Pharma-L16-C-Dementia

What is dementia

A progressive loss of intellectual abilities that interferes with social and/or occupational functioning.

Is dementia a specific disease or condition

No, it is a descriptive term with dozens of pathophysiologic causes.

What are the DSM III-R criteria for diagnosing dementia

Demonstrable impairment in short-term and long-term memory.

What disturbances of higher cortical functioning may occur in dementia

Apraxia, acalculia, agnosia, or language dysfunction.

What other symptoms may accompany dementia

Impaired abstract thinking, judgment, or personality changes.

How must dementia symptoms affect a patient’s life to meet diagnostic criteria

Must significantly interfere with work or social activities and represent changes from an earlier level of function.

Can dementia occur exclusively during delirium

No, it must not occur exclusively during delirium.

What is required for the etiology of dementia according to DSM III-R

An "organic" factor must be related to the disturbance.

What general medical conditions can affect cognitive function

Uremia, vitamin deficiencies, and toxins.

What is the next step after determining that dementia is present

Search for treatable causes.

What factors influence the efficiency of neuronal function

Glucose content, oxygenation level, hormonal state, and extracellular electrolyte balance.

Why is toxic encephalopathy a concern in the elderly

Elderly individuals often take multiple medications, increasing the risk.

What is the typical onset pattern of most toxic encephalopathies

Acute onset.

Can toxic encephalopathy mimic dementia

Yes, some cases have a chronic course with dementia-like characteristics.

What initial tests are used in dementia workup

History, physical exam, and mental status exam.

Which lab tests are common in dementia workup

Serologic tests for syphilis, B12, folate, sed rate, and thyroid function.

What imaging studies are used in dementia diagnosis

Neuropsychological testing, chest x-ray, EEG, lumbar puncture, SPECT, PET, EMG, and EKG.

What percentage of dementia cases does DAT account for

About 50%.

What are historical features of DAT

Insidious onset, even sex distribution, and onset as early as the 5th decade.

What percentage of DAT cases are autosomal dominant

5%.

Which chromosome mutation is most common in autosomal dominant DAT

Chromosome 14.

How does having a first-degree relative with DAT affect lifetime risk

Increases lifetime risk from 23% to 48%.

How does DAT prevalence change with age

Prevalence doubles every 5 years above age 65.

Which chromosome markers are associated with increased DAT risk

Chromosome 19 and 12 markers.

What are key features of the initial stage of dementia

Memory impairment, misplacing items, repeating comments, word-finding difficulty, indecisiveness, and reduced effectiveness in activities.

What cognitive domains are affected in the intermediate stage of dementia

Language, reasoning, spatial orientation, and executive function.

What difficulties arise in the intermediate stage

Trouble with new information, attentional deficits, and faltering judgment and insight.

What are the main characteristics of the final stage of dementia

Incontinence, inability to recognize family, mobility and feeding difficulties, and loss of "self."

What sensory and motor changes occur late in dementia

Extrapyramidal deficits like myoclonus, rigidity, cogwheeling, and gait instability.

What are common dual organic causes of dementia

Vascular disease and Dementia Alzheimer’s Type (DAT).

What do imaging studies show in dementia

Generalized atrophy, especially in the temporal lobe, inconsistently related to the degree of dementia.

What may EEG reveal in dementia patients

Slowing of brain activity.

What are the gross neuropathological findings in dementia

Cortical sulci widening, ventricle enlargement, and gross atrophy.

What microscopic neuropathological features are seen in dementia

Amyloid-containing plaques, neurofibrillary tangles, and granulovacuolar degeneration in the hippocampus.

Which medications are used as acetylcholinesterase inhibitors for dementia

Aricept, Reminyl, and Exelon.

What psychosocial and legal interventions are important in dementia care

Support groups, daycare, respite care, residential care, advance directives, estate planning, and addressing driving issues.