- 3 genes identified to cause Early Onset AD: Amyloid protein, APP (on Chr 21), and Precinillin 1&2 (deal w/ metabolism of amyloid protein)
- Alzheimer's Disease (AD): More plaques present; decrease activity in temporal areas
- Amnesia: Impairment in ability to learn new information despite normal attention
- Best Test for AD/Dementia: Ask family member of an important RECENT event - then ask patient detailed questions; ~90% correct = normal; ~50% correct = AD/Dementia
- Criteria for Delirium: Disturbance of consciousness: reduced awareness of environment, ability to focus, sustain, and/or shift attention
- Delirium: Transient, organic/medical cause, acute onset, fluctuations (waxing & waning)
- Dementia: Persistend deficits causes intellectual impairment
- Diagnosis of Probably AD: Dementia present; Onset b/w 40-90yo; Deficits in 2 or more cognitive areas; Pregression of deficits > 6mo; Consciousness undisturbed
- Earliest Finding of Dementia: Short term memory defect, while long term memory intact w/ details
- Findings on EEG: Diffuse slowing @ resting state (Delirium = theta/beta waves in resting state; Normal = alpha waves) NOT DIAGNOSTIC!
- Frontotemporal dementia: Predominated w/ tangles; decrease activity in frontal areas; personality changes may occur
- Generic Etioligies of Delirium: Systemic conditions, Endocrinopathies, Nutritional deficiencies, Intoxication, Withdrawal syn, Infections, Intracranial disorder, Focal cerebral lesions, etc
- Major causes of Delirium: Hypoxia to brain; Depleted Na+ levels; Anticholinergic drugs; Infections (UTIs, etc)
- Neuropathology of AD: Neurofibrillary Tangles = intracellular; Amyloid Plaques = extracellular
- Normal Aging: Slight decrease of all memory -- short-term memory should not continually decrease while past (LT) memory stays intact
- Predisposing Factors for Delirium: 75-85 yo; brain damage; chronic brain disease (AD)
- Psychiatric Symptoms often seen w/ AD: Depression; Anxiety/Agitation; Psychotic symptoms; Sleeping disorders; Bipolar disorder; Paranoia
- Required Lab Tests for Dementia ("Medical Work-up"): Brain scan (only to R/O tumor, stroke, etc), TSH levels, possible depression (Dx), CBC, serum levels, including vitamin B12
- Risk Factors for Dementia: >65yo, Female gender, Head trauma, CV health decrease, Depression, ApoE4
- Stage 1 of AD: Patient doesn't talk as much; Short-term memory defective
- Stage 2 of AD: Fluent aphasia; Memory severely impaired; Structural scan shows Temporal-parietal atrophy
- Stage 3 of AD: Intellectual function severely impaired; Mutism; Incontinence; Structural scan shows Diffuse atrophy