Dementia Overview and Types

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

When is pharmacotherapy particularly needed for patients?

When the disease is in its early stages.

When patients refuse treatment.

When patients experience no symptoms.

When functional impairments affect quality of life. (correct)

What is the role of dopamine agonists before starting levodopa treatment?

They cure the disease.

They can delay the onset of dyskinesia. (correct)

They prevent all side effects.

They completely replace the need for levodopa.

What should be done if monotherapy with a dopamine agonist is unsatisfactory?

Stop all medications.

Increase doses of the dopamine agonist only.

Switch to anticholinergic medications.

Add levodopa to the treatment regimen. (correct)

What is the impact of aging on the use of dopamine agonists?

Elderly patients may not experience delayed dyskinesia from dopamine agonists. Signup and view all the answers

What complications may occur in patients treated with levodopa after 3-5 years?

Motor fluctuations and dyskinesia. Signup and view all the answers

What would be a beneficial addition for patients experiencing 'wearing off' symptoms while on levodopa?

Add medications that block neurotransmitter degradation. Signup and view all the answers

What is an appropriate early treatment for patients with prominent tremors?

Non-dopaminergic medications like beta-blockers. Signup and view all the answers

What should be considered if minimal improvement is seen after medication adjustments?

Consider alternate diagnoses. Signup and view all the answers

What condition is primarily caused by a blockage in blood flow leading to a stroke?

Embolism Signup and view all the answers

Which of the following can cause a cardiac embolism?

Atrial fibrillation Signup and view all the answers

Which type of stroke accounts for 15%-20% of total cases?

Hemorrhagic stroke Signup and view all the answers

Which of the following conditions is NOT listed as a cause of rapidly progressive dementia (RPD)?

Chronic lung disease Signup and view all the answers

What is a common characteristic of hemorrhagic infarction?

Typically asymptomatic Signup and view all the answers

What is a characteristic symptom of Alzheimer's disease (AD) as part of its diagnosis?

Progressive memory decline Signup and view all the answers

What can cause subarachnoid hemorrhage?

Aneurysm rupture Signup and view all the answers

Which diagnostic tool is considered the most important for determining the type of dementia?

History taking Signup and view all the answers

Which of the following conditions is referred to as a paradoxical embolism?

Patent foramen ovale (PFO) Signup and view all the answers

In the absence of a new medication or infection, an abrupt onset of dementia could indicate which type of etiology?

Vascular or mixed etiology Signup and view all the answers

What can result from the transformation of an ischemic stroke?

Hemorrhagic transformation Signup and view all the answers

What type of hemorrhage is caused by the rupture of blood vessels and is most commonly associated with high blood pressure?

Intracerebral hemorrhage Signup and view all the answers

What aspect is essential to evaluate during the history taking for dementia diagnosis?

The onset of systemic diseases Signup and view all the answers

Which cognitive test was originally designed to distinguish between dementia and depression?

Mini Mental State Examination (MMSE) Signup and view all the answers

Which symptom is most associated with frontotemporal dementia (FTD) in progressing symptoms?

Progressive aphasia Signup and view all the answers

What type of history should be consulted for background in the evaluation of a cognitive disorder?

Consultation with other healthcare professionals Signup and view all the answers

What is the impact of neuropsychiatric symptoms (NPSs) on patients with dementia and their caregivers?

NPSs can lead to greater impairment in daily activities and earlier institutionalization. Signup and view all the answers

Which factor is NOT a potential cause of neuropsychiatric symptoms in dementia patients?

Genetic predisposition Signup and view all the answers

What term is used to describe NPSs in dementia that reflects their nature as responses to unmet needs?

Responsive behaviors Signup and view all the answers

Which of the following is one of the most common neuropsychiatric symptoms in patients with dementia?

Agitation Signup and view all the answers

How are neuropsychiatric symptoms related to the progression of dementia?

They suggest more rapid disease progression and worse outcomes. Signup and view all the answers

What types of symptoms can be included within neuropsychiatric symptoms in dementia?

A variety including agitation, sleep impairment, and paranoia Signup and view all the answers

What effect can NPSs have on the safety and care of patients with mild cognitive impairment (MCI) or dementia?

Impact the safety and care negatively. Signup and view all the answers

Which of the following statements about the relationship between caregiver factors and NPSs is true?

Poor caregiver mental health can exacerbate NPSs. Signup and view all the answers

What should be documented before prescribing medication to a patient?

The risks and benefits of the medication Signup and view all the answers

Which of the following describes a recommended approach for prescribing psychotropic medications to geriatric patients?

Frequent reassessment of the need for treatment Signup and view all the answers

What is the primary non-pharmacological characteristic of mood disorders that often leads to treatment with drugs?

Agitation Signup and view all the answers

Which of the following is a potential adverse effect of antidepressants?

Hyponatremia Signup and view all the answers

When should low-dose psychostimulants be considered for a patient on SSRIs?

If the patient exhibits prominent apathy and is medically ill Signup and view all the answers

Which of the following patients should psychostimulants be avoided in?

Patients with severe cardiovascular disease Signup and view all the answers

What is the main effect of high doses of SSRIs on patients?

Worsening apathy Signup and view all the answers

In which circumstance is there generally less hesitation to prescribe antidepressants?

For patients with a previous history of cerebrovascular disease Signup and view all the answers

What NPSs can cholinesterase inhibitors help treat?

