Lecture 12: Dementia Flashcards Preview

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Flashcards in Lecture 12: Dementia Deck (37):
1

Dimentia: Essentials of Dx

-progressive intellectual decline
-not due to delirium or psychiatric dz
-age = main risk factor
-other risk factors = fam hx and vascular dz

2

Dimentia: General Considerations

-progressive decline in intellectual fxn that is severe enough to compromise social and occupational fxn
-typically begins after 60 and prevalence doubles evert 5 yrs
-85 and older: 50% with dementia
-most dementia is acquired or as result of another disorder (stroke)

3

Risk Factors for Dimentia

-Fam hx
-DM
-other vascular dz risk factors
-significant head injury

4

Delirium

-acute confusional state that often occurs in response to an identifiable trigger such as: drugs, intoxication, withdrawal, med side effects, infxn, met. disturbances, sleep deprivation or other neuro dz
-fluctuating levels of arousal
-improves after removal or tx of precipitating factor

5

Signs/Sx's of Dementia

-Short term memory loss
-word difficulty
-visual spatial dysfxn
-executive dysfxn
-apathy
-apraxia

6

Short term memory Loss

-repeating questions/stories and diminished ability to recall details of recent convos or events
-sue to pathologic changes in hippocampus

7

Word difficulty

-difficulty recalling names of ppl, places, or objects
-low frequency words first affected
-speech laden with pronouns and circumlocutions
-pathology at temporoparietal jxn of L hemisphere

8

Visual spatial dysfxn

-poor navigation and getting lost in familiar places
-impaired recognition of previously familiar places
-trouble discerning objects against a background
-R parietal lobe is affected

9

Executive Dysfxn

-easy distractibility
-impulsivity
-mental inflexibility, concrete thoughts
-slow processing speed
-poor planning, organization or impaired judgement -due to areas of frontal or subcortical areas

10

Apathy

-indifference

11

Apraxia

-loss of learned motor behaviors
-due to dysfxn of frontal or parietal lobes (especially L parietal)

12

Hx questions : dementia

-establish risk factors
-document pt's current capacity to perform basic ADLs and IADLs
-note extent go decline from premorbid level of fxn

13

PE dementia

MMSE
Montreal Cognitive Assessment

14

Montreal Cognitive Assessment

-takes longer but slightly more sensitive
-26 and greater is normal: consider rechecking in 6 mnths-1 yr
-25 and below: needs full cognitive eval

15

Imaging: dementia

-indicated for a new progressive cognitive complaint
-exclude occult CV dx, tumor or other structural abnormalities
-MRI is preferred method

16

Labs

- any pt with cog impairment: measure B12, T4, TSH

17

Alzheimer's Dz facts

-most common dementia 60+
-up to 50% have it in 80s
-not really genetic, more epidemic

18

Alzheimer's Risk Factors

-age
-low education
-uncontrolled DM
-fam hx
-APOE genotype
-mutations: APP gene on chrom 22; Presinillin 1 on chrome 14; Presinillin 2 on chrom 1

19

AD Signs/Sx's

-short term memory impairment
-2 or more cognitive domains involved
-animal fluency worse than letter fluency
-some fxnl impairment in real life
-variable deficits of executive fxn, visuospatial fxn and lang

20

AD Dx

-stage with MMSE, but don't test unless symptomatic
-F/u every 6 mnths
-MRI shows atrophy in hippocampus

21

Vascular Dementia: facts

-2nd most common
-pathophysiology: multiple ischemic attacks

22

VD signs/sx's

-stepwise or progresive accumulation of cognitive deficits in association with repeated strokes
-sx's depend on localization of stroke

23

VD Risk Factors

-smoking
-DM
-HTN
-Hypercholesteremia

24

VD: 2 types

-Multiple Infarct Dementia: medium large vessel; stepwise deterioration; strokes on MRI
-Subcortical Dementia: small vessel dz; gradual decline; no memory problem; letter fluency worse than animal; MoCA worse than MMSE; lacunas and other white matter changes on MRI

25

VD tx

-prevent vascular events
-Afib: anticoags

26

Frontotemporal Dementia: pathology

-defined by protein found in intraneural aggregates
-Peak incidence in 6th decade
-familial cases due to mutations in specific pros

27

FTD types

1) Behavioral variant FTD
2) Semantic Dementia
3) Progressive Nonfluent Aphasia

28

Behavioral Variant FTD

-deficits in empathy, social compartment insight, abstract thought and executive fxn
-behavior is disinhibited, impulsive and ritualistic with prominent apathy
-decrease/increase in sex or sweet/fatty foods
-preservation of memory
-Focal R frontal atrophy

29

Semantic Dementia

-deficits in word finding, single word comprehension, object and category knowledge and face recognition
-behaviors: rigid, ritualistic and may be similar to behavioral variant
-focal asymmetric temporal pole atrophy

30

Progressive nonfluent aphasia

-speech is effortful with dysarthria, phonemic errors, sound distortions and poor grammar
-focal extrapyrimidal signs and apraxia of R arm and leg common
-Focal L frontal atrophy

31

Corticobasal Degeneration

-unilateral ideomotor apraxia, agraphthesia astereognosis
-Alien hand syndrome
-myoclonic jerks
-Gait: preserved until late

32

Lewy Body Dementia

-cog dysfxn with prominent visuospatial and executive deficits
-psych disturbances with anxiety, hallucinations and fluctuating delirium
-Parkinsonism motor deficits
-less problems with memory

33

Prion Disorders: pathophys

-rare
-caused by infectious proteins called prions
-induce conformation change of normal brain protein into abnormal isoform that causes neuronal vacuolation, reactive proliferation of astrocytes and microglia and deposition of B amyloid plaquea

34

Prion Disorders: sx's

-myoclonic fasciculations, ataxia, visual disturbances, pyramidial and extrapyrimdial sx's
-specific EEG: slow waves and high voltages

35

Wernecke's Encephalopathy

-due to alcoholism, poor dietary intake of thiamine
-anorexia, muscle cramps, parasthesis, irritability
-hrt failure and peripheral nerve d/o
-give Thiamine

36

Vit. B12 Deficiency

-macrocytic anemia, megaloblastic blood smear, low serum Vit. B12 levels
-anemia, mucosal cell changes, parasthesias of peripheral nerves
-pale, icteric, sallow, decrease vibration and position sense, memory disturbance
-give Vit. B12

37

Pellegra (aka Nicotinic Acid deficiency)

-due to alcoholism and nutrient drug interactions
-anorexia, weakness, irritability, mouth soreness, glossitis, stomatitis, wt loss
-advanced: dermatitis, diarrhea, dementia
-give oral niacin