Dementia
Dementia, Delirium, Amnesia
Dementia: cognitive impairment (attention, concentration, speech), memory loss; chronic, insiduous, permanent
Delirium: cognitive impairment, memory loss; acute, overt, wax/wane, reversible
Amnesia: no cognitive impairment, memory loss
Normal Aging vs MCI vs Dementia
Normal aging
mild cognitive impairment
Dementia
cognitive test -
test +
test +
function normal (act independently)
function normal
function -
Workup
look for reversible causes first
if no reversible causes, organic dementia
Reversible Causes
TSH/T4
CMP: BUN/Cr
LFT: liver cirrhosis
B12
RPR
Screen for depression/pseudodementia
CT/MRI: look for hydrocephalus, hematoma
Dementia
Alzheimers
path: plaques and tangles, Ch21 association
pt: elderly
symptoms:
short term memory goes first, then long term
spares social graces
diagnosis: clinical. CT shows diffused cortical atrophy
treatment: supportive, education, Ach I
Pick
path: frontotemporal degeneration
Symptoms: personality goes first (hypersexual, hyperaggressive), retain memory at first
diagnosis: clinical. Imaging shows frontal temporal degen
treatment: supportive
Lewy body
path: lewy body
symptoms: parkinsonian symptoms with dementia. Dementia predominant. Visual hallucination
diagnosis: clinical
treatment: supportive
Vascular
path: stroke
symptoms: step wise decline with each stroke
diagnosis: presence of infart on imaging not enough, must have step wise decline
treatment: treat stroke
CJD
path: prions
pt: consume undercooked meat or sporadic mutation
symptoms: really yound dementia (30-40s) with myoclonus
diagnosis: MRI
treatment: supportive
NPH
path: increased ICP
symptoms: wet, wobbly, weird
diagnosis: CT shows hydrocephalus. LP shows improvement of function
treatment: VP shunt
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