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57 Cards in this Set
- Front
- Back
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characteristics of dementia
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gradual progression of multiple cognitive deficits
impaired ability to learn new info short term memory is involved much greater than long term aphasia apraxia agnosia disturbance in executive functioning |
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failure in the execution of a learned motor task despite normal strength and coordination
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apraxia
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failure to recognize or identify objects despite intact sensory function
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agnosia
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by far the most common type of dementia
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Alzheimer's disease
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epidemiology of Alzheimers dementia
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incidence of 1% at age 60 and double every 5 years after
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associated with increased risk of developing late onset Alzheimers dementia
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presence of apolipoprotein E4 allele on chromosome 19
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what is associated with early onset Alzheimers dementia
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abnormalities in chromosome 21, 14 and 1
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1/3 of AD patients don't have ApoE4 allele
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**
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what disorder is associated with development of AD in virtually 100% of cases by age 40
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Down's syndrome
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what cortical neurons are particularly affected in Alzheimers dementia
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association cortex, deeper layers of the temporal cortex and hippocampus
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what neurotransmitter is affected in Alzheimers dementia
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significant drop-out of the basal forebrain cholinergic neurons which project to the cerebral cortex - ACh
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what do amyloid plaques do in the brain of alzheimers patients and the end result
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trigger:
1. inflammation 2. hyperphosphorylation of tau protein leading to neurofibrillary tangles 3. free radical toxicity resulting in neuronal loss and cholinergic dysfunction |
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senile plaques
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extracellular nruonal and glial processes composed of amyloid beta protein
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neurofibrillary tangles
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intracellular collection of abnormal filaments that have distinction paired helical structure composed of tau protein
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3 pathological features of alzheimers dementia
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senile plaques
neurofibrillary tangles granulovacuolar degeneration of hippocampal pyramidal cells |
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what is maintained in a patient with Alzheimers dementia
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social skill
long term memory |
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what symptoms can present in a person with late features of alzheimers dementia
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apathy
social withdrawal depression anxiety agitation delusions hallucinations |
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what signs on exam can present in person with late features of alzheimers dementia
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gait instability
parkinsonian features frontal lobe release signs |
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what may be a better way of engaging a patient with frustration during a mental status exam
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engage them informally and in conversation ask questions about their favorite sports team or TV show
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imaging in Alzheimers dementia
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PET scan shows hypometabolism especially in temporal-parietal regions
amyloid imaging is a specific PET scan that bind to amyloid |
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what should always be checked in a patient with a poor mental status exam
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metabolic work-up:
electrolytes kidney and liver function B12 level thyroid studies bladder infections |
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what groups of drugs are used for Alzheimers dementia
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acetylcholinesterase inhibitors
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list the drugs used for alzheimers dementia
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Donepezil
Rivastigmine Galantamine Memantine |
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Memantine
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noncompetitive NMDA receptor antagonist
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what should be treated in patients with late stages of alzheimers dementia
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agitation
psychosis aggressive behavior depression -atypical neuroleptics |
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Multi-infarct Dementia
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multiple cortical strokes results in a stepwise decline, and associated with hemiplegia, visual field defects, aphasia, and sensory loss
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associated with dementia presenting along with: dysarthria, dysphagia, emotional incontinence, and apathy
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multiple subcortical strokes
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why can the development of dementia in parkinson's disease greatly interfere with treatment
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medications used to treat PD can cause confusion and hallucinations
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patients present with early symptoms of parkinsonism and dementia
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Dementia with Lewy Bodies
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classic triad of dementia with lewy bodies
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1. dementia with fluctuating cognition
2. recurrent visual and nonvisual hallucination 3. motor features of parkinsonism |
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characteristics of dementia with lewy bodies
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prominent hallucinations
fewer tremors orthostasis hypersensitivity to neuroleptic and antiemetic medications 100% have REM behavior disorder |
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pathology seen in dementia with lewy bodies
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1. lewy bodies seen throughout the brain, not just subcortical region like idiopathic PD
2. loss of dopamine-producing neurons in substacia nigra 3. loss of ACh producing neurons in basal nucleus 4. senile plaques 5. granulovacuolar degeneration |
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abnormal proteinaceous (alpha-synuclein) cytoplastmic inclusions
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lewy bodies
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drug of choice for dementia with lewy bodies
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acetylcholinesterase inhibitors
because hallucination often worsened by medication used to treat parkinsonism (increased dopamine) |
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dementia associated with early behavioral problems and chorea
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Hunginton's disease
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when is dementia noted in HIV
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late manifestation of the disease process
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associated with rapidly progressive dementia, non-epileptic myoclonic jerks, and ataxia
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Creutzfeldt-Jakob Disease
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most prominent manifestation of CJD
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dementia
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most common cause for CJD
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sporadic
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diagnosis of CJD supported by
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periodic sharp waves on EEG
raised level of 14-3-3 protein in CSF signal changes in the basal ganglia seen on MRI |
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what symptoms would suggest frontotemporal dementia
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early features of disinhibition and personality change
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associated with thiamine deficiency
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wernicke's encphalpathy
Korsakoff's syndrome |
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common cause of thiamine deficiency
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chronic alcoholism
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classic features of wenicke's encephalopathy
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1. ophthalmoplegia - usually CN VI
2. encephalopathy - can progress to coma 3. gait instability - midelin truncal |
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what can precipitate symptoms of underlying thiamine deficiency
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administration of IV glucose
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associated with anterograde and retrograde memory deficit, little insight, and profound confabulation
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Korsakoff's syndrome
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associated with degeneration of thalamus, mamillary bodies, peri-aqueductal structures, pons
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Korsakoff's syndrome
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treatment of Wernicke's encephalopathy/Kofsakoff's syndrome
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treat with thiamine
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classic non-specific triad of symptoms in normal pressure hydrocephalus
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gait apraxia - first symptom
dementia - subcortical with withdrawn, depressed symptoms Urinary incontinence |
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pathology of normal pressure hydrocephalus leading to gait apraxia and urinary incontinence
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failure of the arachnoid granulations to resorb CSF leading to ventricles enlarging and pushing against pathway important for control of legs and bladder
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why is normal pressure hydrocephalus frequently overdiagnosed
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because hydrocephalus ex-vacuo appears like enlarged ventricles, patients actually have AD with gait instability and urinary incontinence
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differentiate pseudodementia (depression) from actual dementia
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depression - onset may be abrupt and may fluctuate from day to day, emphasizes failures, personality changes, aware and distressed (good insight)
dementia - slow and steady progression, emphasizes achievements, cheerful, unaware and unconcerned (low insight) |
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symptoms often associated with withdrawal from alcohol and sedatives
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delirium tremens - hallucinations, restlessness, autonomic over-activity, and irritability
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characteristics of encephalopathy
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acute onset
fluctuating course sleepy often reversible |
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how do know if primary aphasia is present
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language deficits are far our of proportion to the memory loss, unlike dementia or encephalopathy
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memory loss begins after a fall
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chronic subdural hematoma
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how to distinguish focal mass lesion on exam from dementia or encephalopathy
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look for focal abnormalities on exam - this will not be found in person with dementia or encephalopathy
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