Info
🌱 來自: Huppert’s Notes
Cognitive Impairment🚧 施工中
Cognitive Impairment
Alzheimer’s disease
• Epidemiology: Most common form of dementia. Typically symptoms appear after age 60 yr. Increasing prevalence with increasing age.
• Pathophysiology: Loss of neurons and synapses in the cerebral cortex (particularly in the temporal/parietal lobes); thought to be due to misfolding of amyloid beta protein, although poorly understood
• Symptoms: Memory loss (particularly short term memory), decreased attention, visuospatial dysfunction, disorientation
• Treatment:
- Mild/moderate: Cholinesterase inhibitor – donepezil, galantamine, rivastigmine
- Severe: NMDA antagonist – memantine
Other etiologies of dementia
• Vascular dementia: Second most common cause of dementia; often multiple infarcts cause a stepwise decline. Treatment: Aspirin; control vascular risk factors
• Atypical parkinsonian syndromes: See movement disorders section above
• Normal pressure hydrocephalus (NPH): Idiopathic or due to hydrocephalus out of proportion to brain parenchymal atrophy with normal opening pressure. Typically, gait instability occurs first (magnetic gait due to apraxia), followed by urge incontinence, cognitive impairment (executive dysfunction, apathy). Diagnosis: Large volume LP with pre- and post-MOCA and motor testing. Treatment: VP shunt
• Creutzfeldt-Jakob disease (CJD): Median onset 60 yr. Rapidly progressive ataxia/dementia that is uniformly fatal (70% die within 1 yr). Diagnosis: LP – 14-3-3 protein, RT-Quic; EEG = periodic sharp waves. No effective treatments
• Pseudodementia: Depression can cause memory loss. Patients may be apathetic with formal testing and thus may perform poorly and out of proportion to their actual deficits