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Flashcards in Dementia Deck (45)
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1

Delirium

1. A disturbance in attention (i.e., reduced ability to direct, focus, sustain, and shift attention) and awareness (reduced orientation to the environment).

2. The disturbance develops over a short period of time (usually hours to a few days), represents a change from baseline attention and awareness, and tends to fluctuate in severity during the course of a day.

3. Theres a disturbance in cognition (e.g., memory deficit, disorientation, language, visuospatial ability, or perception).

2

Types of dementia

-Alzheimer’s
-Frontotemporal
-Lewy Body
-Parkinson’s Vascular
-Huntington’s
-HIV
-Traumatic Brain Injury
-Prion Disease

3

Dementia causes a progressive decline in intellectual functioning severe enough to _______

interfere with person’s normal daily activities and social relationships

4

Dementia causes progressive declines in

-memory
-visual-spatial relationships
-performance of routine tasks
-language and communication skills
-abstract thinking
-ability to learn and carry out mathematical calculations

5

2 categories of dementia

Reversible and Irreversible

*Individuals must have intensive medical physical to rule out reversible types of dementia

6

Reversible causes of dementia

"DEMENTIA"
D-drugs, delirium
E-emotions (depression) & endocrine disorders
M-metabolic problems
E-eye & ear problems
N-nutritional disorders
T-tumors, toxicity, trauma to head
I-infections
A-alcohol, arteriosclerosis

7

Irreversible causes of dementia

-Alzheimer’s
-Lewy Body Dementia
-Pick’s Disease (Frontotemperal Dementia)
-Parkinson’s
-Heady Injury
-Huntington’s Disease
-Jacob-Cruzefeldt Disease

8

Alzheimer’s Dementia

-Insidious onset/gradual progression
-Memory & learning impairment, sometimes executive impairment
-Then perceptual-motor & language impairment
-Social cognition affected late in disease
-Gait disturbance, dysphagia, incontinence, myoclonus, seizures
-5% Diagnosed between around age 65, prevalence increases steeply, esp in 80s
-Mean survival 10yrs after diagnosis

9

Alzheimer's dementia- About 0.1 % autosomal dominant inheritance, which have an onset before age

65
-This form of the disease is known as early onset familial Alzheimer's disease

10

Alzheimer's dementia-
Most of autosomal dominant familial AD can be attributed to mutations in one of three genes:

-those encoding amyloid precursor protein (APP)
-those encoding presenilins 1 and 2

*Most mutations in the APP and presenilin genes increase the production of a small protein called Aβ42, which is the main component of senile plaques.

11

Most cases of Alzheimer's disease do not exhibit

autosomal-dominant inheritance

12

Alzheimer's dementia- environmental and genetic differences may act as risk factors. The best known genetic risk factor is the

inheritance of the ε4 allele of the apolipoprotein E

13

know mini mental status exam

in other deck too

14

Frontotemporal Dementia

-Encompasses Pick’s disease and several related illnesses.

-Insidious onset/gradual progression

-Reflect loss of frontal and temporal lobe function

-FT dementia accounts for 15% cases of dementia

-Higher proportion in individuals younger than 65

*Tau inclusions, pick bodies

15

Symptoms of Frontotemporal Dementia

-Broad decline in insight
-Social skills, interpersonal conduct
-And executive functioning
-Mental rigidity
-Easily distractibility, labile affect and speech and language impairments
(echolalia and perseveration)
-Disinhibition
-Apathy
-Loss of sympathy/empathy
-Perseverative or compulsive behavior
-Hyperorality and diet changes

16

Frontotemporal Dementia shows a prominent decline in ______, but a relative sparing of _________

-prominent decline in social cognition or executive abilities
-also decline in language ability, object naming, grammar
-Relative sparing of learning, memory, and perceptual-motor function

17

Frontotemporal Dementia average age of onset is

53 years followed by fatal progression lasting less than 4 years

18

Compared to Alzheimer’s disease, FT Dementia does not have impairments in

visual-spatial abilities – a function governed largely by the parietal lobes

-maintain their ability to copy a picture but not to draw one from their memory.
-do not lose their sense of direction, even in new surrounding
-do not manifest constructional apraxia

19

FT shows prominent personality and behavioral disturbances accompanied by only relatively mild ________

memory impairment

20

On CT/MRI, FT shows

-Frontal and anterior temporal lobes are atrophic. -Plaques and tangles are uncommon or absent

*Pick’s disease – neurons containing argentophilic (silver staining) inclusions (Pick bodies)

21

FT has some gene mutations, 10% linked to mutant gene on _______

chromosome 17, which codes for tau (MAPT)

22

Dementia with Lewy Bodies

-Cognitive decline, ≥1 yr prior to onset of parkinsonism features
-Fluctuating cognition w/ variations in attention/alertness (looks like delirium)
-Recurrent VH
-REM sleep behavior disorder
-Severe neuroleptic sensitivity (50%)
-Lewy bodies have greater distribution than in Parkinson’s

23

Dementia with Lewy Bodies age

Older than 65

-sometimes initially diagnosed as alzheimer's

24

Pathology of Dementia with Lewy Bodies age

-abundance of intracytoplasmic inclusions (lewy bodies) in cerebral cortex neurons that stain with alpha- synuclein antibodies
-Concentration of lewy bodies correlates with dementia
-Similar to Alzheimer’s disease, but older individuals with nonspecific cognitive deficits.

25

Non-cognitive features of Dementia with Lewy Bodies (aka-S/S)

-characterized by mild extrapyramidal features, masked face, bradykinesia, and gait impairment.
-sudden unexpected changes in cognition, attentiveness and alertness; mimics episodes of delirium or toxic-metabolic encephalopathy
-Visual Hallucinations: detailed visions of people and animals, associated with lewy bodies in the temporal lobes
-Visual hallucinations also frequently develop in pts with advanced Alzheimer’s and Parkinson’s disease – but not at the onset of these illnesses

26

About 50% of patients with Dementia with Lewy Bodies have REM sleep behavior disorder, which consists of

running, punching, and similar motions while asleep

27

DLB is similar to extrapyramidal symptoms you see in Parkinson’s however DLB does not __________

repond to Parkinson’s treatment with L-dopa

-also pt will have visual hallucinations

28

DLB pt with visual hallucination can be treated with

-antipsychotic agents
-dopamine blockers, readily produce pronounced extrapyramidal signs
-small amounts of antipsychotic agents can cause EPS (extrapyramidal symptoms)

29

DLB treatment- what to give for cognitive function and visual hallucinations

Cholinesterase inhibitors stabilize or improve cognitive function and reduce visual hallucinations for several months

30

DLB treatment- what will help REM sleep behavior disturbance

Long acting benzodiazepines, such as clonazepam, suppresses the REM sleep behavior disturbance