Apathy, anxiety, depression, disinhibition, and aberrant motor symptoms Signup and view all the answers

In which condition should cholinesterase inhibitors not be used?

Frontotemporal dementia (FTD) Signup and view all the answers

What is a significant adverse effect of carbamazepine, especially in geriatric patients?

Sedation and ataxia Signup and view all the answers

Which of the following antipsychotics is most likely to cause extrapyramidal symptoms (EPS)?

Haloperidol Signup and view all the answers

What condition is primarily treated with antipsychotics in dementia?

Psychosis and aggression Signup and view all the answers

Which mood stabilizer is not commonly recommended for treating neuropsychiatric symptoms?

Valproic acid Signup and view all the answers

What is a possible effect of long-term use of first-generation antipsychotics (FGAs)?

Tardive dyskinesia Signup and view all the answers

Which of the following is a side effect of antipsychotics?

Weight gain and metabolic changes Signup and view all the answers

Study Notes

Dementia "

Dementia is a syndrome of acquired cognitive deficits that interfere with daily function, not caused by delirium or severe depression.
Common causes include neurodegenerative conditions (e.g., Alzheimer's disease), cerebrovascular disease, trauma, and infections.
DSM-5 replaced dementia with major neurocognitive disorder.
Cognitive or behavioral symptoms represent a decline from previous function, interfering with daily life. The decline is not explained by delirium or mental illness and includes two or more of: amnesia, agnosia, aphasia, executive dysfunction, and behavioral change.
Alzheimer's Disease (AD) is the most common type, accounting for nearly 50% of dementia cases. Often combined with cerebrovascular disease.

Pathologic subtypes

AD is the most common dementia-causing pathology.
Frontotemporal dementia (FTD) and dementia with Lewy bodies (DLB) are other major neurodegenerative diseases. Also, Limbic-predominant age-related TDP-43 encephalopathy (LATE).
FTD has a 50% genetic component.
DLB is associated with Parkinson's disease (PD), and family history of PD increases risk.

Mild Cognitive Impairment (MCI)

MCI is an asymptomatic period of disease preceding dementia, with preserved daily function.
E.g., amnestic MCI (mild memory deficits) in people with AD.

Risk factors

Cardiovascular risk factors (diabetes, hypertension, smoking, prior stroke, physical inactivity) are also dementia risk factors.
Repeated or severe head trauma, exposure to pesticides, fewer years of education, and anticholinergic drug use are dementia-specific risk factors.
Age is the greatest risk factor for dementia.

Genetic factors

Genetic influences are significant in early-onset Alzheimer's disease (EOAD).
EOAD occurs before age 65.
Mutations in the amyloid precursor protein gene (APP) and presenilin genes (PS1, PS2) result in 100% risk of EOAD.

Clinical features (Alzheimer's Disease)

Neurodegenerative condition characterized by neuronal death and accumulation of toxic protein aggregates (beta-amyloid and tau).
First symptoms are memory impairments (recent/episodic).
Onset is insidious with gradual progression. Other cognitive functions decline: language, executive function, visuospatial function, praxis.
Behavior problems (apathy, irritability, aggression) arise with progression.
Motor function eventually deteriorates.

Clinical features (Frontotemporal Dementia)

Early symptoms involve personality and/or language changes, unlike the early memory problems of AD.
Three types: behavioral variant (bvFTD), semantic dementia (SD), and progressive nonfluent aphasia (PNFA).

Clinical features (Dementia with Lewy bodies)

Patients have alpha-synuclein aggregations (Lewy bodies) in the brain.
Hallucinations/delusions and fluctuations in symptom severity are common.
Parkinsonism (also a factor in PD)
Family history of PD may be a predisposing factor.
REM sleep behavior disorder (RBD) often precedes DLB symptoms.
Sensitivity to neuroleptic drugs and fluctuations are indicators.

Other types

Vascular dementia (vascular cognitive impairment [VCI]) = cerebrovascular disease + neurodegenerative conditions (e.g. AD).
Limbic-predominant age-related TDP-43 encephalopathy (LATE) is a newly discovered FTD pathology. It's clinically similar to AD with memory problems; found more frequently in older adults.

Diagnostic Criteria for AD

Insidious start and clear-cut worsening of symptoms
Cognitive deficits on history and examination (amnestic or nonamnestic)

Clinical features (Vascular Dementia)

Clinical presentation can be similar to other types of dementia, but it often shows a more step-wise, or stepwise, progression. The condition can result from multiple small (or large) strokes impacting cognitive functions.

Diagnostic Tests

Basic blood tests (complete blood count, blood glucose, electrolytes, etc.)
Neuroimaging (e.g., CT, MRI, PET, SPECT)

Management

Education and support for patients, caregivers, and families are crucial.
Driving evaluation is essential, moving towards prohibition in severe cases and on-road assessment/computer tests in mild/moderate dementias.
Plan for the future (e.g., power of attorney).
Control co-existing conditions.
Medications play a minor role; cholinesterase inhibitors have limited effects or have potential adverse effects.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Explore the different aspects of dementia, including its definition, common causes, and the major neurocognitive disorders recognized today. Learn about Alzheimer's disease, frontotemporal dementia, and dementia with Lewy bodies, and how these conditions impact daily functioning and cognitive abilities.