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118 Cards in this Set
- Front
- Back
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For the Clinical features of Cortical Dementia, what does DEAR GRAMPA mean?
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D-decline in social or occupational functioning
E-executive functioning decline A-apraxia (motor function impairment) R-rule out other conditions G-gradual onset and progressive decline R-runs in families A-aphasia M-memory impairment P-personality changes can occur A-agnosia (can't recognize objects) |
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What is the progression of Cortical Dementia?
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lasts 8-10 years, and range is 2-22 years
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Is this clinical course and history describing Pseudodementia or Dementia?
-Family always aware of dysfunction -rapid progess of symptoms -symptoms of short duration -previous psychiatric history common |
Pseudodementia
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Is this clinical course and history describing Pseudodementia or Dementia?
-Family often unaware of dysfunction -Slow progression of symptoms -symptoms of long duration -previous psychiatric history uncommon |
Dementia
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Are these complaints describing Pseudodementia or Dementia?
-Patient reports cognitive loss -Patient emphasizes disability -Patient makes little effort to perfrom simple tasks -Patient usually reports strong sense of distress -Loss of social skills often early |
Pseudodemntia
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Are these complaints describing Pseudodementia or Dementia?
-Patient minimizes cognitive loss -Patient conceals disability -patient struggles to perform tasks -Patient often appears unconcerned -Social skill often retained |
Dementia
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Are these clinical features describing Pseudodementia or Dementia?
-attention and concetration often intact -Don't know answers typically -Recent and remote memory loss usually severe |
Pseudodementia
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Are these complaints describing Pseudodementia or Dementia?
-Attention and concentration often faulty -near miss answers frequent -recent memory loss more severe than remote memory |
Dementia
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Dementia of Lewy bodies' shares clinical features with what 2 diseases?
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Parkinson's and Alzheimer's
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Dementia of Lewy bodie's neuropathologic hallmark findings are what?
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intracellular Lewy body present in substantia nigra, brain stem, entorhinal, cortex
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Like AD dementia, Dementia of Lewy bodies' also has what?
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plaques and tangles
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Dementia of Lewy Bodies is more present in what sex?
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males 2:1
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What is the age of onset for Dementia of Lewy bodies?
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50-80 years
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What percent of Dementia of Lewy Bodies' pts have Parkinson symptoms?
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80%
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What is the specific tx for Dementia of Lewy bodies?
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there isn't a specific treatment
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What can't you use Neurleptic medications in Dementia of Lewy Bodies pts?
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because they can cause delirium and even death
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What drugs can be helpful for psychosis and agitation in pts w/ Dementia of Lewy bodies?
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-Quentiapine (Seroquel)
-Clozapine (Clozaril) -Cholinesterase |
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What are the criteria for Dementia of Lewy Body Disease?
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-Fluctuating Cognitive Impairment
-One of the following (will go into in another question) -The above for over a period of months -Rule out other causes -No evidence of vascular dementia |
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What is ment by fluctuating cognitive impairment?
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-memory and one other area affected
-Episodic confusion followed by lucid interval |
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When dementia of Lewy body disease means you have to have one of the following, what are they?
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-visual (most common) auditory hallucination, paranoid delusion
-Mild extrapyramidal symptoms, neuroleptic sensitivity, unexplained fall, transient clouding or loss of consciousness |
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What is the prevelance of FTD?
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unknown
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FTD is characterized by what?
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frontotemporal atrophy
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What is seen in frontal and temporal corticis?
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neuronal loss, astrocytosis, and vacuolization
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In some cases of FTD, what are present?
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intracellular pick bodies
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FTD dementia are linked to what chromosome?
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17
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What is the average of onset for FTD?
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54
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What is the average duration of FTD disease?
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7 years
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FTD progresses how compared to AD?
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faster
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What sex is FTD more common in?
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males
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FTD more often presents with what?
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-personality changes
-behavioral disturbances -impaired executive function impairment |
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Features of what syndrome are more common in FTD than AD?
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Kluver-Bucy Syndrome such as hypersexuality, placidity, and hyperorality
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What are common symptoms of FTD?
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-apathy
-disinhibition -intrusiveness -irritability -aggression |
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When in FTD does dysphasia manifest?
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early
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When does bradykinesia, rigidity, and gait disorders develop in FTD?
