Alzheimer's Vascular dementia Parkinson's associated dementia other - lewy bodies, chronic ETOH abuse, frototemporal

Hx - ask informant memory loss? confusion? wandering? RISK Difficulty problem solving? new focal neuro s/s New Meds? Substances? Family Hx of CV/dementia

Mini-Mental Status exam Montreal Cognitive Assessment (MoCA) Clinical Dementia rating (CDR) Focal Neuropsyc testing for specific domains - recent memory, language, executive function, visual/auditory memory

other Underlying dz? S/s Evidence of Self neglect? Evidence abuse?

Old APOE E4 mutation FH - esp. AA

Hx MRI not helpful labs- rule out reversible causes

Dementias Flashcards by O lawformonde

Dementia decreasing in USA w/

Cardio risk factor management

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Dementia

Types

Alzheimer’s
Vascular dementia
Parkinson’s associated dementia

*other - lewy bodies, chronic ETOH abuse, frototemporal

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Acute Onset
Stepwise
Risk Factors
Frontal deficits
Neuro Signs
Gait
Imaging

Vascular dementia

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Gradual onset
Memory Loss
Normal exam

Alzheimer’s Dz

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Parkinsonism
Hallucinations
Fluctuations
Frontal deficits
Visuospatial

Parkison’s w/ dementia

Lewy bodies

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Behavior
Frontal deficits
Family Hx
Young onset

Frontotemporal dementia

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Dementia

Hx - ask informant
memory loss?
confusion?
wandering? RISK
Difficulty problem solving?
new focal neuro s/s
New Meds? Substances?
Family Hx of CV/dementia

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Dx tests

Mini-Mental Status exam
Montreal Cognitive Assessment (MoCA)
Clinical Dementia rating (CDR)
Focal Neuropsyc testing for specific domains
- recent memory, language, executive function, visual/auditory memory

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Physical Exam

other Underlying dz? S/s
Evidence of Self neglect?
Evidence abuse?

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Labs

TSH
B12
*rarely help

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Alzheimer’s Dz

Path

Neurofibrillary tangles
Neuritic plaques
Cerebral atrophy

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Alzheimer’s Dz

Who?

Old
APOE E4 mutation
FH - esp. AA

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Alzheimer’s Dz

Risk Factors

CV
- Low education
- Sedentary
- Brain trauma
- Benzo use

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progressive memory loss
short term BAD
long term GOOD
sundowning - worse at night
language difficulty
wandering

S/s

Alzheimer’s Dz

*NOT DELIRIUM = sudden onset

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Alzheimer’s Dz

Hx
MRI not helpful
labs- rule out reversible causes

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Alzheimer’s Dz

Rx Tx

Mild vs. Severe

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MILD = AchE blockers
Donepezil
Galantamine
Rivastigmine

*SEVERE = Memantine

NO HELP REALLY

NO BENZOS/Sedatives to sleep = Quicker death

Alzheimer’s Tx

Non-Pharm Tx

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treat all other conditions
routines for daily living to MINIMIZE DISTRESS
Minimize Care-giver/environment changes

Alzheimer’s Dz

Prognosis

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8-10 years from Dx

*Worse= age, male, low MMSE at Dx

From strokes

Abrupt onset
stepwise deterioration
PE = stroke-like
MRI/CT = stroke
risk factors (stroke risks) : CV, DM, smoking

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Vascular Dementia

Tests

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Hx/ PE
Neuropsychatric testing
MRI
blood tests = other cause, cholesterol
Cardio/Carotid Echo = embolic sources?

Vascular Dementia

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Rx= AchE blocker/Memantine

PT/OT
routines/minimize environment changes

Vascular Dementia

Prognosis

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Prevent strokes!

Memory Cognitive Impairment

Types

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Amnestic = MC, forgetfulness
Non-amnestic = problem w/ executive function, language, visuospatial function)

10% PROGRESS TO ALZHEIMER’S

Mild Cognitive Impairment

History

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IMPAIRING JOB/LIFE?

med/psyc Hx
FH dementia?
how have abilities / behavior changed?

Mild cognitive impairment (MCI) Work-up

* rule out reversible causes (meds, depression, toxins, etc.) * GET BASELINE FUNCTIONING (mmse/full neuropsyc if suspicious)

* repeated blows to the head | * football players

Blow-Induced Dementia (CTE) * MUST PREVENT * PREVENT from YOUNG AGE

S/s TRIAD: Dementia Gait disturbance Urinary Incontinence (ONLY THIS)

Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus NPH Path 1ary vs. 2ary

Primary = not understood, HTN, Large head Secondary = CSF can't reabsorb across arachnoid villi

Gait = block turning, short steps Urinary = beginning-urgency, changing? cognitive disturbance = psychomotor slowing, DOWN executive function/attention, apathetic (NOT LIKE ALZHEIMERS) Signs?

Normal Pressure Hydrocephalus NPH

NPH vs. Alzheimer's Affect

FLAT in NPH

Normal Pressure Hydrocephalus Dx

* MRI = ventriculomegaly w/ normal sulci depth * LP = 30-50cc CSF removal improves gait/cognitive * neurosurgeons - other tests

Normal Pressure Hydrocelphalus NPH Tx

Ventricular Shunt (to stomach/atrium) * need shunt revisions over time * prognosis - death w/ fall usually

* rare * extreme disinhibition, inappropriate behavior * police arrest * refuse help, deny problem S/s?

Frontotemporal Dementia 6-8 yrs left

Frontotemporal Dementia Tx

SSRI = decrease disinhibition Atypical Anti-psycs * Olanzapine * Quetiapine (typical make worse! (Risperidone)

Huntington Dz Path

Expanded CAG repeate on Chrom 4, auto-dom

Progressive chorea dementia Anger bursts Antisocial Behavior S/s?

Huntington Dz

Huntington Dz Dx

History Physical Genetic testing

Abnormalities in ALMOST EVERY Neuro System S/s?

Creutzfeldt-Jakob Dz

Alzheimer's Dz Dx

Dementia * function at work impaired * function decline * No psyc disorder * Hx from patient AND informant Cognitive Impairment (2+) * acquire/remember new info * Reasoning/complex task/judgement * visuospatial abilities * language * Personality/behavior

Dementias Flashcards

(39 cards)