dementia

Question 1

1. List the diagnostic features of dementia

Answer 1

impairment of memory and cognition without change in state of consciousness

criteria is memory plus one of: aphasia, apraxia (complex motor function), agnosia (naming things), executive functioning

Question 2

2. List the clinical criteria for Alzheimer’s disease as well as the clinical stages and characteristics of each stage

Answer 2

most common form of dementia

less than 65 yo is early onset

treat with anticholinesterases for mild to moderate, nmda agonist for moderate to severe

can see marked neuroatrophy of brain on imaging

starts with difficulty finding the right word, leads to anomia and apraxia, the severe cognitive defects

Question 3

3. List the different etiologies of dementia and recall which ones are potentially reversible

Answer 3

alzheimers, vascular (often has a stepwise decline via multiple infarcts), frontotemporal (early behavioral disturbances), lewy body (has parkinsonian features and early onset of visual hallucinations, seeing animals, and can’t be given antipsychotics), creutzfeld-jakob disease (very fast progressin, myoclonis twitch, triphasic EEG complex), Huntington’s disease (chromosome 4, choreiform movements, autosomal dominance), HIV dementia (apahty and pyshomotor slowing with preserved memory

all the above are non reversible

Wernicke Korsakoff’s is reversible, it’s chronic alcoholisms causing B12 deficiency, causes anterograde amnesia, needs IV thiamine DEFORE glucose

Question 4

4. Summarize the basic dementia work-up, to include laboratory data, imaging, and history

Answer 4

get basic lab data, imaging (CT) for vascular, suspect the 3 big causes (alzheimers, vascular if local lesion and stepwise decline, lewy body if parkinsonian symptoms)

Question 5

5. Name the neurotransmitters, pathological lesions (if known), and brain areas implicated/affected in the most common forms of dementia

Answer 5

alzheimers is acetylcholinergic and in nucleus basalis

Question 6

6. Name the “cognitive enhancers” used to ameliorate memory problems in dementias

Answer 6

anticholinesterases (rivastigmine, neostigmine, donepezil) and nmda agonists

memantine is an nmda agonist

Question 7

7. Differentiate between dementia, depression, delirium, and amnestic disorder

Answer 7

do it

Question 8

molecular cause of alzheimer’s?

Answer 8

formation of beta amyloid plaques causing necrosis

Question 9

what’s delirium?

Answer 9

impairment of consciousness and cognition, abrupt in onset, waxes and wanes, hallucinations, bad attention

on year mortality rate of 50%