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later
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FTD exhibits stereotype behavior such as what?
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-echolalia
-perseverative speech |
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FTD demontrates what kind of memory impairment?
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variable
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For FTD, how are the neurologic examination and EEG usually?
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normal
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For FTD what signs may be positive?
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Frontal Lobe release
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What does Tx of FTD rely on?
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management of behaviors
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What are prion proteins?
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normal brains proteins gene located on short arm chromosome
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How common is Creutzfeldt-Jakab Disease?
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1 in 1,000,000
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What is the age of onset and range for Creutzfeldt-Jakab disease?
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50-70 and ragne 20-79
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For Creutzfeldt-Jakab disease, death occurs when?
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within months to 1 year
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Creutzfeldt-Jakab disease has what chracteristic pattern?
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spongiform neuropathologic pattern
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What are the usually initial complaints of Cruetzfeldt-Jakab disease?
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-fatigue
-anxiety -sleep disturbances -appetite changes -depression -impaired concentration -forgetfulness |
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After a few weeks of Creutzfeldt-Jakab disease what happens?
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progressive dementia causes apahsia, amnesia, apraxia, agnosia, and severe congitive deficits
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What are some other features of Cruetzfeldt-Jakab disease?
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-myoclonus
-chorea -tremor -ataxia -cerebellar signs -pyramidal signs -spasticity -rigidity -seizures -hallucinations -delusions |
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Gerstmann-Straussler-Scheinker (GSS) is a type of prion dementia that develops how?
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slowly progressive type
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GSS has what type of genetic trait?
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autosomal dominant
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What is the age of onset for GSS?
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40-60
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The symptoms of GSS are very similiar to what disease?
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Creutzfeldt-Jakab Disease
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What type of prion dementia is seen in certain tribes of New Guinea?
It is associated with what? |
Kuru type
associated with cannibalism |
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What are some types of subcortical or mixed dementias?
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-Dementia due to Parkinson's
-Dementia due to Huntington's -Vascular Dementia |
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How many Parkinson's pts develop demntias?
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over 1/3
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PD (Parkinson's Disease) affects how many?
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1 per 1000
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What are risk factor for PD that can mean a worse outcome?
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PD onset after 60 and tx resistant PD
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PD is characterized by a loss of what?
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dopamine producing cells in the substantia nigra
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In PD, what is more impaired than memory?
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executive function, attention and speed of thought processes
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What percent of PD pts also develop depression?
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60%
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What percent of PD pts develop hallucinations?
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30%
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What can be a complication of antiparkison medication?
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Psychosis
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Tx for PD is usually what?
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symptomatic
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What do you want to avoid in PD pts?
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typical neuroleptics
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What are perferred meds for the tx of PD?
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-Clozapine
-Quetiapine -Olanzapine |
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Huntington's is what type of gene and is located where?
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autosomal dominant gene located on short arm of chromosome 4
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Hungtington's is characterized by what?
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chorea personality disturbance, mood disorder, and dementia
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Huntington's affects how many ppl?
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1 per 10,000
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What is the average age of onset for Huntingtons?
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late 30s to early 40s
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In Huntingtons there is a progressive shrinkage of what?
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the bilateral caudate nucleus
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What are some early psychiatric symptoms of Huntingtons?
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-apathy
-slow thought process -attention deficits -impulsivity -emotional lability -violence -impaired executive function |
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What global impairment is seen in Huntingtons?
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-amnesia
-apahsia -agnosia -apraxia -personality changes |
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Mania and Psychosis is seen in what percent of Huntingtons pts?
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10%
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Suicide accounts for what percent of Huntington deaths?
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5.7%
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What percent of Huntington pts attempt suicide atleast once?
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25%
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What are some tx options for Huntingtons?
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Neuroleptics such as Haldol and Respirodol
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Vascular Dementia accounts for what percent of all dementias?
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15-30%
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What are some risk factors for Vascular dementia?
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-HTN
-hypercholesterolemia -diabetes -stroke |
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For vascular dementia, there is usually what type of decline?
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step-wise
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Vascular dementia frequently resembles what other type of dementia?
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AD
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What is the percent of depression in those with vascular dementia?
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50-60%
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Delusion and hallucinations frequently present when?
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in stroke involving nondominant hemisphere
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What are common symptoms of Vascular Dementia?
