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Dementia Flashcards

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1
Q

disorder affecting the cerebral cortex that plays a critical role in thinking like memory and language

A

cortical dementia

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2
Q

signs of cortical dementia include

A

memory loss
aphasia
apraxia
agnosia

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3
Q

dysfunction in the parts of the brain that are beneath the cortex

A

subcortical dementia

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4
Q

the ______pathways facilitate speed and efficiency of thought

A

frontostriatal pathways

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5
Q

What is the pyramidal system

A

motor system with fibers originating from the cerebral cortex; corticospinal tract called pyramid in medulla

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6
Q

What is the extramyrapidal system

A

motor system with fibers originating from the basal ganglia and cerebellum

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7
Q

what are signs and symptoms of parkinsonism

A

tremor
bradykinesia
cogwheel rigidity
postural instability

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8
Q

acquired persistent decline of intellectual functioning; impaired memory and atleast one other cognitive domain, impairs ADL’s, NO clouding of the sensorium and NO underlying psychiatric disease

A

dementia

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9
Q

what percentage of people get dementia over age of 65

A

10%

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10
Q

what percentage of people over the age of 85 get dementia

A

up to 50%

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11
Q

memory impairment in people who are NOT demented and have INTACT ADL’s (activity of daily living)

A

mild cognitive impairment

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12
Q

approximately what percentage of people progress to dementia

A

6-25%

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13
Q

most common dementia over the age of 65

A

alzheimer disease

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14
Q

a progressive, degenerative brain disease characterized by memory loss and loss of other cognitive function

A

alzheimer disease

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15
Q

what are the risk factors for alzhimer disease

A

down syndrome, family history of alzheimer and advanced age

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16
Q

what type of dementia is characterized by loss of short term memory early with changes in behavior, personality, judgement and ADL’s

A

alzheimer disease

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17
Q

beta secretase plays a significant role in what disease

A

Alzeheimer disease

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18
Q

cholingergic defiency in the cortex and basal forebrain is associated with

A

alzheimer disease (contributes to cognitive deficits)

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19
Q

how does glutamate contribute to the pathogenesis of alzheimer disease

A

by overstimulating various glutamate receptors leading to excitotoxicity and neuronal cell death

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20
Q

late onset alzheimer disease is assoicated with what chromosome

A

19 (most common)

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21
Q

what chromosomes are associated with early onset alzheimer disese

A

chromosomes 1,14,and 21

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22
Q

familial alzheimer disease is what type of geneic disease

A

autosomal dominant involving APP gene chromosome 21 or presenilin 1 protein gene-chromosome 14

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23
Q

how do you diagnose AD

A

clinical + histopathological-extracellular deposition of amyloid beta protein, intracellular neurofibrillary tangles and loss of neurons especially in the hippocampus

