Dementia and Delirium Flashcards Preview

Clinical Neuroscience weeks 1-3 > Dementia and Delirium > Flashcards

Flashcards in Dementia and Delirium Deck (32):
1

Dementia, Depression, Delirium commonly have overlapping symptoms

ok

2

Dementia=

Impairment of intellectual/ cognitive function of sufficient severity to interfere with social or occupational activities

3

Delirium=

Clouding of consciousness with reduced capacity to shift, focus, and sustain attention to environmental stimuli.
I'm delirious right now,,,can't focus or sustain attention

4

Key features of dementia

- cognitive deficits in multiple domains, usually but not always including memory
- Progressive deterioration over months to years
- cognitive impairment interferes with activities of daily life
- No disruption of alertness

5

Key features of delirium

- Acute disorder generally assoc with medical illness, drugs, metabolic disorders
- Deterioration over days to weeks
- Fluctuating course
- altered level of consciousness, exciteable, delusions, hallucinations

6

Some causes of Dementia we need to know

- Alzheimer's
- Dementia with Lewy Bodies
Frontotemporal Demetia

7

Alzheimer's Dz characterized by what neuropathology findings

- Loss of cerebral cortical neurons
- Neuritic plaques containing Beta Amyloid
- Neurofibrillary Tangles

8

features inconsisten with Alzheimers

- Sudden or acute onset
- focal neurological findings
- seizures or gait disorder

9

WHat is a neuritic plaque

Composed of dystrophic neurites or synapses containing tau protein aggregates surrounding a core of beta-amyloid

10

WHat are neurofibrillary tangles

cortical pyramidal cells filled with aggregates

11

Autosomal dominant Alzheimers (early onset) is linked to what three genes

- APP (chrom 21)
- Presinilin 1 (chrom 14)
- Presinilin 2 (chrom 1)

12

Sporadic alzheimers (late onset)

Apo E4 chrom 19
a2 macroglob (chrom 12)

13

50% of late onset ALzheimer's cases carry one or more copies of the APOE4 allele

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14

Homozygosity for APOE4 basically assures that by age 80 the individual will develop alzheimer's disease

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15

Combination of APOE3/APOE4=

second most likely to develop alzheimers

16

Strong Risk Factors for Alzheimers

Age
Genetics
Down's Syndrome

17

Weak Risk factors for Alzheimers

Education level/mental activity
Female
Head Injury
Hypercholesterolemia
Smoking

18

The levels of acetylcholine in the cortex of pts with alzheimers disease is....

low...one reason is because the nucleus basalis becomes atrophied in alzheimers pts. This nucleus generally harbors neurons that innervate the neocortex using Ach

19

Pharmaceutical compaines have targeted which two enzymes as tx for ALzheimers disease

AChe: Because of ACh is low in AD and AChE generally inactivates synaptic ACh. By blocking this pocess you increase levels of ACh.

BuChE is made by astrocytes and it too cleaves ACh., Pharmaceutical companies have also targeted this enzyme

20

Lewy Bodies are what?

Eosinophilic, spherical inclusions with a halo appearance located in the cytoplasm of neurons located in the Substantia Nigra in PD pts.

21

Dementia with Lewy Bodies

Dementing disease with the clinical characteristics of PD plus an early presenting Dementia characterized frequently by hallucinations, delusions, etc...
Dementia BEFORE Parkinsons is key

22

Lewy bodies present where in the brain of DLB patients

Neocortex

23

DLB pts respond less well to what drug?

Levodopa

24

DLB pts extremely sensitive to what drugs

Neuroleptic drugs given for hallucination

25

Frontotemporal Dementia...These disorers showpreferential atrophy of the frontal lobe and/or temporal lobes

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26

Microscopic characterization of Frontotemporal dementia

deposition of ubiquitin and hyperphosphorylated Tau protein with neurons

27

Clinical features of FTD

Emphasis on prominent personality and behavioral changes with less prominent memory loss.
Pts may show:
- loss of personal awareness, disinhibition, impulsiity, withdrawla

28

Picks disease age of onset

5th decade

29

30-40% of picks disease features chromosomal mutation where?

chromosome 17 for Tau protein

30

Picks disease characteristics

progressive loss of judgement with disinhibition, social misconduct, or withdrawal out of proportion.

If temporal lobe is primarilyinvolved then there is early loss of receptive language function

31

Pick bodies

intracytoplasmic inclusions of tau protein

32

Folstein mini-mental status exam

workup for dementia....score less than 27 is suspicious of impaired cognition, depression, or a combination