Dementia

Question 1

An acquired syndrome of decline in memory and other cognitive functions sufficient to affect daily life in an alert patient

Answer 1

Dementia

Question 2

Is dementia an inherent part of aging?

Answer 2

No!

Question 3

What percentage of people over the age of 65 have Alzheimer dementia? What about over the age of 85?

Answer 3

Greater than 65 – 6-8%

Greater than 85 – 45%

Question 4

What is the most common type of dementia?

Answer 4

Alzheimer Disease

Question 5

What is the second most common cause of dementia?

Answer 5

Lewy body dementia

Question 6

this type of dementia is caused by amyloid plaques and tau neurofibrillary tangles

Answer 6

Alzheimer Disease

Question 7

This type of dementia is caused by cytoplasmic alpha-synuclein inclusion bodies

Answer 7

Lewy body and Parkinson dementia

Question 8

This type of dementia is caused tau or ubiquitin proteins

Answer 8

Frontotemproal dementia

Question 9

What are some definite protective factors for dementia?

Answer 9

We don’t know!

Question 10

What is the biggest risk factor for dementia?

Answer 10

Age

Question 11

What are thought to be possible protective factors for Alzheimer disease?

Answer 11

NSAIDs, antioxidants, intellectual activity, physical activity, and statins

Question 12

What chromosome is associated with dementia?

Answer 12

19

Question 13

What are three key parts to a physical exam when assessing a dementia patient?

Answer 13

Neurologic status, mental status, and functional status

Question 14

What are some routine labs that should be ordered when assessing a possible dementia patient?

Answer 14

CBC, Na+, BUN/Cr, fasting glucose, RPR, TSH, vitamin B12 level

Question 15

When should you consider brain imaging as part of your assessment?

Answer 15

If onset occurs at age less than 65

Neurologic signs are asymmetric or focal

Clinical picture suggests normal-pressure hydrocephalus

Patient has had recent fall or other head trauma

Question 16

What are some distinguishing signs that separate delirium from dementia?

Answer 16

1. Acute onset
2. Cognitive fluctuations over hours
3. Impaired consciousness and attention
4. Altered sleep cycles

Question 17

Is vascular dementia a gradual or sudden onset?

Answer 17

Can be either

Question 18

What is the difference between Lewy Body Dementia and Parkinson’s dementia?

Answer 18

The chronology of symptoms and pattern of cognitive deficits

If Parkinson disease has been diagnosed or has been present for 2 or more years before cognitive symptoms are seen, probably parkinson disease dementia.

If parkinsonian symptoms are present at the same time as cognitive symptoms, a diagnosis of dementia with lewy bodies should be considered

Question 19

Frontotemporal dementia is usually a gradual or sudden onset? are patients usually older or younger than 60?

Answer 19

Gradual onset

Usually age less than 60

Question 20

How many dementia stages are there?

Answer 20

7

Question 21

Individuals in this stage of dementia feel as if they are having memory lapses, especially in forgetting familiar words or names.

Answer 21

Stage 2

Question 22

When do friends and family members typically begin to notice signs of dementia?

Answer 22

Stage 3

Question 23

At what stage does some assistance with day-to-day activities become essential?

Answer 23

Stage 5

Question 24

At what stage do patients lose the ability to respond to their environment, speak, and lose control of movement?

Answer 24

Stage 7 – final stage

Question 25

What are some nonpharm treatments for dementia?

Answer 25

Cognitive rehabilitation, group therapy, physical and mental activity Environmental modification-- orientation and memory measures such as clocks, calendars, to-do lists, visual clues

Question 26

What class of drugs is commonly used to treat dementia?

Answer 26

Cholinesterase inhibitors -- donepezil, rivastigmine, galantamine

Question 27

Do we recommend the use of cholinesterase inhibitors for the treatment of vascular dementia?

Answer 27

No

Question 28

Do we recommend use of cholinesterase inhibitors for the treatment of frontotemporal dementia?

Answer 28

No -- often worsens agitation

Question 29

What are four common causes of behavioral disturbances that may present like dementia?

Answer 29

1. Infection 2. Dehydration 3. Constipation 4. Medication toxicity

Question 30

Have pharm or non-pharm treatments shown to be more effective for behavioral disturbances in dementia?

Answer 30

Non-pharm. Always try non-pharm treatments before trying medication

Question 31

In patients with depression that lasts 2 weeks or more and results in significant distress, a trial of _______ should be strongly considered.

Answer 31

Antidepressants

Question 32

If depressive symptoms last longer than 2 months after behavioral therapy interventions have been implemented, treatment with _________ is warranted.

Answer 32

Antidepressant

Question 33

What medications can we use for manic symptoms?

Answer 33

Valproic acid and carbamazepine

Question 34

What two classes of medications should be avoided in dementia patients?

Answer 34

Benzo's and anticholinergics

Question 35

What is the primary goal of dementia treatment?

Answer 35

Enhance quality of life and maximize function by improving cognition, mood, and behavior