Dementia Flashcards
Most imp risk factor for dementia
Increasing age
Potentially Reversible Causes of Dementia
- Hypothyroidism
- Neurosyphilis
- B12/folate deficiency/thiamine deficiency
- Medications
- NPH
- Depression
- Subdural hematoma
Irreversible Causes of Dementia
- Alzheimer disease
- Parkinson, Huntington
- Multi-infarct dementia
- Dementia with Lewy bodies, Pick disease
- Unresectable brain mass
- HIV dementia
- Korsakoff syndrome
- PML
- CJD
Severe depression may cause a. decline in cognition that is difficult to. distinguish clinically from Alzheimer disease but is responsive to antidepressant therapy
Pseudodementia (depression)
Clinical approach to dementia – lab and imaging studies
- CBC w/ differential
- CMP
- Thyroid (TSH)
- B12
- Folate
- VDRL (syphilis)
- HIV screening
- CT scan or MRI of head
Pathology of Alzheimer Disease
Senile plaques (age-specific)
Neurofibrillary tangles (age-specific)
Alzheimer Disease Dx
Clinical dx; exclude other causes first
CT or MRI = diffuse cortical atrophy with enlargement of the ventricles
Alzheimer Disease Tx
Cholinesterase Inhibitors (b/c AD pts have lower levels of ACh)
AVOID ANTICHOLINERGIC MEDS
Donepezil, rivastigmine, galantamine, vit E (?)
DLB Course
What may slow progression of disease?
More rapid than Alzheimer
- Visual hallucinations predominate
- EPS + fluctuating mental. status
- Dementia
Selegiline***
CJD
- Rapidly progressive dementia**
- 2 out of 4 clinical features:
- Myoclonus**
- Akinetic mutism
- Cerebellar or visual. disturbance
- EPS
- Periodic sharp wave complexes and/or Positive 14-3-3 CSF assay
Alzheimer’s Disease causative genes
Presenilin I, II and amyloid precursor protein gene
ApoE4 increases risk but is not diagnostic
Which. test is most specific for dementia with Lewy Body?
A. CT
B. PET scan
C. MRI
D. LP
E. Urine cytology
B. PET scan
