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Neurology > Dementia Lecture Powerpoint > Flashcards

Dementia Lecture Powerpoint Flashcards

1
Q

Most common type of dementia in patients >65 years old

A

Alzheimer’s disease

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2
Q

Dementia definition

A

Syndrome characterized by progressive loss of cognitive functions that interfere with patients daily living as well as anterograde amnesia (cannot learn new things and have difficulty with language, abstract reasoning, judgement, visuospatial processing, etc)

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3
Q

What is NOT affected in dementia but is in delirium? (2 things)

A

Arousal and alertness

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4
Q

Short term memory is stored in the ___, long term memory is stored in the ___ and acquired via ____. Remote memory (>6 months to years) is stored in the ___, no longer requiring ____ for retrieval

A

Pre-frontal cortex, hippocampus, rehearsal, neo-cortex, hippocampus

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5
Q

Alzheimer’s disease epidemiology

A

1 in 9 people age 65 and older, 1/3 age 85 and older, mean survival is 8-10 years from onset without treatment, but 15+ with treatment

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6
Q

Alzheimer’s disease Risk factors, which is the greatest? (4)

A
  • Age (greatest)
  • Family and genetics
  • Past head trauma
  • Lifestyle and heart health
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7
Q

Alzheimer’s disease clinical features (5)

A
  • Anosgnosia (loss of awareness of one’s own deficits)
  • memory dysfunction
  • personality change
  • psychiatric disturbance
  • late stage motor involvement
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8
Q

Clinical course of alzheimer’s disease

A

Mild: memory/orientation
Moderate: activities of daily living
Severe: behavioral disorders, nutrition, hygiene

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9
Q

Alzheimer’s effect on memory

A

-Immediate and short term are affected first, remote not impaired until disease advances

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10
Q

Apraxia

A

loss or impairment of ability to execute complex coordinated movement usually a later finding of alzheimer’s disease

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11
Q

Sundowning theory

A

Theorized to be due to remote memory remaining in an alzheimer’s patient despite lack of short term memory causing them to be triggered at certain points later in the day to be confused as to why their routine from their remote memory is interrupted leading to distress

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12
Q

Alzheimer’s disease diagnostic criteria (5)

A
  • progression over 6 months
  • anterograde amnesia
  • multiple cognitive deficits
  • impairment in functioning
  • other conditions ruled out
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13
Q

Best diagnostic study for mild cognitive impairment

A

Montreal cognitive Assessment (MOCA) (better than the mini mental status exam)

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14
Q

Alzheimer’s diagnostic studies (5)

A
  • CBC, electrolytes, TSH, B12 (checking if infection or other cause for symptoms in elderly)
  • CT or MRI (rule out)
  • EEG (rule out nonconvulsive seizures)
  • Lumbar puncture (not routine, rule out metastatic cancer, hydrocephalus, etc)
  • Genetic councilor referral (amyloid ligand PET imaging not typically covered by insurance)
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15
Q

There is no ____ for screening for Alzheimer’s

A

Gold standard

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16
Q

Alzheimer’s disease is a diagnosis of…

A

…exclusion

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17
Q

MRI findings Alzheimer’s disease (2)

A
  • Diffuse cerebral atrophy in frontal, temporal, and parietal lobes
  • Hippocampal atrophy
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18
Q

Microscopic findings of Alzheimer’s disease (3)

A
  • Neurofibrillary tangles in hippocampus
  • neuritic plaques containing amyloid in cortical cells
  • granular-vacular degernation of neurons especially in hippocampus
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19
Q

Alzheimer’s disease pathophysiology

A

-Reduced amount of acetycholine and reduced activity in entire cholinergic pathway (basal forebrain to cortex and hippocampus)

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20
Q

Treatment for Alzheimer’s is ____ not ____

A

palliative (preservative), curative

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21
Q

Drugs to slow progression of Alzheimer’s (2)

A
  • Acetycholine and butylcholine esterase inhibitors

- N-methyl-D-aspartate receptor antagonists (NMDA)

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22
Q

Alzheimer’s disease admission criteria (5)

A
  • acute illness cannot be managed by patient or caregivers at home
  • short term admission for eval and adjustment to psychotropic meds
  • short term respite care
  • long term care facility if cannot be provided at home
  • hospice care if <6 months
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23
Q

Mild cognitive impairment in alzheimer’s disease treatment (4)

A
  • pharmacologic treatment not effective!
  • exercise
  • cognitive interventions
  • long term planning
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24
Q

Moderate cognitive impairment in alzheimer’s disease treatment (3)

A
  • cholinesterase inhibitors recommended but benefit is modest
  • vit E supplementation
  • exercise
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25
Q

Severe cognitive impairment in alzheimer’s disease treatment (4)

A
  • Cholinesterase inhibitors
  • Memantine
  • antipsychotics to treat severe agitation and psychosis if dangerous
  • management of comfort
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26
Q

Alzheimer’s disease medications do not….

