Dementia

Question 1

Define compression fracture in TBI

Answer 1

a depressed skull fracture in which the broken bone exerts pressure on the brain

Question 2

Define concussion

Answer 2

bow to head or sudden deceleration usu causing an AMS, either temporary or prolonged. “brief loss of consciousness”

Question 3

Define countrecoup

Answer 3

bruising or damage to brain tissue on the side opposite where the blow was struck

Question 4

Define diffuse brain injury

Answer 4

injury to cells in many areas of the brain rather than in one specific location

Question 5

Define epidural, subdural, intracerebral and subarachnoid hematomas

Answer 5

Epidural -outside the brain and its fibrous dura but under the skull; rupture of middle meningeal arteries (“lucid period”)

subdural - btw brain and dura; rupture of bridging veins

intracerebral -in the brain tissue (often basal ganglia)

subarachnoid -around the surfaces of the brain, btw dura and arachnoid membranes; usu due to rupture of saccular/berry aneurysm

Question 6

Define focal injury in TBI

Answer 6

confined to a specific area of the brain

Question 7

Define penetrating injury in TBI

Answer 7

when an object, such as a bullet or hay hook, breaks thru the skull, enters the brain and rips the soft brain tissue in its path

Question 8

Define skull fracture

Answer 8

breaking the bones surrounding the brain. A depressed skull fracture is one in which the broken bone exerts pressure on the brain

Question 9

T/F Memory is the slowest part of the conscious mind to recover from a TBI. It can be weeks or months before your survivor is able to routinely store new memories.

Answer 9

True

Question 10

Post-traumatic amnesia can occur for longer than the coma itself and causes the patients to act in an almost child-like state. The best environment is little or no stimulation. What are some guidelines to follow when interacting with someone suffering from post-traumatic amnesia?

Answer 10

• always identify yourself when entering the room
• tell her that it is morning, afternoon or evening to help her orient to time
• warn her when you are going to touch her
• show photos of familiar ppl
• surround her with familiar objects
• repeat that she has been injured and is in hospital
• dont’ ask her to recall injury
• be patient

Question 11

What are the three stages to your family member’s rehabilitation?

Answer 11

• Acute inpatient rehabilitation in a specialized facility offering a full range of therapies
• An outpatient day program in a structured group setting with a full range of therapies
• Individual outpatient therapy to treat more troublesome impairments

Question 12

What are the 2 primary components of rehabilitation after TBI?

Answer 12

1. relearning forgotten skills

2. compensating for more enduring impairments

Question 13

What’s the first goal in rehab after TBI?

Answer 13

relearn ADLs

Question 14

If your survivor is not yet ready for rehabilitation, but no longer requires the special care of an acute hospital, your health insurer will no longer pay the hospital bill. In this situation, you have three options:

Answer 14

• You can pay the bill yourself, if a bed is available.
• You can care for your patient at home, but this is a demanding job that requires medical skills.
• You can place your loved one in a long-term care facility, such as a nursing home, until she’s ready for rehabilitation.

Question 15

What is chronic traumatic encephalopathy?

Answer 15

a progressive neurodegenerative disease in the category of tauopathies

multiple mild TBIs –> late-life dementia

symptoms: tremors, unsteadiness, masked faces, mental deterioration (parkinsonism)

Question 16

About how many ppl a year in the US suffer TBI? What are the 2 top likely causes? Which age group and gender is at most risk?

Answer 16

1.7 million
1) falls and 2) MVAs
males; 0-4 and 15-19

Question 17

TBI to the pituitary glands can affect?

Answer 17

• growth in children
• BP
• fatigue
• depression
• sex drive
• body temp
• pain

Question 18

TBI to the amydala can affect?

Answer 18

• memory formation
• emotional sensitivity
• learning & retention
• depression
• anxiety

Question 19

TBI to the frontal lobes can affect?

Answer 19

• emotions
• impulse control
• language
• memory
• social & sexual behavior

Question 20

TBI to the parietal lobes can affect?

Answer 20

-ability to locate parts of your body & recognize parts of your body

Question 21

TBI to the temporal lobes can affect?

Answer 21

hearing, language, ability to recognize a familiar person’s face, processing sensory info

Question 22

TBI to the occipital lobes can affect?

Answer 22

distortion of visual field, perception of size, color & shape

Question 23

TBI to the cerebellum can affect?

Answer 23

movement, muscle tone and gait

Question 24

TBI to the brainstem can affect?

Answer 24

HR, breathing, swallowing

Question 25

TBI to the hypothalamus can affect?

Answer 25

sex drive, sleep, hunger, thirst, emotions

Question 26

TBI to the hippocampus can affect?

Answer 26

new memory creation, new memory retention, mood, confusion, disorientation

Question 27

What are age-associated cognitive changes?

Answer 27

- difficulty retrieving words and names (names are hardest to remember) - slower processing speed - difficulty sustaining attn when faced with competing environmental stimuli - learning something new takes a bigger effort - no functional impairment (function is key!)

Question 28

What is mild cognitive impairment (MCI)?

Answer 28

- memory complaint confirmed by others - objective memory impairment for age and education - preserved general cognition - normal activities of daily living - not demented * **no functional impairment; may or may not progress to Alzheimers

Question 29

Early onset Alzheimer's disease is rare. It occurs btw 30-60, familial in most cases. What are some genes involved and on what chromosomes?

