384.2 🩺 國考版

384.2.1 高頻考點

384.2.1.1 DLB Core Features (4)

  1. Fluctuating cognition
  2. Visual hallucinations
  3. REM behavior disorder
  4. Parkinsonism

384.2.1.2 DLB vs PDD

  • DLB: cognitive within 1 yr of parkinsonism (or before)
  • PDD: motor > 1 yr before cognitive

384.2.1.3 DLB Supportive

  • Severe antipsychotic sensitivity
  • Autonomic dysfunction
  • Non-visual hallucinations

384.2.1.4 DLB Biomarkers

  • DaT-SCAN abnormal
  • MIBG decreased
  • PSG-confirmed RBD

384.2.1.5 DLB Imaging

  • Relative preservation medial temporal lobe
  • Generalized hypometabolism (occipital — distinguishes from AD)
  • Cingulate island sign

384.2.1.6 DLB Pathology

  • α-synuclein Lewy bodies (cortical + diffuse)
  • Often + AD pathology

384.2.1.7 DLB Treatment

  • ChEI very responsive (rivastigmine, donepezil)
  • Pimavanserin for psychosis
  • AVOID typical antipsychotics + olanzapine + risperidone (severe sensitivity!)
  • Quetiapine, clozapine cautiously
  • Levodopa cautiously for parkinsonism

384.2.1.8 Antipsychotic Sensitivity

  • Severe EPS, NMS-like
  • Can be fatal
  • Up to 50% have severe reaction

384.2.1.9 Vascular Dementia Types

  • Multi-infarct
  • Strategic infarct
  • Subcortical ischemic (small vessel)
  • Hemorrhagic
  • Mixed

384.2.1.10 VCI Features

  • Stepwise (multi-infarct) or gradual (subcortical)
  • Subcortical pattern: psychomotor slow, executive
  • Vascular risk factors

384.2.1.11 VCI Treatment

  • Vascular risk factor management (key)
  • Antiplatelet for non-cardioembolic
  • Anticoagulation for AF
  • ChEI limited evidence

384.2.1.12 CADASIL

  • AD, NOTCH3
  • Recurrent strokes + migraine + cognitive + mood
  • Anterior temporal white matter
  • See Ch376

384.2.2 Specific Issues

384.2.2.1 Mixed Dementia

  • AD + vascular very common (~ 30-40%)
  • AD + DLB also
  • Treat both

384.2.2.2 Binswanger Disease

  • Subcortical small vessel
  • White matter disease
  • Lacunar infarcts
  • Executive + gait disorder
  • HTN typically

384.2.2.3 Hippocampal Sclerosis of Aging

  • Pure amnestic, mimics AD
  • Older patients
  • Often + TDP-43 (LATE)

384.2.2.4 NPH (Normal Pressure Hydrocephalus)

  • Triad: gait + cognition + urinary incontinence (“wet, wobbly, wacky”)
  • Ventricular enlargement out of proportion
  • Improvement with LP/VP shunt (large volume tap test, ICP monitoring)
  • Cognitive subcortical pattern

384.2.2.5 NPH vs Vascular Dementia

  • Both have subcortical features
  • NPH gait apraxia “magnetic”
  • NPH responds to shunt