N2Wk4- 10-5 Hon Dementia

Front 1

Dx of dementia

Back 1

– A decline in memory and at least one other cognitive function (aphasia, apraxia, agnosia, or a decline in an executive function, such as planning, organizing, sequencing, or abstracting).
- has to impair everyday life in comparison to previous functioning (must get baseline first)

Front 2

Pt has increased confusion worse than baseline and has UTI can u diagnose dementia?

Back 2

no has to be outside the confines of delirium and psycho problem

Front 3

Numbers of dementia in the US?

Back 3

> 4% over age of 65
>20% over age of 85

Front 4

Causes of Dementia...
MCC

Back 4

1. degenerative process
a. Alzheimers (50-75% of all cases)
b. Diffuse Lewy body disease (maybe 2nd MCC)
c. Parkinson's disease
d. Frontotemporal lobar degeneration
(frontotemporal dementia (Pick's disease)
- Progressive nonfluent aphaia
- Semantic dementia

Front 5

Frontotemporal dementia aka?

Back 5

pick disease

Front 6

Degenerative dementias

Back 6

Progressive supranuclear palsy
• Corticobasal degeneration
• Multiple system atrophy
• Huntington’s disease
• Olivopontocerebellar degeneration

Front 7

What are vascular dementia causes?

Back 7

1. MI
2. Single stroke
3. Binswanger's disease
4. Vasculitis
5. Subarachnoid hemorrhage

Front 8

Infectious causes of dementia

Back 8

Infectious
• Fungal meningitis
• Syphilis
• AIDS dementia
• Creutzfeldt-Jakob disease
• Post-herpes simplex encephalitis

Front 9

Memory storage

Back 9

inframedial temperol lobes

Front 10

Psychiatric like dementia relations?

Back 10

Psychiatric or depression untreated for years could lead to dementia
• Depression
• Alcohol abuse
• Drug-related disorder
• Personality disorder
• Anxiety disorder

Front 11

Toxic causes of dementia?

Back 11

Toxic/Metabolic
• Vitamin B12 deficiency
• Thyroid deficiency
• System failure: liver, renal, cardiac, respiratory
• Heavy metals
• Toxins (e.g. glue sniffing)- very bad for causiing

Front 12

Traumatic causes of dementia

Back 12

• Subdural hematoma
• Closed head injury
• Open head injury
• Pugilistic brain injury- boxer's
• Anoxic brain injury

Front 13

tumor causes of dementia

Back 13

• Glioblastoma
• Lymphoma
• Metastatic tumor

Front 14

Evaluation of patient with dementia

Pearls looking for?

Back 14

Consider a separate interview.

- • ? Short-term memory problems remember tasks?
• ? Time course (rapid or slow progression) slow usually
• ? Functioning of patient – work, finances, reading newspaper, watching
T.V., shopping, hobbies
• ? Safety – driving, cooking, weapons in home
• ? H/O head injury, toxin exposure, infection, psychiatric problems
• ? Family history of dementia

Front 15

Which diseases have EEG signs?

Back 15

Creutzfeldt-Jakob, encephalitis)

Front 16

Examination of possible demented pt?

Back 16

Standardized short mental state test e.g. Folstein Mini-Mental State Examination. Also ask about news events
– Look for cardiovascular risk factors (HTN, arterial bruits, arrhythmia, heart murmurs)
– Full neurologic examination

Front 17

Dx for Alzheimer's disease

Back 17

Dementia established by means of clinical examination and documented with the Mini-Mental State Examination or similar examination and confirmed with neuropsychological tests
deficits in 2 or more ares of cognition
– Progressive worsening of memory and other cognitive function
– No disturbance of consciousness
– Onset between the ages of 40 & 90 yr, most often after 65.
– Absence of systemic disorders or other brain diseases that in and of themselves could account for the progressive deficits in memory and cognition.

Front 18

Onset of alzheimer's age?