Answer 29

- abnormal presenilin 2 on chromosome 1 - abnormal presenilin 1 on chromosome 14 - abnormal amyloid precursor protein (APP) on chromosome 21

Question 30

The late onset Alzheimer disease is the most common form and develops after age 60. Which apolipoprotein gene increases risk? Which one is protective?

Answer 30

``` E4 = increases risk E2 = protective ```

Question 31

List gross and microscopic findings in someone with Alzheimer's disease

Answer 31

Gross --> cerebral atrophy (occipital lobe is spared) with ventricular enlargement Microscopic 1) amyloid plaques of extracellular deposits of beta-amlyoid with neuritic plaques 2) beta amyloid deposits near vessels --> cerebral amyloid angiopathy 3) filamentous intracellular inclusions of tau protein called neurofibrillary tangles and neuropil threads 4) granulovacuolar degeneration 5) hirano bodies

Question 32

Comment on the activity of a, b, and y-secretase on Alzheimer's disease

Answer 32

a-secretase cleaves APP into normal protein that won't aggregate b-secretase and y-secretase (catalytic subunit is presenilin) cleave APP to form beta amyloids, and more Ab42 vs Ab40. In AD, more total Ab and more Ab42

Question 33

What are two biggest risk factors for developing late onset AD? Briefly list other symptoms

Answer 33

1) age!!! 2) ApoE e4 female, family h/o of dementia, lower income, fewer yrsof education, lower occupational status, depression, head injury, low folate and B12, high homocysteine, postop delirium, alcohol abuse

Question 34

What are the 3 key features of AD

Answer 34

- impaired cognition - impaired function - behavioral disturbances

Question 35

List some early symptoms w/in the 3 key features of AD.

Answer 35

1) impaired cognition: trouble keeping appts, difficulty finding words, misplacing objects 2) impaired function: difficulty driving, difficulty selecting clothes, missing appts, probs at work 3) behavioral disturbances: subtle changes in personality, social withdrawal, depression

Question 36

What is pseudodementia?

Answer 36

When elderly are actually depressed, but are diagnosed with dementia. Treat with anti-depressants (SSRIs)

Question 37

AD is usually sporadic and late-onset. Frontotemporal Dementia aka Pick's Disease has an insidious onset with gradual progression. How is pick's disease distinct from AD clinically?

Answer 37

A person with Pick's disease will show behavioral disturbances, often inappropriate ones before having memory loss. So 1st thing to go is social interpersonal conduct, emotional blunting, loss of insight with memory loss occurring much later. Therefore, it's characterized by behavioral abnormalities (lose filter!)

Question 38

What are pick bodies found in Pick's disease?

Answer 38

circular bodies made of tau proteins

Question 39

AD is assoc with degeneration of the basal nucleus of meynert due to ach deficiency, which contributes to the memory deficits. List the 3 achase inhibitors in our notes that can be used to slow down memory loss.

Answer 39

donepezil rivastigmine galantamine

Question 40

excitotoxicity may cause neuronal damage in AD so there are drugs used in AD that are glutamate NMDA receptor blocker. List one.

Answer 40

Memantine -a partial agonist of NMDA receptor (not first-line unlike donepezil; but often given with donepezil)

Question 41

List the 3 categories of drugs that can be used to treat neuropsych disturbances in AD patients

Answer 41

- antipsychotics (risperidone, haloperidol) - antidepressants (sertraline -ssri, venlafaxin -snri) - anxiolytics (buspirone and lorazepam)

Question 42

After AD, vascular dementia is the 2nd leading cause of dementia. What is involved?

Answer 42

- hypertension related small vessel disease - multi-infarcts (lacunar infarcts) - cerebral amyloid angiopathy (so not unique to AD) - can have subcortical leukoencephalopathy --> affecting deep white matter; subcortical dementia

Question 43

How does vascular dementia progress? Whats most likely in someone's PMH?

Answer 43

Vascular dementia progresses in a step-wise fashion and usually seen with cardiovascular risk factors

Question 44

You can use achase inhibitors in AD and vascular dementia, but is of no use in?

Answer 44

pick's disease/frontal temporal dementia

Question 45

What is parkinson's disease? Most cases are?

Answer 45

PD cases due to low dopamine seen on pallor of substantia nigra are sporadic and usu affect ppl over 65. Symptoms are resting tremor, akinesia, bradykinesia, shuffling gait, rigidity, postural instability, and at times dementia. Will contain lewy bodies which have eosinophilic inclusions of a-synuclein

Question 46

Lewy body dementia is primarily sporadic and late onset. HOw is this clinical course different from the dementia present in AD/Pick's?

Answer 46

In lewy body dementia, memory is less affected compared to AD. Huge deficits in attention and alertness with vivid hallucinations, delusions. REM sleep problems, autonomic dysfunction as well as frequent falls. Basically, when you see someone with parkinson's symptoms + dementia that will have the onset of dementia w/in 12 months of parkinsonism.

Question 47

T/F: avoid antipsychotics in lewy body dementia

Answer 47

true due to increased sensitivity