NS73: Dementia

  1. Define Demetia.
    • a clinical syndrome characterized by acquired impairment
    • multiple neuropsychological and behavioral domains (memory, cognition, visuospatial skills, langauge)
    • not specific to any pathological process
  2. What are the two basic patterns of dementia?
    • Cortical Dementia (Alzheimer's Disease, Frontotemporal Dementia)
    • Subcortical Dementia (vascular dementia, extrapyramidal syndromes, normal pressure hydrocephalus)
  3. 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
  4. What do you do with someone who presents with mild cognitive impairment?
    tell them to exercise, diet more
  5. Alzheimer's Disease
    • Progressive Neurodegenerative Disorder
    • most common cause of dementia
    • Affects 5 million people
    • 3rd most costly disease in US because of nursing homes
  6. What are the risk factors for Alzheimer's disease?
    • Age
    • Family HX (4X)
    • most sporadic
    • head trauma
    • high BP/cholesterol
    • high homocysteine
    • mutations of chromosomes 1, 14, 21
  7. 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
    • NFTs
    • Neuritic amyloid plaques
    • Low ACh levels
  8. What is the criteria for diagnosis of Alzheimer's Disease?
    • impairment of 2 areas of cognition:
    • memory loss
    • language disturbance
    • apraxia
    • agnosia
    • disturbance in executive functioning
    • progressive decline in memory funciton
    • no disturbance in consciousness
    • no systemic disease that could account for dementia
  9. What can an MRI do for a patient with suspected Alzheimer's Disease?
    • Exclude other possibilities
    • Show brain atrophy, especially in the temporal lobe
  10. How do we treat Alzheimer's Disease?
    • AChI: Tacrine, Donepezil, Rivastigmine, Galanamine
    • NMDA Inhibitor: Memantine
    • Exercise
    • Risk Reduction
  11. What are the symptoms of Frontotemporal degeneration dementia?
    • decline in social conduct precedes cognitive changes
    • Personality change: decline in manners, disinhibited behavior, apathy
  12. What is Primary Progressive Aphasia?
    Expressive Language disorder prior to memory loss
  13. 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)
  14. What is Lewy Body Dementia?
    • Progressive congitive deterioration
    • fluctuation in cognition/attention, well-formed visual hallucinations, parkinsonism
  15. 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
  16. 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
Card Set
NS73: Dementia
Neuroscience Week 7