- a clinical syndrome characterized by acquired impairment
- multiple 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>24
- Normal activities of daily living
- Normal general cognitive function
- objective memory impairment for age and education
- not demented
What do you do with someone who presents with mild cognitive impairment?
tell them to exercise, diet more
- Progressive Neurodegenerative Disorder
- most common cause of dementia
- Affects 5 million people
- 3rd most costly disease in US because of nursing homes
What are the risk factors for Alzheimer's disease?
- Family HX (4X)
- most sporadic
- head trauma
- high BP/cholesterol
- high homocysteine
- mutations of chromosomes 1, 14, 21
What is the pathology seen in Alzheimer's Disease?
- Cortical atrophy: not of primary motor, sensory, and visual cortex
- loss of neurons: hippocampus, entorhinal cortex, Locus Ceruleus, Nucleus Basalis
- Neuritic amyloid plaques
- Low ACh levels
What is the criteria for diagnosis of Alzheimer's Disease?
- impairment of 2 areas of cognition:
- memory loss
- language disturbance
- disturbance in executive functioning
- progressive decline in memory funciton
- no disturbance in consciousness
- no systemic disease that could account for dementia
What can an MRI do for a patient with suspected Alzheimer's Disease?
- Exclude other possibilities
- Show brain atrophy, especially in the temporal lobe
How do we treat Alzheimer's Disease?
- AChI: Tacrine, Donepezil, Rivastigmine, Galanamine
- NMDA Inhibitor: Memantine
- Risk Reduction
What are the symptoms of Frontotemporal degeneration dementia?
- decline in social conduct precedes cognitive changes
- Personality 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 dementia
- temporal relationship of stroke and dementia or stepwise progression of cognitive deficits
- CADASIL- cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoenceophalopathy (mutation in Notch3 gene)
What is Lewy Body Dementia?
- Progressive congitive deterioration
- fluctuation in cognition/attention, well-formed visual hallucinations, parkinsonism
What is Creutzfeldt-Jacob disease?
- sporadic, familial, iatrogenic and new variant
- usually sporadic
- happens around 65 years of age
- rapidly progressive dementia
- startle myoclonus
- focal neurologic symptoms- such as visual loss, aphasia, ataxia, movement disorder
- death within 1 year
What is Normal Pressure Hydrocephalus?
- Slowly progressive cognitive decline
- gait disorder (magnetic/apraxic-feet magnetized to floor gait)
- urinary incontinence
- ventricular enlargement out of proportion to cortical atrophy
- lumbar puncture/ventriculo-peritoneal shunt