Delirious
unable to answer questions
frightened and agitated
Dementia
not concerned with mistakes
tries to answer
pseudodementia
“I don’t know” answers
won’t answer questions
get frustrated & afraid they’ll be wrong
Dementia –progressive and mostly irreversible
progresses slowly (insidious onset) memory gaps disoriented (memory, judgment, abstract thinking, and orientation gets worse over time) poor task performance worse as day goes on appears unconcerned appetite doesn't change
Pseudodementia (depression with demenia syndrome)
progresses rapidly forgetful oriented puts forth little effort improves throughout day communicates stress diminishes stress
Differentiating pseudodementia
Depression with dementia syndrome hx. of depressive episodes presence of vegetative signs (insomnia & weight loss) tendency to "give up trying" often misdiagnosed
Primary Dementia
irreversible
- Alzheimer’s disease
- Vascular dementia
- Pick’s disease
- Lewy body disease
Secondary Dementia
Usually reversible
-cause by other pathological process (hydrocephalus)
Alzheimer’s disease
- widespread brain atrophy
- decreased availability of Ach and/or high glutamate (too much excitatory neurotransmitter = neuronal death)
- marked increased in neuritic plaques & neurofibrillary tangles
- genetic fx. (early-onset)
Pick’s Dementia
- atrophy of frontal and anterior temporal lobes
- behavior manifestations (disinhibition and extreme impatience
-some issues with antipsychotics (can get really crazy)
Vascular dementia
- little TIAs
- brain has multiple vascular lesion in cortex/subcortical areas
- sx. appear more abrupt (stair-step deterioration) get a little worse with each TIA
- brain has multiple vascular lesion in cortex/subcortical areas
-M>F
Creutzfeldt-Jacob disease
- mad-cow disease
- caused by prions that cause spongiform encephalopathy (cells stripped of inner cell material)
Sx: personality changes and seizures
-can be dormant for years then hits and death within a year
Diffuse Lewy Body Disease
- Lewy bodies in:
- frontal and temporal cortex mainly
- also in hippocampus and substantia Niagra
-sx. -severe visual hallucinations, fluctuating alertness (like delirium), some falls & EPS (shuffling walk, cogwheel movements)
Normal pressure hydrocephalus
impaired return of CSF = too much fluid and pressure
enlarge ventricles can be seen on CT/MRIs
-reversible if surgery done early enough
Huntington’s Disease
Insidious behavioral changes Disruption of attention Distinctive choreiform (Involuntary, forcible, rapid, jerky movements) movements appear later: facial twitches
Huntington’s Disease cause
Mutation on chromosome 4
Autosomal dominant
CAG repeats 11-34 times
> 34 number of repeats, earlier the onset and more severe
AIDS dementia
- classic triad of sx (cognitive, motor function, and behavioral sx)
- subcortical dementia with infiltration of infected macrophages or microglial cells in brain
Risk: 3x with CD4 of <200, 7x with CD4 of <100
Wernicke Korsakoff syndrome
vitamin B1 low (rare and potentially reversible dementia)
low B1 (thiamine) = causes demyelination and axon loss in brain and spine
Sx: ataxia, nystagmus, confabulation (long-time story changes through the years b/c patient can’t remember what happened and makes stuff up)
Alzheimer’s Risk Factor
Age African-American and Hispanic hypertension DM Head trauma (football) women (a menopause especially)
Alzheimer’s Stages
Stage 1 (mild): forgetfulness Stage 2 (moderate): confusion Stage 3 (moderate to severe): ambulatory dementia Stage 4 (late): end stage
Alz. Sample of Behaviors
Confabulation: unconscious attempt to maintain self-esteem
Perseveration: repetition of phrase or behaviors
Aphasia: loss of language ability
Apraxia: loss of purposeful movement in the absence of motor or sensory impairment
Agnosia: loss of sensory ability to recognize objects
Cholinesterase inhibitors
- get rid of ACH enzyme that eats ACH
- for mild to moderate AD
- As AD progresses, brain produces less and less ACH making the meds not as useful
-aricept, Exelon, reminy/rivastigmine, Cognex
Namenda (memantine)
- believed to regulate glutamate
- for moderate to severe AD
- mainly to delay the s/s
Other meds to deal with AD as it progresses
for agitation and aggression
- depakote
- carbamazepine (tegretol)
SSRIs and atypical antipsychotics help quell agitation anxiety, and aggression (they have additive anticholinergic effects -prone to falls, but slow down the movements)