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24
Q

extracellular deposits in AD

A

neuritic plaques

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25
intracellular deposits in AD
neurofibrillary tangles
26
donepezil
treatment of mild, moderate or severe dementia
27
rivastigmine
treatment of mild to moderate dementia and is also used for dementia related to PD
28
what are the four cholinesterase inhibitors
donepezil rivastigmine tacrine galantamine
29
used to treat AD is a cholinesterase inhibitor and is associated with abnormal liver function tests
tacrine (Cognex)
30
what is measured for people being treated with tacrine
serum transaminases
31
what are the adverse effects of cholinesterase inhibitors
``` nausea, vomitting diarrhea anorexia weight loss bradycardia heart block, syncope insomnia ```
32
what is the name of the one NMDA receptor antagonist used to treat AD
memantine (namenda)
33
what are the adverse effects of memantine
constipation hypertension dizziness headache
34
are drugs a cure for alzheimers diesase
NO
35
parkinsonism visual hallucinations fluctuating cognitive impairment
diffuse lewy body dementia
36
decreased levodopa responsivity is a characteristic of
dementia with lewy bodies
37
significant fluctuations in cognition is common in
DLB
38
this type of dementia usually occurs before, at the same time or very shortly after development of parkinsonian signs
dementia with lewy bodys
39
what are the two troublesome clinical symptoms associated with DLB
hallucinations and agitation
40
what is the first line of drug for DLB
acetylcholinesterase inhibitors (rivastigmine or donepezil)
41
what is the second line of drug for DLB
atypical neuroleptics (clozapine, quetiapine, and aripiprazole)
42
what drugs should you avoid in DLB
haloperidol because of neuroleptic sensitivity
43
DOC for depression in DLB
SSRI's
44
history of one or more strokes with a characteristic stepwise course of memory decline
multi-infract dementia-"vascular dementia"
45
age of onset for vascular dementia is
65 years old
46
predominant involvement of the lower extremities is what type of dementia
vascular dementia
47
focal neurologic signs is characteristic of
vascular dementia
48
frontal dysfunction in vascular dementia may lead to
dysexecutive syndrome with abulia and apathy
49
due to prevalence of mixed pathology what should possibly be prescribed in pts with vascular dementia
cholinesterase inhibitors
50
subcortical arteriosclerotic encephalopathy, multiple infracts in WHITE matter
binswanger disease
51
what chromosome is affected in CADASIL
chromosome 19, notch 3 gene
52
prominent frontal lobe symptoms, early onset, behavior changes and atrophy of frontal and anterior temporal lobes
frontotemporal dementia
53
behavioral variant is the most common form of
FTD
54
what is the first deficit in progressive non-fluent aphasia
anomia
55
fluent with impaired comprehension
semantic dementia
56
link between FTD and ALS
20-40% of FtD is familial and ALS and FTD linked to chromosome 9
57
what percentage of people are affected in individuals with parkinson diseast over age of 60
1%
58
symptom of parkinson disease is due to lack of
striatal dopamine
59
what is the typical age of onset for parkinson disease
over 55 yo
60
characterized by resting tremor, rigidity, bradykinesia and postrual instability
PD
61
lewy bodies
PD
62
risk of dementia with PD increases if
age of onset age of pt duration and severity of illness
63
executive dysfunction, visuaspatial impairments, and verbal memory
PD dementia
64
test of face recognition are in particular impared early in the course of
PD
65
what has been found to be a more accurate brief bedside test for PDD
MOCA
66
antipsychotics for PD
not approved for treatment of behavioral disorders in pts with dementia
67
two antipsychotics for PD
quetiapine and clozapine
68
drugs used for PD
cholinesterase inhibitors, rivastigmine, donepezil, NO anticholinergic meds, low dose quetiapine and clozapine
69
what is age of onset for progressive supranuclear palsy
45-75
70
symmetric onset of bradykinesia and rigidity; RARE TREMOR, vertical supranuclue gaze palzy with downward gaze abnormlaities, prominent postural instability with unexplained fall
progressive supranuclear palsy
71
looks worried associaed with
PSP
72
startled expression, lid retraction and masked facies
PSP
73
MRI of PSP advanced cases reveals
midbrain atrophy thinning of quadrigeminal plate dilation of the 3rd ventricle
74
what disorders should you rule out in PSP
whipple diases
75
what is the CNS WD traid
dementia vertical opthalmoplegia myoclonus
76
examples of reversible dementias
``` normal pressure hydrocephalus vitamin B12 deficiency hypothyroidism syphillis MEDS metabolic disorders tumors alcohol related ```
77
what percentage of dementias are reversible
