Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
18 Cards in this Set
- Front
- Back
Dementia definition?
signs? |
Syndrome consisting of impaired cognition functions interfere w/ ability to function
4A's (Can be involved) 1) Aphasia (language) 2) Amnesia (memory) 3) Apraxia (carry out motor activities) 4) Agnosia (recognize/identify) Also: executive function (planning, organizing, sequencing, abstraction) Irreversible (most of time) |
|
Pseudodementia
|
reversible (DO NOT DIAGNOSE AS DEMENTIA)
- Get when depressed - Give up easily (effort when testing) - No "sundowning" (activity at night; will have diurnal mood variation) - Crying spells, suicidal thoughts - Will notice if have problems with memory (true dementia: don't think have memory problems) - NO APRAXIA, AGNOSIA, APHASIA (Note: Depression often before full onset of Alzheimer's) |
|
Delerium vs. Dementia
|
- Dementia: Usually insidious but acute (ex: stroke), sensorium unimpaired (no clouded consciousness, normal level of arousal, progressive (usually irreversible)
- Delerium: usually rapid/acute, clouded consciousness, agitation or stupor, reversible |
|
Histopathology of AD
|
1) Senile plaque/Beta Amyloid (extracellular)
2) Neurofibrillary tangles/Hyperphosphorylated Tau proteins (Intracellular) 3) Hirano Bodies (intracell - not specific: also see in Creutzfeld-Jakob) 4) Granulovacuolar degen (intracell) 5) Loss of Neurons in nucleus basalis of Meynert |
|
Delirium
|
* decreased attention
*altered memory, orientation, language, mood, perception *Rapid evolution several hours to days! *suspect UTI, alcohol/sedative withdrawl, or Rx. toxicity (elderly) *comes and goes (waxes and wanes) & loss of orientation *Acute Brain Failure: treatable! |
|
Dementia
|
*Slow evolution of multiple cognitive
deficits *Impaired memory *Personality Disturbance *constant & have sense of orientation (NOTE: May not always how symptoms - can have Mini Mental Eval 29/30 and still have dementia) *Alzheimer’s type: 40 < x <90 yo |
|
Frontal Lobe Release signs
|
Delerium brings out reflexes have as a baby
- Palmar grasp - Suck: - Snout: touch above upper lip -> scrunch up against nose - Rooting: touch mandibular ramus -> rotate head TOWARDS stimulus (as if trying to see it) - Glabellar: tap btwn eyes -> nod/shake off head |
|
Treatment of delerium
|
Light
Resynch sleep/wake Ground pt Treat underlying condition Time Phys/Chem restraints |
|
Diagnosing Dementia
|
H&P, PET, SPECT, Labs
Mini Mental status (Can have 29/30 and still have dementia) Focus on: Sensorium/Cognition: - Level of Consciousness (clouded, stupor, etc) - Orientation (name, place, time, situation) - Concentration/attention (serial 7's, digit span) - Read/Write (write sentence, read and follow instructions - Verbal fluency (words start w/ F) - Visual spatial (Draw clock/intersect pentagon) - Memory |
|
Most common cause of degenerative dementia
|
Alzheimers disease (50-60% of all cases)
|
|
Alzheimer's Disease
Early vs late Onset MRI/CT Phys Exam findings |
Early = 65 or younger
Late >65 Familial -> 5th decade (50 yo) onset Insidious onset MRI/CT show atrophy/enlarged ventricals Babinski, frontal lobe release signs, hyperactive reflex PET = best for diagnosis (i |
|
Treatment of Alzheimers Disease
|
Cholinergic Therapies:
- Donepazil - Galantamine - Memantine - Rivastigmine - NOT TACTRINE (COGNEX) (Note: No FDA drugs approved for controlling behavioral/agitation w/ Dementia - ALL off-label use of drugs) "Forgot Me Gal Down the Riva" |
|
Concerns treating Dementia with drugs
|
All are off-label use
Avoid Anti-ACh drugs (make worse; ex: benztropine/anti-PD drugs) BBW: antipsychotics in pt w/ dementia -> increased rate of sudden death Used: - Antipsychotics - Antidepressants - Anticonvulsants - Anxiolytics |
|
Lewy Body Dementia:
Prevalence Signs/Symptoms Histology Concerns |
25% of dementias
Progressive, irreversible (MORE malignant than AD) Visual hallucinations & Parkinsonian features (**Hallmark: hallucinations & movement disorders) Lewy bodies: eosinophilic (red) inclusions in cortex/brainstem Concern: VERY sensitive to psychotropics/antipsychotics |
|
Frontotemporal Dementia
Histology Behavior Other signs/symptoms |
Tau inclusions
Behavior: Either withdrawn OR disinhibited; repeat same action Problems with speech Memory last to go |
|
Vascular Dementia
Onset History Prevalence |
SUDDEN onset
hx HTN, vascular disease #2 behind Alzheimers |
|
NPH
Signs Etiology |
Normal Pressure Hydrocephalus:
Triad: Dementia, Gait disturbance, Urinary incontinent 1) Excess accum CSF 2) Dilated Ventricles 3) Normal CSF pressure 4) Flow obstructed/fluid collects in ventricles (Can give Ventriculo-Peritoneal Shunt) |
|
Wernicke's Encephalopathy
Signs Treatment |
1) Nystagmus
2) Gait disturbance 3) Confusion Treat: Thiamine STAT (can lead to Korsakoff's dementia/psychosis) |