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Neurology > Dementia > Flashcards

Flashcards in Dementia Deck (60):
1

dementia

impair 2/5 functional domains: memory, emotion, executive, language, visuospatial- impacts ADL

2

mild cognitive impairment

doesn't meet criteria for dementia bc no impairment in function. RF for alzheimer's bc 15% dev dementia annually

3

types of memory

episodic- persoanl experiences, primary affected in AD. semantic memory- facts. declarative memory- semantic + episodic memory.. procedural - how do do things= less affected

4

AD v brain areas

atrophy of medial temporal lobe (hippocampi). preserve primary motor and visual cortices. over time --> diffuse brain atrophy.

5

pittsburg compound B

used in PET scans to image beta amyloid plaques in the brain and is used in research for AD

6

cholinesterase inhibitors

used to improve functional and psychiatric sx in early stages of alzheimers. but don't delay natural history of alzheimer. works bc acetylcholine is made in nucleus baseless of meynert. ex donepezil

7

memantine (damenda)

improve AD pt's functional ability. dear glutaminergic overstimulation by inhibiting NMDA R.

8

familial AD

mut amylod precursor. age of onset of AD decr as #apolipoprotein E e4 alleles incr

9

AD patho

cortical neuritic plaques and neuronal loss in cerebral cortex. -these are seen in elderly pt without clinical dementia too.

10

down syndrome

neurodev model for alzhmeimers inevitable

11

AD

age is most important RF. W>M. high edu is protective, most common demential in pt >65. dx can't be made solely on MRI findings.

12

delirium v AD

there are fluctuations of arousal in delirium

13

evaluate pt with dementia

goal: find reversible cause- in minority of pt.
1) electrolyte panel, renal func, hepatic func, TSH, serologic test for syphilis, B12, UA, tox screen, HIV test
2) neuroimaging
3) complete list of medication looking specifically for anticholinergic med, benzodiazepine, opiates
5) LP and EEG only when there are red flags - early onset or rapidly progressing dementia, IC pt, focal neurological findings, sign of systemic illness
6) demential v delirium

14

diffuse lewy body disease (DLBD)

Main: cog decline. fluctuating condition with variation in attention and alertness. prominent visual hallucinations, may have sx of parkinsonism, motor sx (bradykinesia and gain abn). pt are hypersensitive to antipsychotics. sleep disturbance and orthostatic hypotension. def of executive fun

15

lewy body

composed of alpha synuclein. seen in many neuro D like parkinson

16

parkinson v DLBD

both have parkinsonism, motor sx, gait abn, deficits of executive fun. fluctuating cognition and attention/alertness supports DLBD

17

charles bonnet syndrome

mentally healthy with sig visual loss. visual hallucination- animal ppl. know they aren't real.

18

frontaltemporal lobe degeneration

aka pick's disease. 1) behavioral disinhibition/poor judgment( conduct prob, antisocial, substance use, novelty seeking, impulsitivity, HIV related risk behavior) can get 2) apathy, abulia. 3) language disturbance- dv global language difficulties- primary progressive aphasia.
unusual features include: dev new artistic skills. norm memory and general intelligence, basic labs, to screen
occur at younger age and more rapid than other demential. memory is often unaffected

19

ropinirole (requip)

dopamine agonist for parkinson disease. one SE is incr impulsivity like gambling or hyper sexual behavior

20

wenicke-korsakoff syndrome. patho,

necrosis of maxillary bodies. due to def of thiamine/vit B1. giving glu bc thiamine trigger change in Mental status

21

wenicke-korsakoff syndrome sx

1) ataxia- mainly gait
2) encephalopathy
3) eye movement abn including nystagmus and ophthalmoparesis
amnesia and confabulation= unintentional creation of false memories or beliefs. rapid clinical onset.

22

korsakoff pt types

1) chronic alcoholic + IV glucose in ER
2) ICU pt
3) post gastric bypass pt

23

ganser's syndrome

= prison psychosis- syndrome of approximate answers. in prison inmates to manipulate legal situation. form of malingering

24

vascular dementia

present in step wise fashion. focal neuro deficit. RF- stroke (age, HTN, DM, smoking, lipids). can present after stragitacally placed lesion to hippocampus, medial thalamus, or caudate nucleus. often occur in conjunction with other dementing processes like alzheimers

25

normal pressure hydrocephalus

triad: magnetic gait, dementia, urinary urgency/ freq (wobbly, weird, wet) gait is apraxia and pt can mimic walking while lying or sitting. tx. ventriculoperitoneal shunt (at risk for dev subdural hematoma due to dear ICP that pulls brain away from meninges --> tears veins). dx: continuous lumbar drain.
cause: previous pathology in subarachnoid space (meningitis, subarachnoid blood) that interfere with reabsorption of CSF in arachnoid granulation

