Dementias

Question 1

Dementia decreasing in USA w/

Answer 1

Cardio risk factor management

Question 2

Dementia

Types

Answer 2

• Alzheimer’s
• Vascular dementia
• Parkinson’s associated dementia

*other - lewy bodies, chronic ETOH abuse, frototemporal

Question 3

Acute Onset
Stepwise
Risk Factors
Frontal deficits
Neuro Signs
Gait
Imaging

Answer 3

Vascular dementia

Question 4

Gradual onset
Memory Loss
Normal exam

Answer 4

Alzheimer’s Dz

Question 5

Parkinsonism
Hallucinations
Fluctuations
Frontal deficits
Visuospatial

Answer 5

Parkison’s w/ dementia

Lewy bodies

Question 6

Behavior
Frontal deficits
Family Hx
Young onset

Answer 6

Frontotemporal dementia

Question 7

Dementia

Hx

Answer 7

• Hx - ask informant
• memory loss?
• confusion?
• wandering? RISK
• Difficulty problem solving?
• new focal neuro s/s
• New Meds? Substances?
• Family Hx of CV/dementia

Question 8

Dx tests

Answer 8

• Mini-Mental Status exam
• Montreal Cognitive Assessment (MoCA)
• Clinical Dementia rating (CDR)
• Focal Neuropsyc testing for specific domains
  
  • recent memory, language, executive function, visual/auditory memory

Question 9

Physical Exam

Answer 9

• other Underlying dz? S/s
• Evidence of Self neglect?
• Evidence abuse?

Question 10

Labs

Answer 10

TSH
B12
*rarely help

Question 11

Alzheimer’s Dz

Path

Answer 11

Neurofibrillary tangles
Neuritic plaques
Cerebral atrophy

Question 12

Alzheimer’s Dz

Who?

Answer 12

• Old
• APOE E4 mutation
• FH - esp. AA

Question 13

Alzheimer’s Dz

Risk Factors

Answer 13

• CV
  
  • Low education
  • Sedentary
  • Brain trauma
  • Benzo use

Question 14

• progressive memory loss
• short term BAD
• long term GOOD
• sundowning - worse at night
• language difficulty
• wandering

S/s

Answer 14

Alzheimer’s Dz

*NOT DELIRIUM = sudden onset

Question 15

Alzheimer’s Dz

Dx

Answer 15

• Hx
• MRI not helpful
• labs- rule out reversible causes

Question 16

Alzheimer’s Dz

Rx Tx

Mild vs. Severe

Answer 16

• MILD = AchE blockers
• Donepezil
• Galantamine
• Rivastigmine

*SEVERE = Memantine

NO HELP REALLY

NO BENZOS/Sedatives to sleep = Quicker death

Question 17

Alzheimer’s Tx

Non-Pharm Tx

Answer 17

• treat all other conditions
• routines for daily living to MINIMIZE DISTRESS
• Minimize Care-giver/environment changes

Question 18

Alzheimer’s Dz

Prognosis

Answer 18

8-10 years from Dx

*Worse= age, male, low MMSE at Dx

Question 19

From strokes

• Abrupt onset
• stepwise deterioration
• PE = stroke-like
• MRI/CT = stroke
• risk factors (stroke risks) : CV, DM, smoking

Answer 19

Vascular Dementia

Question 20

Vascular Dementia

Tests

Answer 20

• Hx/ PE
• Neuropsychatric testing
• MRI
• blood tests = other cause, cholesterol
• Cardio/Carotid Echo = embolic sources?

Question 21

Vascular Dementia

Tx

Answer 21

Rx= AchE blocker/Memantine

• PT/OT
• routines/minimize environment changes

Question 22

Vascular Dementia

Prognosis

Answer 22

Prevent strokes!

Question 23

Memory Cognitive Impairment

Types

Answer 23

• Amnestic = MC, forgetfulness
• Non-amnestic = problem w/ executive function, language, visuospatial function)

10% PROGRESS TO ALZHEIMER’S

Question 24

Mild Cognitive Impairment

History

Answer 24

IMPAIRING JOB/LIFE?

• med/psyc Hx
• FH dementia?
• how have abilities / behavior changed?

Question 25

Mild cognitive impairment (MCI) Work-up

Answer 25

* rule out reversible causes (meds, depression, toxins, etc.) * GET BASELINE FUNCTIONING (mmse/full neuropsyc if suspicious)

Question 26

* repeated blows to the head | * football players

Answer 26

Blow-Induced Dementia (CTE) * MUST PREVENT * PREVENT from YOUNG AGE

Question 27

S/s TRIAD: Dementia Gait disturbance Urinary Incontinence (ONLY THIS)

Answer 27

Normal Pressure Hydrocephalus

Question 28

Normal Pressure Hydrocephalus NPH Path 1ary vs. 2ary

Answer 28

Primary = not understood, HTN, Large head Secondary = CSF can't reabsorb across arachnoid villi

Question 29

Gait = block turning, short steps Urinary = beginning-urgency, changing? cognitive disturbance = psychomotor slowing, DOWN executive function/attention, apathetic (NOT LIKE ALZHEIMERS) Signs?

Answer 29

Normal Pressure Hydrocephalus NPH

Question 30

NPH vs. Alzheimer's Affect

Answer 30

FLAT in NPH

Question 31

Normal Pressure Hydrocephalus Dx

Answer 31

* MRI = ventriculomegaly w/ normal sulci depth * LP = 30-50cc CSF removal improves gait/cognitive * neurosurgeons - other tests

Question 32

Normal Pressure Hydrocelphalus NPH Tx

Answer 32

Ventricular Shunt (to stomach/atrium) * need shunt revisions over time * prognosis - death w/ fall usually

Question 33

* rare * extreme disinhibition, inappropriate behavior * police arrest * refuse help, deny problem S/s?

Answer 33

Frontotemporal Dementia 6-8 yrs left

Question 34

Frontotemporal Dementia Tx

Answer 34

SSRI = decrease disinhibition Atypical Anti-psycs * Olanzapine * Quetiapine (typical make worse! (Risperidone)

Question 35

Huntington Dz Path

Answer 35

Expanded CAG repeate on Chrom 4, auto-dom

Question 36

Progressive chorea dementia Anger bursts Antisocial Behavior S/s?

Answer 36

Huntington Dz

Question 37

Huntington Dz Dx

Answer 37

History Physical Genetic testing

Question 38

Abnormalities in ALMOST EVERY Neuro System S/s?

Answer 38

Creutzfeldt-Jakob Dz

Question 39

Alzheimer's Dz Dx

Answer 39

Dementia * function at work impaired * function decline * No psyc disorder * Hx from patient AND informant Cognitive Impairment (2+) * acquire/remember new info * Reasoning/complex task/judgement * visuospatial abilities * language * Personality/behavior