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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