Back 18

40-90 most often after 65

Front 19

In summary what is alzheimer's disease come to?

Back 19

diagnosis of exclusion

Front 20

Supportive findings in diagnosis of probably alzheimer's disease

Back 20

Progressive deterioration of specific cognitive functions such as aphasia, apraxia, or agnosia
– Impaired activities of daily living and altered patterns of behavior
– Family history of similar disorders, particularly if confirmed neuropathologically
– Normal L.P.
– EEG: normal or mild generalized slowing
– Progressive atrophy documented by MRI or CT brain

Front 21

What is the problem with CT or MRI of head of older person?

Back 21

most older people will show generalized atrophy of the brain (sulci are bigger and gyri are smaller)

Front 22

Tx goal with Alzheimer's

Back 22

main goal of treatment is to slow the progression of the disease

Front 23

Tx alzheimer's

Back 23

Usually 1 and 2
1. Acetylcholinesterase Inhibitors:
• Donepizil (Aricept)
• Rivastigmine (Exelon)
• Galantamine (Reminyl)
2. NMDA receptor Antagonist
a. Memantine (Namenda) – indicated for moderate to severe dementia of probable
b. Alzheimer’s disease
3. Consider B complex, lipid-lowering agent, aspirin

Front 24

Define mild cognitive impairment

Back 24

Memory complaint by the patient
- tested abnormal for memory, yet not meeting critieria for dementia

Front 25

Define vascular dementia

Back 25

– Cerebrovascular disease such as hemiparesis, lower facial weakness,
Babinski sign, sensory deficit, hemianopia, consistent with stroke, + evidence of relevant cerebrovascular disease at brain imaging
- abrupt within 3 months after recognized stroke, or stepwise progression

Front 26

Diffuse Lewy Body disease

Back 26

may be second most common cause of dementia besides alzheimer's
Tetrad-
a. Parkinsonian symptoms
b. prominent psychotic symptoms
c. prominent psychotic symptoms
d. extreme sensitivity to antipsychotic agents

Front 27

– Often progresses more rapidly than Alzheimer’s disease
Symptoms generally vary a great deal more from one day to the next than do symptoms in Alzheimer’s disease
- Mild to moderate parkinsonian features are often present early in the disease. (w/ no response to L-Dopa and no resting tremor)

Back 27

diffusse lewy body disease- Symptoms generally vary a great deal more from one day to the next
than do symptoms in Alzheimer’s disease

Front 28

Visual hallucination is MC psychotic symptom generally animals or people and hallucinations are often not particularly bothersome see in?

Back 28

Diffuse lewy body disease

- use atypicals if using anti-psychotics

Front 29

– Midbrain Lewy bodies
– Executive dementia sometimes occurs late in illness.
– Resting tremor usually present
– Autonomic dysfunction sometimes seen

Back 29

parkinson's

Front 30

Parkinson's vs. diffuse lewy
– Hallucinations only in response to antiparkinsonian drugs

Back 30

Parkinson's

Front 31

Parkinson's vs. diffuse lewy
corical lewy bodies

Back 31

diffuse lewy body

Front 32

Parkinson's vs. diffuse lewy
autonomic disfunction

Back 32

both

Front 33

Parkinson's vs. diffuse lewy
resting tremor present

Back 33

parkinsons

Front 34

Form of dementia characterized by a slowly progressive deterioration
of social skills and changes in personality, along with impairment of
intellect, memory, and language.

Back 34

pick's (frontotemperal lobe syndrome)

Front 35

Other symptoms of picks disease

Back 35

– Other symptoms include: gradual emotional dullness, loss of moral
judgment, and progressive dementia.

Front 36

Ages for pick's
Imaging shows more what?

Back 36

40-60
atrophy predominant fronto and temporal

Front 37

• Dementia
• Gait disturbance
• Urinary incontinence
What is tx?

Back 37

normal pressure hydrocephalus
-ventriculoperitoneal shunting
- improves gait with potential for dementia reversal