OME: Dementia
What are structural causes of dementia?
"Very Looney CHAP" Vascular dementia Lewy body dementia Creutzfeld jakobs normal pressure Hydrocephalus Alzheimer's Pick's disease
How do you look for non structural sources of dementia?
(1) Labs: B12, TSH, Cr, NH4, RPR (2) Imaging: CT (3) Depression screening
How do you work up memory loss?
(1) Mini mental status exam (2) If dementia: look for labs. Then look at brain structure problems.
Creutzfeld jakobs caused by
- Prions - Eat infected meat, human brains - Sporadic mutation (most common)
Dementia Table
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Alzheimer's vs normal pressure hydrocephalus?
Alzheimer's = DUM dementia —> urinary incontinence —> motor problems Normal pressure hydrocephalus = MUD motor —> urinary incontinence —> dementia
Memory loss —> behavioral problems. Dementia type?
Alzheimer's disease
Most common cause of dementia?
Alzheimer's disease
How to diagnose normal pressure hydrocephalus?
CT or MRI (vs idiopathic intracranial hypertension)
What are treatment options for Alzheimer's?
Cholinesterase inhibitors (donepazil); these delay progression of Alzheimer's but won't treat it.
Young person gets rapid dementia in 6 months + myoclonus. Diagnosis?
Creutzfeld jakobs.
What are the three broad categories of illnesses that involve memory loss?
Dementia Delirium Amnesia
What's the difference between dementia, delirium, and amnesia?
Dementia = chronic (hpns over long time), memory lost, cognitive lost (math, driving...) Delirium = acute, due to substance (alcohol), memory lost, cognitive lost Amnesia = acute, memory lost, cognition is fine
What are non structural causes of dementia?
Depression Chronic subdural hematoma B12 deficiency Hypothyroidism Uremia/renal failure Cirrhosis/liver failure Syphilis mh: head, neck, stomach, lower abdo, genitals
CT findings in Alzheimer's disease?
Diffuse cortical atrophy
What genetic disease is Alzheimer's associated with?
Down's syndrome
Tremors + shuffling gait + rigidity + dementia. Diagnosis?
Lewy Body Dementia (parkinson's + dementia)
Lewy body dementia pathogenesis?
Lewy bodies
How to diagnose vascular dementia?
MRI infarcts may be "old" and not the original cause of current dementia
Pathogenesis of Alzheimer's disease?
Neurofibrillary tangles, amyloid plaques
Alzheimer's screening guidelines?
No screening!
How to treat pick's disease?
No treatment
Creutzfeld jakobs treatment?
None
What is the spectrum of dementia?
Normal aging —> mild cognitive impairment —> dementia
What's the differences between the different levels of dementia?
Normal aging: forget sometimes, normal test result. Mild cognitive impairment: normal life function, low test result. Dementia: can't function normally, low test result
Patient has trouble walking, urinary incontinence, dementia. Diagnosis?
Normal pressure hydrocephalus
Personality change. Dementia type?
Pick's disease aka frontotemporal dementia mh: "p" for pick and personality; picks parts of brain not diffuse
Alzheimer's diagnosis?
Purely clinical Plaques and tangles are only in autopsy.
Causes of vascular dementia?
Risk factors - cardiovascular disease, htn, diabetes Multiple brain infarcts
Patient has stroke. Suddenly, cognitive decline. Diagosis?
Vascular dementia
CT findings in pick's disease?
not diffuse cortical atrophy like Alzheimer's. instead: atrophy in frontal lobe, temporal lobe, hypothalamus
How to treat normal pressure hydrocephalus?
serial lumbar punctures, vp shunt Notice: acetozolamide only works with normal pressure hydrocephalus
Normal pressure hydrocephalus symptom mnemonic?
wet wobbly wacky urinary incontinence, ataxia, dementia
