BISC 4210 - Case Study Exam

What criteria differentiate dementia and delirium? What must be present for a diagnosis of dementia?

Dementia:

• DSM 5 diagnostic - requires progressive impairment in cognition and function that cannot be attributed to something else

  • Decline in memory

  • Reduced control over social/emotional behavior

  • Decline in cognitive ability

  • Preserved awareness » absence of clouding of consciousness

Delirium:

• Cloudiness of consciousness

• Disturbances of cognition » intact remote memories

• Psychomotor disturbances

• Disturbances in sleep wake cycle » inattention

• Acute onset & reversible

Know the major distinctions between cortical and subcortical dementia

Cortical:

• result of disorder affecting cerebral cortex (outer layers of the brain) playing critical role in cognitive processes like memory and language

• AD and Creutzfeldt-Jakob disease

• Severe memory impairment and aphasia

Subcortical:

• result of dysfunction in parts of brain below the cortex

• Huntington’s disease, Parkinson’s, AIDS dementia

• changes in personality and attention span, with a slowing down of thinking

• early - depression, clumsiness irritability

• late - same breakdown of cortical dementia

Know diagnostic criteria for Binswanger Disease and how clinical assessments distinguish between AD

Diagnosis:

• white matter damage and subcortical dementia

• episodic and declarative memory are preserved

• loss of myelin and axon, neurons remain intact early on

Clinical:

• Hyperkinetic preservation (Binswanger)

• Semantic perseveration (AD)

Know causality, risk factors, and symptoms of vascular dementias

Causality - disruptions in supply of blood to the brain; primarily due to stroke/atherosclerosis

Risk Factors - untreated high blood pressure, hypertension, diabetes, high cholesterol, heart disease

Symptoms - confusion, trouble with speech, vision loss, inattention

Diagnosis - MRI (evidence of vascular change ONLY)

Be able to state symptoms of FTD and how they differ from AD

FTD:

• more frequent in under 65

• night wandering

• presence of Pick bodies in cortex, no neurofibrillary tangles or senile plaques

• Difficulty in speech

AD:

• more common with age

• memory loss is worse than FTD

• spatial awareness loss is worse than FTD

• hallucinations and delusions

Be able to describe the difference between types of FTD and how they differ from AD

Behavior variant frontotemporal dementia (bvFTD):

• prominent changes in personality, interpersonal relationships and conduct

• happens in 50s-60s, but can occur early as 20s

• neuron death most prominent in brain areas controlling conduct, judgement, empathy and foresight

Primary progressive aphasia (PPA):

• less prominent

• impacts language skills, speaking, writing, and comprehension

  • Semantic PPA - cannot understand or formulate spoken words, facial recognition, reading/writing

  • NonFluent/Agrammatic PPA - hesitant, labored, ungrammatical communication

Know how dementia with Lewy Bodies and CJD differs from AD and the underlying causes

DLB:

• Caused to atrophy of cortex

• Parkinsonian-like symptoms in LBD » otherwise difficult to differentiate from AD in early stages

• BP drop on standing, dizziness, falls, urinary incontinence

CJD:

• prion disease seen postmortem

• twitching, ataxia, akinetic mutism, dystonia

Be able to list a few brain regions that exhibit atrophy in AD and other tell tale signs of AD

Symptoms:

• ventricular hypertrophy

• memory loss

• decreased/poor judgment

• confusion with time/place

Atrophy:

• hippocampus

• amygdala

• basal forebrain