LECTURE 7: DEMENTIA Flashcards
most common neurological medical condition in the hospital
deliriium
(15-50% of inpatients, 80% elderly in ICU)
-older pts: one organ
-younger: multi organ
how to treat delirium
-eliminate underlying cause
-re-orient (write day/schedule)
-no naps, out of bed in day
-good sleep
dementia characterized by presence of at least 2 of the following:
A. impaired:
1. learning/short term memory (temporal)
2. handle complex tasks (frontal)
3. reasoning/abstract thinking (frontal)
4. spatial ability (parietal)
5. language/aphasia (temporal/parietal)
B. significant impairment in social/work
C. decline from PLOF
D. no diff dx (delirium or depression) -hard to diagnose in hospital
what are differential dx of dementia that are REVERSIBLE?
- depression
- medication side effects
- poor sleep
- hypothyroidism
- neurosyphilis
- autoimmune encephalitis
- normal pressure hydrocephalus
difference between normal pressure hydrocephalus and atrophy on brain scan
-NPH:large ventricles
Atrophy: large sulci, shrinking
evaluation of dementia
history: what is impaired?
-onset
-time course: why did they stop working?
-progression
-education level
-Observation (behavior? grooming?)
-Mental Status Exam
-Neuro exam: hearing loss? involuntary mvmts?
lab tests, imaging
delirium looks like…
acute (hours)
fluctuates (worse at night)
-disrupted sleep wake
-disorganized thinking
-inattention
-drowsiness
-restlessness/agitation/combativeness
-deluisions
-hallucinations
what is normal aging?
decrease in attention and ability to learn new information
does not affect IADLs
in dementia, there are typically two lobes involved. List impairments/lobes
- learning/short term memory: temporal
- complex tasks: frontal
- reasoning: frontal
- spatial ability/orientation: parietal
- language/aphasia: parietal and temporal
these things should impair work/social function, decline PLOF
What are causes of dementia?
- alzheimers
- lewy body
- frontotemporal
- vascular dementia
- parkinsons
- progressive supranuclear palsy
- huntington’s
- alcohol related dementia
- chronic traumatic encephalopathy
10: med side effects
11: prion disease
12: HIV
What is NPH? (normal pressure hydrocephalus)
CSF build up in ventricles!
- memory problems
- magnetic gait
- incontinence
how do you diagnose NPH?
DX: gait test, pull lots of CSF out with LP, then gait test again. If it gets better, treat!
how do you treat NPH?
VP shunt to pull CSF
gait gets treated but memory doesn’t get better much
MMSE tests…
mini mental status exam
total 30
*doesn’t test all lobes
MOCA
tests all lobes
1. visuospatial/executive
2. naming animals
3. memory
4. attention
5. language
6. abstraction (banana-orange-fruit)
7. delayed recall
8. orientation
SLUMS exam
test for dementia
clock drawing tests what domains?
visuospatial
executive
attention
memory
test for dementia
neuropsychological testing includes what?
visual-perceptual-spatial functioning
1. copy geom designs
2. identify faces
3. calculations
4. left right discrimination
EXECUTIVE FUNCTIONING:
1. naming fluency
2. alternate numbers and letters in order
3. stroop test (words/colors)
4. repeated hand gestures
what are two predictors of rapid progression of MCI to dementia?
- medial temporal lobe atrophy in MRI
- hypometabolic pattern on FDG-PET
MCI is defined as
impairment in 1 or more domain but no dementia or no impairment of ADLs
*also known as pre or prodromal dementia
12-18% of people over 60 years old have
MCI
____% of people with MCI per year transition to dementia
8-15%
most effective tx for dementia/MCI
exercise!
early alzheimers looks like
-short term memory loss
-word finding difficulties
-mild executive dysfunction
-mild visuospatial deficits
