Neuropsychological testing for dementia/cognitive impairment
- Aphasia: Ability to understand or express speech
- Agnosia: Ability to interpret sensations and recognize things. Spacial abilities, change in visual perception
- Learning and memory: MMSE, Recall
- Executive function: ability to organize, attention, concentration
Apraxia: Ability to act our intentions psychomotor speed, seen later
Alzheimer’s Disease
Diagnosis
Imaging and Labs
- Rule out other causes. CT (brain injury, tumor, stroke), MRI (cerebral atrophy)
- MRI without contrast typical for diagnosis
PET scans more detailed, hard to get approved by insurance (FDG or Amyloid)
