week 3 (dementia)

dementia definition

syndrome associated with deterioration of cog function that hinders daily living, decline in intellectual function severe enough to interfere with a person’s normal daily activities/relationships

types of dementia

alzheimer’s 60-80% cases, vascular 10-20%, lewy body dementia, frontotemporal dementia (rare), others

early signs of dementa

50% miss signs: self awareness lost so compensate with other emotions, early recognition by others leads to anger and frustration, changes in relationships
50% notice signs: 30% self awareness intact leading to fear/anxiety and clinginess → stress, anger, sadness; 20% self awareness intact leading to excessive control and withdrawal → attempt to hide in fear others will notice; both lead to changes in relationships

alzheimer’s dementia

causes not well understood, possible association with plaques, tangles, protein in brain, chromosomal abnormalities
2/3 women, very costly, leading cause institutionalization, affects 50% nursing home population
SDAT or PDAT

alzheimer’s risk factors

1st degree relative with AD, genetic predisposition, sedentary, low education, head injury
health conditions: HLD, HTN, DM, obesity, depression

SDAT

senile dementia alzheimer’s type
60+ yrs, gradual progression over 7-11 yrs, poor prognosis

PDAT

pre-senile dementia alzheimer’s type
40-60 yrs, rapid progression over 4 yrs, very poor prognosis

Alzheimer’s s/s

memory loss, lang impairment (word finding), visuospatial deficits (getting lost), poor reasoning/problem solving, impaired judgement/safety awareness

vascular dementia

caused by chronic decreased perfusion to brain from multiple infarcts, heart disease, blood vessel disorders
55-70 yrs, sudden with variable course, prognosis varies
death from CVA/CVD or infection, pseudobulbar affect, seizures common

vascular dementia risk factors

CV disease esp arrhythmias, older age, HLD, HTN, DM, smoking

VaD s/s

sudden cog decline typically following stroke, focal → global neuro deficits, apathy, aphasia

Lewy Body dementia

cause not well understood, results in accumulation of Lewy bodies in brain
dementia with Lewy bodies and PD associated dementia

LBD risk factors

older age, protein associated with LBD also associated with PD

LBD common presentations

movement disorder: PD progressing to LBD
cognitive/memory disorder mistaken for Alz: progress to more distinctive features of LBD
neuropsychiatric sx (hallucinations, behavior changes, impaired exec function or complex mental function): progress to LBD, least common

LBD s/s

visual hallucinations, cog impair, Parkinsonism/impaired motor control, fluctuating attention, REM sleep behavior disorder, visuospatial deficits, behavioral and mood changes

LBD tx

antipsychotics contraindicated
impact on brain different from other dementias
worsening movement concerns → neuroleptic malignant syndrome (fever, rigidity, breakdown tissue → kidney failure and death)

frontotemporal dementia

degeneration of frontal and/or temporal lobes of brain, dx as early as 21
behavioral changes most severe, commonly misdiagnosed

FTD subtypes

behavioral variant, primary progressive aphasia, ALS and FTD, corticobasal syndrome, progressive supranuclear palsy

bvFTD

most common, aka Pick’s disease, can overlap with other subtypes
personality changes, apathy, progressive decline in socially appropriate behavior, judgement, disinhibition
memory usually relatively spared, awareness is affected

primary progressive aphasia

gradual loss of ability to convey and receive language, global loss of communication
criteria: gradual impairment of lang, lang problem is initially only impairment, underlying cause is neurodegenerative disease

PPA subgroups

nonfluent/agrammatic: difficult to speak but knows meaning of words, speech apraxia, agrammatism
semantic: progressive loss meaning of words, names of objects/faces, speaks fluently, can repeat words and phrases, word replacement
logopenic: difficulty finding words as speaking, compensate by speaking slow, fluent with episodes of halted speech

dementia diagnostic tools

bloodwork to ensure cog change not due to other causes, spinal tap for evidence of brain waste in CSF
dx imaging to rule out other potentials, specific findings associated with types of dementia

cognitive impairment in adults > 65 yrs

insufficient evidence to support regular screening
medicare annual wellness requires routine assessment of cog function, usually done just through conversation

delirium

usually reversible, abrupt onset, mostly affects attention
acute sudden changes in mentation, common after surgery
level of consciousness can fluctuate, memory and speech are impaired

depression

normal speech, memory, and level of consciousness
from biological, physical, psych, or social causes

delirium causes

dehydration, malnutrition, meds, infection, metabolic dysregulation, prolonged sleep deprivation, substance misuse or withdrawal, immobility, surgery, uncontrolled pain, B/B
typically multifactorial

delirium presentation

inattention, fluctuating cog function, disorientation, hallucinations, paranoia, delusions, disruption of sleep/wake cycle

depression risk factors

female > male, personal or family hx depression, coexisting medical condition, presence of disability, substance misuse, major life changes, stressful or traumatic events

depression s/s

fatigue, loss of appetite, changes in weight, difficulty sleeping, loss of interest, impaired concentration/memory, indecisiveness, restlessness or irritability, suicidal ideation, somatic manifestation with unexplained physical findings
underreported in older adults

major depressive disorder dx

5 of following: depressed mood, loss of pleasure in activities, weight change, insomnia or hypersomnia, agitation, loss of energy/fatigue, feelings of worthlessness or guilt, diminished ability to think/concentrate, recurrent thoughts of death