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Flashcards in Dementia, Cohen I Deck (47):
1

cognition

mental process of knowing, including aspects like awareness, perception, reasoning and judgement

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dementia defintion

deterioration cognition, higher intellectual process, organic disease of brain

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DSM IV

development of multiple cognitive deficits that are sufficiently severe to cause impairment in occupational or social functioning

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is dementia reversible

irreversible

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common initial presentation of dementia

delirium

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primary causes of dementia

----alzheimers
--lewy body dementia/Parkinsons
--multi infarct/Vascular dementia
--fronto-temporal demential
--alcoholism/VitB12 deficiency
-subdural hematomas, creutzfeldt jacob, HIV, normal P hydrocephalus, tumors, progressive supranuclear palsy, huntington, MS, CTE

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findings micro in alzheiemrs

plaques of amyloid
tangles of tau- containing microtubules inside neurons

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what amyloid collects in alzheimers

beta amyloid
AB42 from amyloid precursor protein

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where is most cell death in alzheimers

temporal and parietal lobes

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major connection to alzheimers

downs by age 50 60s

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what NT is lost in alzheimers

Ach

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what collection amyloid or tau is thought to have role in dementia

tau
amyloid blockers or lowering agents not helpful in alzheimers

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prevalence of Alzheimers

>80 majority
>65 common
M

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associations with development of alzheimers

mentally inactive people
victims head trauma
homozygous e4 allele ApoE

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begining of alzheimers

loss of memory for recent information or events like appointments
objects misplaced
trouble recalling names of DISTANT friends at first
repeating stories
restricted speech, cannot complete sentence

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progression alzheimers

visuospatial decline (wandering)
gait disorder with dizziness and poor posture (extension)

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mental state alzheimers

boredom, lack of social inhibitions
irritability
paranoia
denial relationships
depression
can become violent or anxious and agitated

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what is "sundowning"

confusion and agitation at night

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apraxia

loss of simple actions because loss of connections between cortical sites
(inability to button clothing or brush hair etc)

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Mild alzheimers

safe at home
some help with acticities
not threat to self

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moderate alzheimers

kept at home with great effort
full or nearly full caregiver

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severe alzheimers

nursing home or assisted liviing for round-the-clock supervision

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Dx of alzheimers

clinical

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What is PiB

pittsburgh compound that binds to beta amyloid deposition in brain

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amyloid levels and tau levels in CSF in alzheimers

dec beta amyloid
increase tau
(soluble)

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MRI of alzheimers

atrophy in medial temporal lobes

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Must rule out for Dx alzheimers

B12
thyroid
renal and hepatic problems

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thought behind ACHE inhibitors in alzheimers

increase Ach for relief memory impairment, agitated behavior and concentration

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effect of ACHEI in alzheimers patients

modest gains with slower decline
no major difference than non-Tx patients in 2-3 years

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ACHEI used in alzheimers

donepezil
rivastigmine
galantamine

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most widely used ACHEI in alzheimers

donepezil

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effects of rivastigmine

vomtiing, diarrhea
also have as skin pathc to lower effects

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which ACHEI in alzheimers has extended release

galantamine

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MOA memantine

antagonizes glutamate and NMDA R
may prevent cell death from too much glutamate
used alone or with ACHEI

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Good Tx for alzheimers

keep patient mentally and physically active
prevent from seeking social isolation

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"mild cognitive impairment"

patients who function well in social and occupation
very limited problems with memory
do not meet requirements for alzheimers

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Second common cause dementia

lewy body dementia

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presentation lewy body dementia

agitated
decreased facial animation
slowness and imbalance
mild to no tremor
dementia
M>W

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dementia in lewy body

Fluctuating!!!!

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key signs to lewy body to distinguish from alzheimers

visual hallucinations!!
parkinosism
bad response to antipsychotic drugs

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lewy body patients may improve with what therapy

ACHEI

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what is aggregate in lewy body

alpha synuclein
also senile plaques and neurofibrillary tangles

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lewy body involves what parts of brain

diffuse
ANS severely effected

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worse prognosis alzheimers or lewy body

lewy body
death 5-7 yearas

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what drugs make agitation in lewy body disease worse

antipsychotics
olanzapine
risperidal
haloperidol

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lewy body incorrectly Dx as

parkinsons

47

Tx parkinsonism Sx in lewy body disease

low doses levadopa