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-personality changes
-psychomotor retardation -apathy -lack of interest |
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What are tx options for Vascular Dementia?
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-focus on 2nd prevention by addressing risk factors
-Cholinesterase inhibitors are also helpful |
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Normal Pressure Hydrocephalus is characerized by what 3 things?
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-Gait apraxia
-urinary incontinence -Dementia |
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What is ment by an Amnestic Disorder?
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disorder that is mostly memory problems that lead to behavior problems
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For Amnestic disorders, there is a bilateral sclerosis of what?
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mamillary bodies
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For Amnestic disorders, there are degenerative changes where?
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in dorsal medial nucleus of thalamus
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Transient Global Amnesia mostly occurs at what age?
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middle age
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Transient Global Amnesia usually resolves w/in how long?
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24 hrs
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What is the probably cause of Transient Global Amnesia?
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vascular insufficiency of mesial temporal lobe
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What are some other causes of dementia not yet mentioned?
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-HIV
-Multiple sclerosis -Vit. B 12 folate deficiency -Hypthyroidism -Wilson disease (hepatolenticular degeneration) |
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What are some lab tests for Dementia?
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-urinalysis w/microscopy
-CBC -LFT -Renal function -Thyroid -Electrolytes -Serum Ca and Mg -ESR -syphilis test -HIV test -(CXR, EKG, Brain imaging, serum toxicology) are optional |
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Name 6 psychosocial tx for dementia.
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1-educate patient and family
2-ensure patient safety 3-address legal issues early 4-suggest assistance w/financial management 5-when appropriate raise the possiblity of placement 6-care for the caregiver |
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Cognitive enhancer drugs work to do what?
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stabilize or delay the progression of the disease and improves ADL's and cognitive performance
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Cholinesterase inhibitors work how?
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-inhibit ACHase
-reduce intrasnyaptic cleavage and inactivation of ACH |
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Name 3 Cholinesterase inhibitors used to tx dementia.
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-Donepezil (Aricept)
-Rivastigmine (Exelon) -Galantamine (Razadyn) |
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How does Donepezil/Aricept work?
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selectively blocks ACHase
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What are some S/E of Donepezil/Aricept?
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-N/V/D
-bracyarrhythmias and syncope -long half life **generally well tolerate** |
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What is the starting and target dose for Donepezil/Aricept?
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5mg qd for 6-8 weeks and then 10 mg qd
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In addition to ACHase, what else does Rivastigmine/Exelon inhibit?
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butyryl cholinesterase
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What are some side effects of Rivastigmine/Exelon?
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-N/V/D
-abdominal pain -anorexia -dizziness -fatigue -somnolence -short half life |
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What is the starting dose and max dose for Rivastigmine/Exelon?
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-starts at 2mg bid
-max is 6 mg bid |
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How should Rivastigmine/Exelon be taken?
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with meals and titrated slowly to avoid GI side effects
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Galantamine/Razdyn not only inhibits ACH, but also does what?
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enhances nicotinic activity
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What kind of half life does Galantamine have?
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short
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What are some adverse effects of Galantamine?
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GI that is dose related
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What is the initial dose and max dose for Galantamine?
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-4mg bid
-12 mg bid |
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Tacrine/Cognex is what kind of inhibitor?
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nonselective cholinesterase inhibitor
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Tell me 3 things about Tacrine/Cognex.
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-hepatologic
-frequent GI issues -rarely used |
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Name a NMDA Receptor Antagonist
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-Memantine (Namenda)
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How do NMDA receptor antagonists work?
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protect neurons from excessive stimulation by glutamate
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Excessive stimulation by glutamate is hypothesized to cause what?
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neuronal cell death
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Glutamate plays an important role in what?
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in neuronal pathways associated with learning and memory
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What is the starting and max dose for Memantine/Namenda?
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-5mg qd
-10mg qd |
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What types of drugs can be used to treat depression?
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-SSRIs, SNRIs, etc
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What are some drugs that can by used to treat psychosis in dementia pts?
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atypical neuroleptic
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What are some drugs that can treat agitation and aggression in dementia pts?
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-atypical neuroleptic
-mood stablizers -SSRIs -cognitive enhancers |
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What are some less validated tx for dementia?
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-estrogen
-vit E -NSAIDS -Ginko biloba -Selegiline -Statins -low fat diet -increased mental activity |
