Flashcards in Dementia Deck (60):
impair 2/5 functional domains: memory, emotion, executive, language, visuospatial- impacts ADL
mild cognitive impairment
doesn't meet criteria for dementia bc no impairment in function. RF for alzheimer's bc 15% dev dementia annually
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
AD v brain areas
atrophy of medial temporal lobe (hippocampi). preserve primary motor and visual cortices. over time --> diffuse brain atrophy.
pittsburg compound B
used in PET scans to image beta amyloid plaques in the brain and is used in research for AD
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
improve AD pt's functional ability. dear glutaminergic overstimulation by inhibiting NMDA R.
mut amylod precursor. age of onset of AD decr as #apolipoprotein E e4 alleles incr
cortical neuritic plaques and neuronal loss in cerebral cortex. -these are seen in elderly pt without clinical dementia too.
neurodev model for alzhmeimers inevitable
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.
delirium v AD
there are fluctuations of arousal in delirium
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
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
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
composed of alpha synuclein. seen in many neuro D like parkinson
parkinson v DLBD
both have parkinsonism, motor sx, gait abn, deficits of executive fun. fluctuating cognition and attention/alertness supports DLBD
charles bonnet syndrome
mentally healthy with sig visual loss. visual hallucination- animal ppl. know they aren't real.
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
dopamine agonist for parkinson disease. one SE is incr impulsivity like gambling or hyper sexual behavior
wenicke-korsakoff syndrome. patho,
necrosis of maxillary bodies. due to def of thiamine/vit B1. giving glu bc thiamine trigger change in Mental status
wenicke-korsakoff syndrome sx
1) ataxia- mainly gait
3) eye movement abn including nystagmus and ophthalmoparesis
amnesia and confabulation= unintentional creation of false memories or beliefs. rapid clinical onset.
korsakoff pt types
1) chronic alcoholic + IV glucose in ER
2) ICU pt
3) post gastric bypass pt
= prison psychosis- syndrome of approximate answers. in prison inmates to manipulate legal situation. form of malingering
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
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
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
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
MRI: bilateral hyperintesity of mdial temporal lobe and frontal lobes. CSF show anti-Hu ab.
paraneoplastic limbic encephalitis
most commonly associated with small cell lung carcinoma. in young otherwise health girls, more likely associated with ovarian tumor
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
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
transcortical sensory aphasia
lesion in arcuate fasiculus. mild word finding problem, sig trouble naming obj, can't repeat phrases, can follow simple commands
lesion in right inferior frontal gyrus. improper intonation.
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
lesion in cingulate gyrus bilaterally - only speak in extreme duress
involve in emotions and reg aggressive behavior. abn found in schizophrenia and OCD
MCA v aphasia
supply bloc's and wernicke's
due to problem of vocal cord- sound hoarse or breathy
speech problem due to bad M of articulation
language problem from brain injury
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
transcortical motor aphasia
as per broca with intact repetition
transcortical sensory aphasea
as per wernicke's with intact repetition
broc + wernicke. mute. sig weakness
mixed transcortical aphasia
~ global with intact repetition
can't name obj
make up words
phonemic paraphrasia/ literal paraphrasia
mispronuciation, syllables out of seq.
substituted word is related to intended word.
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
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
right parietal lobe
neglect. don't realize there is a problem with CL side of body
fusiform gyrus of temporal lobe. lose facial recognition
parietal lobe/primary somatosensory cortex lesion. can't rec obj by touch
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.
denial of blindness due to damage in bilateral occipital lobes.
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
sleep a lot. awake-spacey, childlike. at times, hungry and hypersexual
emotional outburst without matching feelings. tx by dextromethorphan/quinidine. seen in MS, ALS, AD