10%
78
triad of normal pressure hydrocephalus
dementia ataxia/apraxia incontinence (wet, wacky, and wobbly)
79
MRI of normal pressure hydrocephalus
ventriculomegaly out of proportion to sulcal enlargement and NO evidence of CSF flow obstruction
80
how does normal pressure hydrocephalus occur
idiopathic(elderly) secondary-any age after subarachnoid hemorrhage or menigitis (impaired CSF absorption and inflammation and subsequent fibrosis of the arachnoid granulations)
81
how do you diagnose normal pressure hydrocephalus
H and P MRI or CT Scan Indium cisternogram
82
treatment of normal pressure hydrocephalus
shunt
83
what are three rapidly progressing dementias
CJD HIV chronic meningitis
84
extrapyramidal features and startled induced myoclonus indicative of
CJD
85
CSF indiciates ______ in CJD
14-3-3 protein
86
EEG-pattern of periodic sharp waves or spikes
CJD
87
degenerative brain disease from history of concussions
chronic traumatic encephalopathy
88
cognitive impairment, depression and irrational and impulsive emotional behavior
chronic trauamtic encephalopathy
89
abnormal tau deposition
chronic tramautic encephalopathy
90
increased behavior problems in evening/night
sundowning
91
typically dimented and instiitionalized pts
sundowning
92
how is sundowning managed
reorientating the patient and INCREASED lighting
93
disturbance of consciousness, cognitive change not accounted for by preexisting dementia, develops over a short time period and symptoms fluctuate over the day
Delirium
94
acute, transient, potentially reversible confusional state
delirium
95
delirum occurs in what percentage of patients
10-50% of surgical patients
96
risk factors for delirium include
underlying brain disease such as CVA, dementia
97
confusion asessment method
acute onset and fluctuating course and in-attention and either disorganized thinking OR altered level of consciousness
98
greater than how many errors indicates an abnormality with the A test
greater than 2
99
A test, test for
inattention
100
environmental treatment for delirum
clock calendar lighting
101
medications for delerium
thiamine | haloperidol, atypical antipsychotics and benzodiaxepines
102
500 mg/dl alcohol
respiratory paralysis
103
400 mg/dlalcohol
coma
104
300 mg/dl alcohol
stupor with combativeness, incoherent speech, omiting
105
150-200 mg/dl
slurred speach, ataxia, anger, diplopia, labile mood, dorwsiness
106
50-150 mg/dl
euphoria, shyness, friedliness, impaired concentration and judgement
107
tremulousness
most common alcohol withdraw symptom, insomnia, agitation, increased sympathetic activity
108
formication
crawling feeling
109
occurs 48-72 hours after the last drink and usually follows seizures, if a seizure occurs during DTs think of another cause (ex: meningitis)
delirium tremens
110
characteristic of DT
similar to withdrawal but also have fever, tachycardia, sweating
111
mortality associated with DT is usually from
cirrhosis,shock, and pneumonia
112
treatment of delirium tremens
``` prevention sedation with benzodiazepine, phenobarbital fluids, electrolytes, glucose nutrition, vitamins treat underlying condition ```
113
acute syndrome, thiamine defiency, diffuse axonal neuronal and myelin loss, petechial hemorrhages, global confusion, impaied memory, inattentiveness, abnormal eye movements, ataxia
wernicke encephalopathy
114
what should be concidered in the differential diagnosis in all patients with acute delirium or acute ataxia
wernicke encephalopathy
115
what is the treatment for wenicke encepahlopathy
thiamine
116
transketolase deficiency indicates
thimaine deficiency
117
can be precipitated by giving IV glucose to thiamine deficient patients before glucose in susceptible pts
wernicke encepahlopaty
118
amnesia, confabulation, impaired sight, lesion in dorsal medial nucleus of thalamus, mammillary bodies and brain stem, usually memory deficits remain despite treatment
korsakoff syndrome
119
altered brain function from metabolic abnormalties which are a consequence of liver dysfunction
hepatic encephalopathy
120
what is the best characterized neurotixin that preciptates HE
ammonia
121
clinical features of hepatic encepahlopathy
``` distrubed sleep bradykinesia asterixis rigidity hyperative DTS ```
122
stage 1 HE
euphoria confusion sleep disorder
123
stage 2 HE
lethargy, confusion, asterixis
124
stage 3 HE
marked confusion, slurred speech, sleep
125
stage 4 HE
coma
126
treatment of HE
eliminate underlying cause if possible
127
drugs to reduce serum ammonia
lactulose and neomycin
128
confusion, ataxia and nystagmus
wernicke encepahlopathy
129
dementia ataxia incontinence
normal pressure hydrocephalis
130
ataxia, areflexia, ophthalmoparesis
miller fisher variabt of GBS

Clinical Neurosciences (16 decks)

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