A

….work well for everyone

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27
Q

Vascular dementia definition

A

Dementia brought on by either multiple or singular (rare) infarcts decreasing adequate blood flow to the brain (ischemia, not necessarily stroke), begins as mild changes and worsens gradually leading to cumulative damage

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28
Q

Vascular dementia epidemiology

A

2nd most common cause of dementia, prevalence rises steeply with age

29
Q

Vascular dementia risk factors (4)

A
  • TIA
  • Age
  • High blood pressure
  • High cholesterol
30
Q

Emotionally labile

A

Easily fluctuating without warning or transition

31
Q

Vascular dementia clinical features (5)

A
  • Memory impairment
  • language disturbance
  • impairment of motor skills
  • emotionally labile
  • Loss of intellectual skills more abrupt (progress in steps (flat then decline rapidly)
32
Q

Middle cerebral infarct signs

A

Aphasia, confusion, anosognosia

33
Q

Anterior cerebral infarct signs

A

Frontal lobe syndrome (dis-inhibition, poor planning, lack of initiative)

34
Q

Posterior cerebral infarct signs

A

Visual distortions, hallucinations, cortical blindness

35
Q

Thalamic infarct signs

A

Global cognitive and psychiatric dysfunction

36
Q

Vascular dementia studies and which one is diagnostic (3)

A
  • Neurocognitive exam
  • Lab tests to rule out other etiologies
  • CT and MRI is diagnostic
37
Q

Treating vascular dementia sees more ___ than other kinds of dementia treatment

A

Cognitive improvement

38
Q

Frontotemporal dementia (Pick’s disease)

A

Clinical syndrome associated with shrinking of the frontal and temporal anterior lobes of the brain

39
Q

Frontotemporal dementia 2 clinical categories

A
  • Changes in behavior

- Problems with language

40
Q

Behavioral changes in frontotemporal dementia (4)

A
  • Inappropriate social behavior (sexually)
  • lack of empathy
  • agitation or blunting emotions
  • repetitive or compulsive behavior
41
Q

Language changes in frontotemporal dementia (2)

A
  • Difficulty making or understanding speech

- spatial skills and memory remain intact

42
Q

Frontotemporal dementia epidemiology

A

-Mean onset is 58 years old, 10-15% of all dementia, highly heritable

43
Q

Frontotemporal dementia cause and risk factors (2)

A
  • Abnormal deposits of several proteins inside brain

- family history and connection with ALS

44
Q

Frontotemporal dementia diagnostic studies (2)

A
  • Clinical

- PET and MRI***

45
Q

Frontotemporal dementia treatment options

A
  • management of symptos

- off label use of antidepressants or antipsychotics

46
Q

Key differences between alzheimer’s disease and frontotemporal dementia (4)

A
  • Age at diagnosis is clue
  • Memory loss more prominent in early alzheimer’s
  • Spatial orientation more common in alzheimer’s
  • speech changes differ
47
Q

Dementia with lewy bodies definition

A

Progressive dementia that leads to decline in thinking, reasoning, and independent function due to abnormal microscpic protein deposits (alpha synuclein protein) that damage brain cells over time

48
Q

Dementia with lewy bodies epidemiology

A

-3rd most common cause of dementia

49
Q

Dementia with lewy bodies symptoms (4)

A
  • Parkinson’s symptoms (closely related)
  • REM sleep disorder
  • visual hallucinations
  • less memory loss than other dementias
50
Q

Dementia with lewy bodies is a….

A

…clinical diagnosis

51
Q

Dementia with lewy bodies is the same thing as…

A

…parkinson’s disease dementia???

52
Q

Hallmark finding of parkinson’s disease dementia

A

-hallucinations

53
Q

Antipsychotic drugs need to be used with extreme caution in what type of dementia?

A

Dementia with lewy bodies (may impair swallowing, cause acute episodes of hallucinations, or worsen parkinson’s symptoms)

54
Q

Key differences between dementia with lewy bodies and alzheimer’s (2)

A
  • Memory loss is more prominent in early alzheimer’s

- Hallucinations and REM sleep disorder normal to see in early stage DLB than alzheimer’s

55
Q

Normal pressure hydrocephalus definition

A

Brain disorder which excess CSF accumulates in brain ventricles but pressure level normalizes because brain becomes compressed resulting in thinking and reasoning problems, difficulty walking, and loss of bladder control

56
Q

Normal pressure hydrocephalus epidemiology

A

-Idiopathic and secondary occur equal proportions, idiopathic most common in adultts >60

57
Q

Normal pressure hydrocephalus triad of symptoms

A
  • Gait apraxia (shuffling along, feet glued to deck)
  • decline in thinking (dementia)
  • Bladder incontinence (late stage, does not improve)
58
Q

Diagnosis for normal pressure hydrocephalus (2)

A
  • MRI detecting enlargement of ventricles

- CSF tap and removal to see if symptoms improve

59
Q

Normal pressure hydrocephalus treatment (1)

A

-Shunt of CSF to peritoneum

60
Q

Huntington’s disease

A

Progressive brain disorder caused by single defective dominant gene on chromosome 4 in which certain areas of brain start to break down causing emotional disturbances, loss of intellectual abilities, and uncontrolled movements (chorea)

61
Q

Huntington’s disease epidemiology

A

Age of onset ranges from childhood to 8th decade, most often in mid life

62
Q

Huntington’s disease symptoms (3)

A
  • Uncontrolled movement of arms, legs, head, face, upper body (chorea)
  • progressive decline in thinking and reasoning skills
  • OCD often
63
Q

Huntington’s disease treatment (1)

A

-Management of symptoms

64
Q

Creutzfedlt-Jakob and other prion disease definition

A

-Class of dementias caused by abnormal form of proteins in brain known as prions, characterized by spongy appearance of brain tissue leading to classification as transmissible spongiform encephalopathies (TSE’s)

65
Q

Creutzfedlt-Jakob and other prion disease symptoms (3)

A
  • Psychiatric symptoms
  • rapid cognitive decline
  • abnormalities in walking and balance
66
Q

Creutzfedlt-Jakob and other prion disease diagnostic studies (3)

A
  • CSF analysis
  • Electroencephalogram
  • MRI
67
Q

Creutzfedlt-Jakob and other prion disease treatment and prognosis

A
  • No cure, management of symptoms

- 2 year fatality

68
Q

What kind of changes in the brain are hallmarks of alzheimer’s?

A

-Amyloid plaques and neurofibratory tangles

69
Q

What type of dementia is associated with chronic alcoholism

A

Korsakoff syndrome

Neurology (23 decks)

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