Dementia

Question 1

Definition of dementia

Answer 1

• a syndrome of progressive and significant impairment of ADL
• memory loss + 1 other cognitive impairment (language, visuospatial ability, calculation, judgement, problem solving)

Question 2

Major RFs of dementia

Answer 2

age, fhx, low education level, females, vascular disease (smoking, DM, BMI>30, HTN)

Question 3

Mild cognitive impairment

Answer 3

measurable cognitive impairment that does NOT disrupt ADL

Question 4

Neurobiology of dementia

Answer 4

• Disruption of cerebral neuronal circuits
• Memory and cognitive functions (ACh receptors)
• Behavior and mood (noradrenergic, serotonin, dopamine)

Question 5

Alzheimer’s Disease on imaging

Answer 5

diffuse atrophy of cerebral cortex, secondary enlargement of ventricular system, amyloid plaques

Question 6

AD symptoms

Answer 6

MEMORY

frontal lobe: anosognosia, executive fxtn impairment (navigation)
parietal/temporal: aphasia, visuospatial skills
Hippocampus: impaired ability to form new memories

Question 7

Frontal lobe impairment

Answer 7

executive function

anosognosia

Question 8

Parietal/temporal impairment

Answer 8

Language

Visual-spatial skills

Question 9

Hippocampus impairment

Answer 9

impaired ability to form new memories

Question 10

2 types of vascular dementia

Answer 10

multi-infarct

diffuse white matter

Question 11

multi-infarct vascular dementia signs on PE

Answer 11

focal neuro signs: hemiparesis, unilateral Babinski, visual field defect

Question 12

multi-infarct vascular dementia on imaging

Answer 12

multiple lesions with focal damage

Question 13

diffuse white matter vascular dementia

Answer 13

Chronic ischemia small vessels

Insidious and slowly progressive

Question 14

diffuse white matter vascular dementia signs

Answer 14

Pyramidal signs

Cerebellar signs

Question 15

signs of frontotemporal dementia

Answer 15

behavior/mood changes - poor personal and social skills, repetitive behaviors, disinhibition

MEMORY spared

Question 16

Pick’s disease

Answer 16

rare subset of frontotemporal dementia with Pick’s bodies on microscope

Question 17

Parkinsonian dementia

Answer 17

dementia follows Parkinson’s disease

Question 18

What are Lewy Bodies?

Answer 18

very tiny abnormal protein structures found in brain neurons

Question 19

CJD

Answer 19

prion disease of infectious proteins
rapidly progressive dementia
issues with muscle coordination
myoclonus
eventually can't move or speak and enter coma
subtypes: Kuru, Mad Cow

Question 20

Huntington’s Disease

Answer 20

• autosomal dominant degenerative brain disorder

- chorea, behavior disturbances, executive impairment

Question 21

Wernicke’s Encephalopathy

Answer 21

MALNOURISHED individual (freq alcoholic)
Vit B1/thiamine deficiency

Question 22

Where does Vit B12 absorption occur?

Answer 22

distal ileum

Question 23

Korsakoff’s Syndrome

Answer 23

IRREVERSIBLE dementia from CHRONIC B1 deficiency

Question 24

Vit B12 deficiency

Answer 24

pernicious anemia

Question 25

Lewi Body dementia

Answer 25

Abnormal aggregates of proteins that develop in nerve cells of substantia nigra and cortex in PARKINSON’S DISEASE Dementia precedes Parkinsons

Question 26

Most common cause of dementia

Answer 26

Alzheimer's (55%)

Question 27

Drugs that increase incidence of dementia

Answer 27

ANTICHOLINERGICS Tricyclic antidepressants (doxepin) antihistamines (chlorpheniramine) antimuscarinics for bladder control (oxybutynin)

Question 28

Meds to treat cognitive symptoms

Answer 28

Cholinesterase inhibitors: Donepezil (Aricept) Neuropeptide Modifying Agents: Memantine (Namenda) - blocks glutamine

Question 29

Meds to treat behavioral symptoms

Answer 29

SSRI: Prozac (fluoxetine), Celexa (citalopram) Antipsychotics: Risperdone (risperdal)

Question 30

Diffuse atrophy of cerebral cortex

Answer 30

Alzheimer's

Question 31

How is dementia different than delirium?

Answer 31

- delirium has rapid onset (dementia insidious and progressive) - delirium involves hallucinations, agitation, and clouded consciousness (dementia doesn't)

Question 32

Primary deficit of delirium is ______.

Answer 32

attention

Question 33

Primary deficit of delirium is ______.

Answer 33

attention

Question 34

How are dementia and delirium the same?

Answer 34

both have memory impairment and confusion

Question 35

78 yo who has is admitted due to visual hallucinations, inconsistent participation in personal care activities, inability to manage at home. DDXs?

Answer 35

Lewy Body dementia Alzheimer's/vascular dementia Delirium

Question 36

Medication with biggest risk of delirium

Answer 36

Benzodiazepines

Question 37

When is the best time to use benzodiazepines for delirium?

Answer 37

using benzos for alcohol withdrawal and DTs (delirium tremors) can be life-saving * also use for acute seizures