NS73: Dementia

Define Demetia.

a clinical syndrome characterized by acquired impairmentmultiple neuropsychological and behavioral domains (memory, cognition, visuospatial skills, langauge)not specific to any pathological process

What are the two basic patterns of dementia?

Cortical Dementia (Alzheimer's Disease, Frontotemporal Dementia)Subcortical Dementia (vascular dementia, extrapyramidal syndromes, normal pressure hydrocephalus)

What are the symptoms of Mild Cognitive Impairment?

Memory complaint by patient, confirmed by family or physician---> MMSE>24Normal activities of daily livingNormal general cognitive functionobjective memory impairment for age and educationnot demented

What do you do with someone who presents with mild cognitive impairment?

tell them to exercise, diet more

Alzheimer's Disease

Progressive Neurodegenerative Disordermost common cause of dementiaAffects 5 million people3rd most costly disease in US because of nursing homes

What are the risk factors for Alzheimer's disease?

AgeFamily HX (4X)most sporadichead traumahigh BP/cholesterolhigh homocysteinemutations of chromosomes 1, 14, 21

What is the pathology seen in Alzheimer's Disease?

Cortical atrophy: not of primary motor, sensory, and visual cortexloss of neurons: hippocampus, entorhinal cortex, Locus Ceruleus, Nucleus BasalisNFTsNeuritic amyloid plaquesLow ACh levels

What is the criteria for diagnosis of Alzheimer's Disease?

impairment of 2 areas of cognition:memory losslanguage disturbanceapraxiaagnosiadisturbance in executive functioningprogressive decline in memory funcitonno disturbance in consciousnessno systemic disease that could account for dementia

What can an MRI do for a patient with suspected Alzheimer's Disease?

Exclude other possibilitiesShow brain atrophy, especially in the temporal lobe

How do we treat Alzheimer's Disease?

AChI: Tacrine, Donepezil, Rivastigmine, GalanamineNMDA Inhibitor: MemantineExerciseRisk Reduction

What are the symptoms of Frontotemporal degeneration dementia?

decline in social conduct precedes cognitive changesPersonality change: decline in manners, disinhibited behavior, apathy

What is Primary Progressive Aphasia?

Expressive Language disorder prior to memory loss

What is vascular dementia?

accounts for 10-20% of dementiatemporal relationship of stroke and dementia or stepwise progression of cognitive deficitsCADASIL- cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoenceophalopathy (mutation in Notch3 gene)

What is Lewy Body Dementia?

Progressive congitive deteriorationfluctuation in cognition/attention, well-formed visual hallucinations, parkinsonism

What is Creutzfeldt-Jacob disease?

sporadic, familial, iatrogenic and new variantusually sporadichappens around 65 years of agerapidly progressive dementiastartle myoclonusfocal neurologic symptoms- such as visual loss, aphasia, ataxia, movement disorderdeath within 1 year

What is Normal Pressure Hydrocephalus?

Slowly progressive cognitive declinegait disorder (magnetic/apraxic-feet magnetized to floor gait)urinary incontinenceventricular enlargement out of proportion to cortical atrophylumbar puncture/ventriculo-peritoneal shuntWET/WOBBLY/WACKY