Flashcards in Dementias, MacIntyre Deck (49):
1
top 3 causes of dementia
alzheimers
vascular
lewy body
2
majority dementia presents when
>90 y.o
15-20% >85 y.o
3
dementia reclassified as
neurocognitive disorders
4
what is essential in Dx dementia
not due to delirium or other mental Dx
5
major vs mild dementia
major interferes with ADLs (not independent)
6
what cognitive domains decline in dementia
complex attention
executive function
learning/memory
language
perceptual motor
social cognition
7
what cognitive domains decline in dementia
complex attention
executive function
learning/memory
language
perceptual motor
social cognition
8
signs of dementia
aphasia
agnosia
apraxia
progressive onset
no clouding of consciousness
9
which dementia can have clouding of consciousness
lewybody
10
NT in alzheimers
cholinergic neurons loss
dec Ach
11
avoid what medsin dementia
anticholinergics!!!
12
medical workup in dementia
VITAL signs
Hx and PE
cognitive testing
labs
neuroimaging when indicated
13
what labs to order for dementia
CBC, CMP, HIV/Syphilis tests, ammonia, thyroid, B12/Folate, UA, EKG, CXR
14
differential in dementia
delirium
pseudodementia
benign senescent forgetfullness
medical illness
15
what are reversible dementias
B12 deficiency
folate deficiency
tumor
infection
subdural hematoma
NPH
16
autopsy findings alzheimers
atrophy and enlarged ventricles
17
risk factors for alzheimers
downs APP
female sex
head trauma Hx
lower education level
ApoE alleles
18
what chromosomes may be assoc with alzheimers
1, 14, 21
19
what alleles assoc with alzheimers
ApoE e4 increase
ApoE e2 protective
20
accumulation of what in alzheimer
amyloid plaques and tau tangles
21
plaqu in alzheimer
APP amyloid B42
22
tangles in alzheimer
phosphorylated tau
intracell accumulation
23
clinical signs of alzheimers
behavioral
psychosis! depression, agitation!!!!
sundowning (wander at night)
24
careful Tx alzhemier because
elderly are sensitive to side effects etc
start low go slow
25
Tx alzheimer drug classes
ACHEI
memantine (NMDA R blocker)
antipyschotics
valproic acid
SSRI
26
ACHEI used in alzheimer
donepezil
rivastigmine
galantamine
27
avoid benzos why in alzheimer
inc risk dementia
INC risk for falls!!!
addiction
cannot detox elderly who are addicted
28
vascular dementia
onset relates to CVA and decline prominent in complex attention and frontal/executive function
29
demographics vascular dementia
more common in men
abrupt onset step wise decline
30
clinical signs vascular dementia
dysrhythmia, murmurs, bruits,
31
risk factors for vascular dementia
smoking, BP, glucose, aspirin
32
Tx vascular dementia
control risk factors
can try ACHEI
33
Presentation frontotemporal dementia
insidious onset/gradual progression
behavioral or language types
**overreaction!!
34
demographics frontotemporal dementia
men>women
usually in 50s
earlier onset
35
Tx frontotemporal dementia
ACHEI or mood stabilizers(aggression)
36
Lewy Body dementia overlaps with
PD
37
signs of lewy body dementia
psychosis (visual hallucinations!!!)
parkinosonian features
fluctuating mental function looks like delirium
paradoxical antipsychotic Tx reaction!!!
38
what is the paradoxical antipsychotic Tx reaction
inc psychosis and inc side effects with Tx ine lewy body
39
CJD
prion disease
clonus, ataxia, biomarker evidence
triphasic waves on EEG
Tx supportive, rapidly fatal
40
Chronic Traumatic Encephalopathy marked by
impulsivity, dysarthria, emotional lability
41
Tx CTE
ACHEI
valproic acid
sSRI
avoid anticholinergics!
42
abulia
lack of motivation, seen in HD
43
what funciton go away first in HD
complex tasks
memory and language later
44
Tx HD
antipsychotics, ACHEI, mood stabilizers, SSRI
45
PD accumulates what
alpha synuclein or tau protein in substantia nigra
have lewy bodies
46
Tx PD
dopaminergic agents---- can cause psychosis!!!
47
how to distinguish lewy body and PD
PD requires cognitive decline >1 year Dx of PD
48
dementia from HIV
neurtoxicity of HIV macrophages
49