26

shunt surgery pt need

1 of 4. 1) clearly identified etiology of hydrocephalus 2) gait difficulties >cog impairment 3) substantial improvement after CSF removal 4) no atrophy and WM lesions on imaging

27

transient global amnesia

complete and reversible anterograde and retrograde memory loss lasting up to 24hr. often occur in emotional or sexual activity. migraine phenomenon. rarely recurs though pt need to be worked up for vascular disease and epilepsy. tx with observation bc self limited disorder.
MRI show temporary abn in hippocampus

28

limbic encephalitis

MRI: bilateral hyperintesity of mdial temporal lobe and frontal lobes. CSF show anti-Hu ab.

29

paraneoplastic limbic encephalitis

most commonly associated with small cell lung carcinoma. in young otherwise health girls, more likely associated with ovarian tumor

30

kluver-bucy syndrome

hypersexuality, plaicidity - decr fear response. docile in settings that should trigger fear, aggressiveness, anger. hyperphagia and hyperorality-overeat + examine obj with mouth, pica. visual agnosia- can't rec familiar faces or obj

31

wenicke's aphasia

receptive, sensory, fluent aphasia. can't understand language. correct grammar but nonsensical. can't repeat phrases or follow complex commands. not aware of deficit. not associated with weakness

32

transcortical sensory aphasia

lesion in arcuate fasiculus. mild word finding problem, sig trouble naming obj, can't repeat phrases, can follow simple commands

33

abnormal prosody

lesion in right inferior frontal gyrus. improper intonation.

34

pure word deafness

bilateral lesion in primary auditory cortex in the superior temporal lobe or disruption of connection between these areas. can't comprehend speech meaning, but can hear sounds, speak, read, write

35

akinetic mutism

lesion in cingulate gyrus bilaterally - only speak in extreme duress

36

cingulate gyrus

involve in emotions and reg aggressive behavior. abn found in schizophrenia and OCD

37

MCA v aphasia

supply bloc's and wernicke's

38

dysphonia

due to problem of vocal cord- sound hoarse or breathy

39

dysarthria

speech problem due to bad M of articulation

40

aphasia

language problem from brain injury

41

broca's

expressive, non-fluent aphasia. can't produce language or repeat phrases, intact comprehension, aware of deficit. associate with weakness. when recovery can become a transcortical motor aphasia

42

transcortical motor aphasia

as per broca with intact repetition

43

transcortical sensory aphasea

as per wernicke's with intact repetition

44

global aphasia

broc + wernicke. mute. sig weakness

45

mixed transcortical aphasia

~ global with intact repetition

46

anomic aphasia

can't name obj

47

neologism

make up words

48

phonemic paraphrasia/ literal paraphrasia

mispronuciation, syllables out of seq.

49

semantic paraphrasia

substituted word is related to intended word.

50

gerstmann's syndrome

lesion to dominant angular gyrus-area of parietal lobe near superior edge of temporal lobe. agraphia-def in writing. acalculia- def in learning or comprehending math. finger agnosia- can't distinguish fingers on hand. left-right confusion

51

apraxia

disorder of skilled mvt not caused by weakness, akinesia, deafferentation, ab tone or posture, mvt disorders like tremor or chorea, intellectual deterioration, poor comprehension or uncooperativeness

52

right parietal lobe

neglect. don't realize there is a problem with CL side of body

53

prosopanosia

fusiform gyrus of temporal lobe. lose facial recognition

54

astereoagnosia

parietal lobe/primary somatosensory cortex lesion. can't rec obj by touch

55

alexia without agraphia

lesion in left occipital lobe ++ splenium. could be caused by infarction of PCA. visual info only reach only the right occipital lobe but can't be processed by language areas on left. so can't read but can write.

56

anton's syndrome

denial of blindness due to damage in bilateral occipital lobes.

57

balint's syndrome

damage to both posterior parietal lobes.
1) optic ataxia- incoordination of hand and eye mvt
2) oculomotor apraxia- no voluntarily guide eye mvt
3) simultanagnosia- inaility to perceive more than 1 obj at a time in one's visual field

58

kleine-levin syndrome

sleep a lot. awake-spacey, childlike. at times, hungry and hypersexual

59

pseudobulbar palsy

emotional outburst without matching feelings. tx by dextromethorphan/quinidine. seen in MS, ALS, AD

60

alien hand syndrome

associated with demential, it occur in corticobasal dengeneration. cones of epilepsy surgery where corpus callosum is severed to prevent generalization of seizures.