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  1. Approach To Medicine
  2. Neurology
  3. Dementia

Dementia

Modified 01:48, 15 Sep 2017 by apavel | Page History
    Table of Contents
    1. 1. Rigid Movement Disorders
      1. 1.1. Progressive Supranuclear Palsy
      2. 1.2. Lewy Body Dementia
      3. 1.3. Normal Pressure Hydrocephalus
      4. 1.4. Vascular Parkinsonism
      5. 1.5. MSA
    2. 2. Alzheimer's Dementia

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    Rigid Movement Disorders

    ParkinsonsDisorders.jpg

     

    Progressive Supranuclear Palsy

    • Dementia, atremulous parkinsonism, eye movement abnormalities (classically vertical gaze palsy)
      • Dementia: cognitive slowing, passivity, apathy.  (subcortical)
      • Vertical Gaze: Vertical gaze palsy, convergence insufficiency
        • Messy eating, unable to eat
        • "Square Wave Jerks" - inappropriate horizontal sacchades..
      • Parkinsonism: dystonic facial appearance, axial rigidity, gait hesitation, postural instability
    • Neuroimaging:
      • Marked atrophy of the brainstem and midbrain.
    • Pathology:
      • Widespread neurofibrillary tangle deposition throughout basal ganglia, midbrain, brainstem, cerebellum.
    • Prognosis:
      • Relentlessly progressive.. causing death from aspiration within 8-12years.
    • Source: MKSAP question

     

    Lewy Body Dementia

    • Visual hallucinations (often precede parkinsonism)
    • REM (rapid eye movement) sleep behaviour disorder
    • TODO: expand this section.

     

    Normal Pressure Hydrocephalus

    • Triad:
    1. Gait Impairment
    2. Urinary Incontinence
    3. Cognitive Impairment

     

    Vascular Parkinsonism

    • Symptoms:
      • Predominant lower extremity involvement
      • Gait impariemnt
      • Step-wise course

     

    MSA

    • Characterized by autonomic dysfunction
    • Types:
      • MSA-A - autonomic predominant
      • MSA-C - cerebellar symptoms

    Alzheimer's Dementia

    • Treatment

    • Cholinesterase inhibitors & Memantine

    • Mild-to-mod dementia (MMSE 10-26)

     

    • Donepezil
    • Rivastigmine    
    • Galantamine

     

    • If Vitamins Preferred:

      • Vitamin E 2000 IU daily

    • Mod-To-Advanced (MMSE < 17)
      • Add Memantine to cholinesterase inhibitor (or memantine alone if don’t tolerate AChE inhibitor)
    • Severe Dementia (MMSE < 10)
      • Continue memantine OR d/c medications to maximize quality of life.
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