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Alzheimer's
Vascular
Fronto-Temporal
Lewy Body
Pt Profile
>65yo
Caucasian
women>men
45-65yo
PC
early stage
memory lapses
amnesia: forgetful
agnosia: cannot recognise
people/places etc
aphasia
dementia
memory loss
decline in problem solving ability
spatial awareness difficulties
fluctuating levels of awareness and
attention
semantic dementia
aphasia
agnosia
sleep disorder
REM
restless legs syndrome
nocturnal cramps
fainting spells
disease progresses
difficulties with language
apraxia
prob planning and making decisions
confusion
later stage
wandering, disorientation
apathy
psych symptoms eg depression,
hallucination, delusions
behavioural probs eg disinhibition,
aggression, agitation
altered eating habits
incontinence
parkinsonism
tremor
rigidity
lack of facial expression
festinating gait
HPC
progressive, worsening
no disturbances of consciousness
step-wise progression
fluctuating
progressive
PMHx
hypercholestrolaemia
HPTN
DM
cardiovascular conditions
Trisomy 21 (amyloid)
parkinson?
cerebrovascular events
AF
HPTN
DM
hyperlipidemia
coronary heart disease
Alzheimer's
Vascular
DHx
benzodiazepines (drug-induced
cognitive impairment)
other medications that suggest CV
pathologies
FHx
SHx
smoking
obesity
Exam / Ix
anticholinesterase (AChE)
eg donepezil, rivastigmine,
galantamine
acetylcholine
Lewy Body
Exam
neuro exam: primitive reflexes in later
stages
impaired orofacial movements eg
coughing, swallowing, gag reflex
Exam
cognition eg MMSE etc
Dementia Screen
to rule out other causes of memory
probs/confusion
MRI
infarcts, cortical lacunae, extensive
white matter changes
can show mixed AD and vascular
dementia
Dementia Screen
MRI/CT
general/diffuse atrophy of
frontal/temporal lobes
amyloid plaques
atrophy of cholinergic fibres (
acetylcholine)
Mx
Fronto-Temporal
MRI
lobar atrophy of frontal and temporal
lobes
loss of neurons/gliosis but no plaque
formation
Histology
FTLD-TAU: corticobasal degeneration;
progressive supranuclear palsy (PSP)
FTLD-TDP: TDP-43
FTLD-FUS: rare, with ubiquinated
inclusions
Alzheimer's
contra-i: bradycardia, conduction prob
in heart
SE: anorexia, abdo pain, nausea
vomiting, diarrhoea, insomnia,
confusion, agitation, headahce
Vascular
statin
AChE and NMDA antagonist
DO NOT help symptoms in vascular
dementia
given only if there is mixed dementia
Fronto-Temporal
psychosis (only if SSRI failed) - risks of
extrapyramidal SE
levadopa/carbidopa or dopamine
agonists if there are Parkinsonian
symptoms
Lewy Body
psychiatric/behavioural probs - can
induce severe sensitivity rxn
anti-parkinsonian Tx can worsen
psychosis
NMDA antagonist
eg memantine
for severe dementia, not widely used
inhibit glutamate NMDA-r, prevent
excitotoxicity
contra-i: seizure, leukopenia
can be given with AChE
SE: diarrhoea, insomnia, dizziness,
headache, hallucinations
Prognosis
7-10yrs
depending
3-4yrs