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Medicine II: Neurology > Dementia > Flashcards

Dementia Flashcards

(48 cards)

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1
Q

What is the relationship between depression and dementia?

A

depression can mimic AD and other dementias
depression can be a harbinger of dementia
depression can be a symptom of dementia

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2
Q

What is normal pressure hydrocephalus?

A

problem with reabsorbtion of CSF fluid

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3
Q

Who is at a greater risk for normal pressure hydrocephalus?

A

those with a history of meningitis or subdural hemorrhage

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4
Q

What are the classic characteristics of normal pressure hydrocephalus?

A

gait apraxia
urinary incontinence
confusion

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5
Q

What are the MRI findings of normal pressure hydrocephalus?

A

ventriculomegaly out of proportion to any sulcal atrophy, subependymal leakage

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6
Q

What is the treatment for normal pressure hydrocephalus?

A

placement of a ventriculoperitoneal shunt

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7
Q

What is the prognosis of normal pressure hydrocephalus?

A

presence of triad, short duration, significant improvement after large volume LP (110-120cc (40 per day))

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8
Q

What is mild cognitive impairment?

A

cognitive complaint and dysfunction of exam but preserved function with no other etiology

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9
Q

What is amnestic mild cognitive impairment?

A

MCI with a memory component

GREATER risk of developing PD (10-15%)

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10
Q

What is the relationship between MCI in pts younger than 55 and dementia?

A

MCI in patients younger than 55 have NO EVIDENCE of a conversion to dementia

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11
Q

What is the most common dementia in ages 60 and over?

A

AD

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12
Q

What is the percentage of the population who is over 80 with AD?

A

50%

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13
Q

What is the first and worst sign of AD?

A

MEMORY

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14
Q

What are other characteristics of AD?

A

should have two or more cognitive domains involved
animal fluency > letter fluency
some functional impairment
amyloid plaques

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15
Q

What does the MRI show with AD?

A

atrophy, particular in the hippocampal regions

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16
Q

What are the risk factors for AD?

A 
AGE
low education
uncontrolled DM
FHx
APOE genotype
Mutations (chromosomes 21, 14, 1)
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17
Q

Is there a correlation between down syndrome and AD?

A

yeas almost all pts with down syndrome have AD by 50 yo

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18
Q

How do we stage and follow AD?

A

MMSE and MoCa

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19
Q

What are the MMSE scores?

A 
>20 = mild
10-20 = moderate
<10 = severe
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20
Q

T/F: AD is misdiagnosed in higher educated pts and under-diagnosed in undereducated.

Study These Flashcards
A

false other way around

21
Q

What is multiple infarct dementia?

Study These Flashcards
A

Step wise deterioration and focal signs and symptoms

strokes on MRI

22
Q

What is subcortical dementia?

Study These Flashcards
A 
gradual and/or stepwise deterioration
no memory problem
letter fluency > animal
MoCA < MMSE
Lacunes and/or white matter changes on MRI
23
Q

What are the four horsemen of neurological Apocalypse?

Study These Flashcards
A

smoking
DM
HTN
hypercholestremia

24
Q

What is an addition risk factor for multi-infarct dementia?

25
What is mixed AD/VD?
they share a common risk factor (DM), these symptoms co occur; need to treat both!
26
What is Lewy Body dementia?
same pathology as parkinsons, but in the cortex | less problems with memory, more with executive function
27
What are the symptoms of LBD?
*early halucinations, rigidity, falls and fluctuating loss of consiousness NEED to have visuospatial dysfunction
28
What is Parkinsons Disease Dementia?
subtle cog problems, memory is less of a problem | low letter fluency and MoCA
29
What are the types of parkinsonian syndromes?
progressive supranuclear palsy | corticobasal degeneration
30
What are the symptoms of progressive supranuclear palsy?
gaze palsy especially on downward gaze early parkinsonism, especially falls and rigidity, less so tremor. more subcortical abnormalities
31
What are the symptoms of corticobasal degeneration?
``` unilateral ideomotorapraxia, agraphesthesia, astereognosis alien hand syndrome myoclonic jerks some parkinsonism GAIT is often preserved until late ```
32
What are the types of frontotemporal lobe degenerations?
frontotemporal dementia progressive non-fluent aphasia semantic dementia
33
How do frontatemporal lobe degenerations compare with PD?
earlier onset (40s)
34
What are the characteristics of frontotemporal dementia?
early odd and innappropriate behavior, food cravings, poor judgement, loss of insight and empathy may test perfectly normal
35
What does the MRI show in pts with frontotemporal lobe dementia?
atrophy in the right frontal and temporal lobes
36
What are the characteristics of progressive non-fluent aphasia?
pt has a loss of luency and language expression early | MRI may show increased atrophy in left frontal and temporal lobes
37
What are the characteristics of semantic dementia?
language is fluent but patient loses the meaning of things, may lose empathy some memory problems MRI may show increased atrophy in bilateral anterior temporal lobes
38
When do we check for dementia?
complaints of chronic memory loss of changes in thinking or behavior if there is a strong FHx of dementia
39
What is the MoCA?
Montreal cognitive assessment (takes 10 min) 30 point scale, 26 or above is normal add a point if not a HS grad
40
What is the typical onset of AD?
gradual and slowly getting worse
41
What are symptoms of AD?
forgetting things changes in language expression or comprehension weakness, numbness, vision loss on one side of body early halucinations early slowing down, gait changes, fall, tremor urinary incontinence paranoia poor judgement disinhibitted behavior strange new food cravings
42
What do we also screen for with AD?
depression
43
What is the association of sleep studies with CPAP?
if pt has symptoms suggestive of obstructive sleep apnea, will help control vascular risk and may help with mild cog symptoms
44
What are non medical treatments for dementia?
exercise and intellectual stimulation
45
Treatments for dementia:
acetylcholinesterase inhibitors (gradually titrate) donepezil- mild, moderate, severe dementia rivastigmine- mild to moderate AD & PD galantamine- mild to moderate AD
46
What is the main side effect of acytlcholinesterase inhibitors?
GI problems, also can have bradycardia, sleep disturbances and muscle cramps
47
What are things to think about when using rivastigmine and galantamine?
rivastigmine- only the last month is therapeutic | galantamine- dont use in MCI, adverse effects
48
What are other treatments for dementia?
memantine (weak NMDA antagonist)- moderate to severe AD ``` Ergoloid mesylates (sympathetic metabolic enhancer)- idiopathic cog decline in elderly SE= bradycardia, feeling of runny nose ```

Medicine II: Neurology (12 decks)

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