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Flashcards in Dementia Deck (71):
1

Three memory systems:

-short term --> long term --> sensory memory

2

How long does information stay in short term memory? long term?

-15-20 seconds in short term
-days to lifetime in long term

3

Common dementia symptoms in newly diagnosed MCI patients:

-impaired orientation
-poor short term memory

4

Psych symptoms assc with newly diagnosed dementia:

-anxiety
-depression
-paranoia

5

List the 8 primary neurodegenerative disorders:

1) AD
2)FTD
3) PD
4)DLB
5) PSP
6) HD
7) WD
8) CJD

6

List the three vascular dementias

1) multi infarct
2) Binswangers
3) CADASIL

7

Three specific infectious causes of dementia

1) syphilis
2) Lyme
3) HIV

8

#1 Form of Dementia

AD

9

What MMSE score is diagnostic of mild moderate and severe A. dementia?

20-24, 11-19, less than 10

10

Symptoms of severe AD

apraxia
mutism
no recall

11

Criteria for diagnosing AD:

-GRADUAL memory impairment affecting social/occupational functioning
-Cognitive disturbance (aphasia, apraxia, etc)

12

Three areas of brain + 1 NT involved in pathogenesis of AD:

-hippocampus, cerebral cortex, amygdala
-Ach

13

Specific cholinergic changes in the brain during AD:

1) reduced choline acetyltransferase activity
2) decreased neurons in forebrain
3) loss of nicotinic receptors in hippocampus/cortex

14

What do presynaptic nicotinic receptors modulate?

Release of Ach, glutamate, serotonin, NE

15

Gross changes in AD:

cerebral atrophy
hydrocephalus ex vacuo

16

Senile plaques:
-location
-makeup
-stain

-cortex
-fragmented neurites, astrocytes, microglia
-silver stain

17

NF Tangles
-location
-makeup
-stain

-pyramidal cells of hippocampus + cortex
-intracytoplasmic twisted filaments
-H/E

18

Earliest AD lesion

physiologic lesion of the hippocampus

19

Drug treatments for AD:

-AchEi
-antipsychotics/ depressants
-estrogen replacement

20

What is the generic name for:
-Aricept
-Exelon

-Aricept: Donepezil
-Exelon: Rivastigmine

21

Benefits to use of Aricept/Donepezil:

-Long half life, high bioavailability, not affected by food

22

Benefits to use of Exelon/ Rivastigment?

-No hepatic metabolism/ CYP involvement

23

Potential preventative treatments for AD:

-red wine
-Statins
-NSAIDs
-exercise, smoking cessation

24

NPH Triad

1)Dementia
2) Gait Apraxia
3) Urinary Incontinence

25

Therapy for NPH:

1) spinal taps
2) shunts

26

Picks Disease:
Prominent early impairments

-language (echolalia, etc)
-behavioral changes

27

What is preserved in Picks Disease?

-praxia, visuospatial
-memory

28

Population most commonly effected by Picks:

Females over age 60

29

Areas of atrophy in Picks:

1) frontal
2) ANTERIOR temporal lobe

30

Pick Bodies Appearance + Other Path assc with Picks

-intracytoplasmic inclusions (spherical)
-ballooned neurons

31

Locations of pick bodies:

-cortex
-basal ganglia
-brainstem

32

Criteria for diagnosis with Dementia + Lewy Body

Dementia + One Hallmark

33

What are the core features of DLB?

1) fluctuations in cognition/alertness
2) hallucinations
3) parkinsonism

34

Exclusionary characteristics for DLB

strokes
other brain disorders

35

STEELE-RICHARDSON-OLSZEWSKI SYNDROME is aka?

Progressive Supranuclear Palsy

36

Who gets PSP?

Males over age forty

37

In addition to gaze deficits, list 4 features of PSP:

1) Parkinsonism
2) Pseudobulbar Palsy
(dysphagia)
3) Subcortical Dementia (executive)
4) Language Impairment

38

What is seen on imaging of PSP

atrophy of pons + midbrain
sparing of cortex + cerebellum

39

Pathology assc with PSP

NF tangles in midbrain

40

Describe Supranuclear Palsy:

Downgaze --> Upgaze Palsy
Vertical --> Horizontal Involvement

Apraxia of Eyelid Opening

41

Cortical Basal Ganglionic Degeneration:
Onset

M+F over age 70; unilateral onset

42

Survival Rate CBGD

5-10 years

43

Clinical Features of CBGD

1) extrapyramidal rigidity
2) tremor
3) apraxia
4) alien hand syndrome
5) subcortical dementia
6)SN gaze palsy
7)CS tract involvement

44

CBGD MRI findings

assymetric parietal lobe atrophy

45

CBGD PET findings

decreased metabolism: thalamoparietal and medial frontal lobes

46

CBGD Pathology:

-atrophy, gliosis in parietal + medial frontal lobes CL to involved limb
-degeneration of substantia nigra
(no bodies, plaques, tangles)

47

Genetic Changes assc with HD

AD
4
CAG repeat

48

HD symptomatic triad

1) Personality changes
2) Dementia
3) Psychosis

49

Pathophys cause of HD

degeneration of GABA/cholinergic neurons in the striatum

50

HD MRI findings

boxcar ventricles (caudate and cortical atrophy)

51

HD PET findings

hypometabolism in caudate and putamen

52

Treatments (3) for HD

Haldol
Tetrabenazine
Klonopin

53

Genetic Change assc with Wilsons:

AR chromosome 13 =defective Cu binding ATPase = low biliary excretion of Cu

54

Symptoms assc with WD

1) dementia, psychosis
2) dysphagia, dysarthria
3) rigidity, tremor

55

Labs assc with WD

1)High Ciu
2) Low serum ceruloplasmin
3) High LFTs

56

Pathologic findings assc with WD

1) opalski cells (large astrocytes)
2) degeneration, cavitation in putamen
3) red, atrophic BG

57

Treatment WD

Penicillamine + Pyridoxine
Zinc acetate
Liver transplant

58

Five important infectious causes of dementia

1) HIV
2) SSPE
3) PML
4) Neurosyphillis
5) Prion Disease

59

Diagnostic Criteria for AIDs Dementia

2 abnormalities for 1 month

60

Virus causing PML

Papova (JC, SV40)

61

Patients Predisposed to PML

1) Tysabri
2) AIDs
3) Hodgkins
4) CLL

62

Triad of PML

1) Vision Loss
2) Dementia
3) Hemeparesis

63

Pathology of PML

1) occipital demyelination
2) oligodendrocytes contain eos intranuclear inclusions

64

Treatment PML

1) Vistide
2) Cytarabine
3) HAART

65

LAb findings assc with CJD

EEG changes
14-3-3 protein in CSF

66

CJD findings on MRI

pulvinar sign (bilateral high signal in pulvinar nucleus of thalamus)

67

Binswanger Dementia Criteria:

1) Dementia +
2) (2/3)...systemic vascular disease, cerebral vascular disease, subcortical brain dysfunction
3) Bilateral leukoaraiosis

*Must not be multiple lesions or severe dementia

68

CADASIL Genetic Mutation

1) AD
2) 19
3) NOTCH 3

69

CADASIL clinical features

1) strokes
2) dementia
3) migraine
4) depression or mania

70

Onset Cadasil

20-40, death within 30 years

71

Which of the dementia syndromes show mainly subcortical dementia?

-PSP
-CBGD
-WD
(seen also in DLB but not predominate)