Dementia – 10/31/17

Normal aging = no change in independent functioning

Mild cognitive impairment = stage between normal aging and dementia

  • Subjective reports of cognitive decline
  • Objective findings of impairment of cognitive decline
  • Loss of independence in daily functioning
  • No significant impairment in occupational and social functioning

Dementia = deterioration of cognitive function severe enough to impair occupational and social functioning; biggest risk factor = age

Alzheimer’s disease

  • Most common type of dementia
  • Insidious development of recent memory loss
  • Word finding difficulties early
  • Visuospatial dysfunction (getting lost in familiar places)
  • Problems with executive function (problem solving ability)
  • No role for biomarker testing

Lewy Body dementia

  • Dementia precedes Parkinsonian symptoms
  • Visual hallucinations

Parkinsons dementia

  • Parkinsonian features before onset of dementia
  • Symptoms of Parkinsons include = bradykinesis + rigidity, pill-rolling tremor, postural/gait instability

Frontotemporal dementia

  • Can occur in younger people
  • Change in social behaviors
  • Loss of executive functioning and decision making
  • Has a genetic component 40% of the time so genetic counseling is beneficial


Varicella Zoster – 10/18/17

Primary infection – chicken pox (lesion at varying stage on the trunk, face, and extremities)
Reactivation – shingles (painful, unilateral rash in a restricted dermatome)

Clinical manifestations – 1) Rash – most common location is thoracic and lumbar dermatomes
2) Acute neuritis – 75% of patients have pain/burning/throbbing prior to onset of rash

Complications in immunocompetent hosts – post-herpetic neuralgia (7.9%), ocular complications (1.6%),, meningitis (0.5%), oticus (0.2%)

Disseminated if > 3 contiguous dermatomes or 2 dermatomes on separate parts of the body

Diagnosis for encephalitis/meningitis – elevated WBC with lymphocytic predominance, elevated protein, positive VZV PCR or IgM

Treatment: IV acyclovir

Vaccines: Age > 60 give live vaccine unless immunosuppressed
VZIG – give to exposed pregnant or immunosuppressed patients

Disseminated Gonococcal Infection – 10/16/17

  • Young (< 40 years old)
  • Women (because they are usually asymptomatic)
  • 0.5-3% of people infected with N. gonorrheae
  • Common cause of acute arthritis in young people

Clinical Manifestations

  • 1) triad of tenosynovitis (migratory), dermatitis (painless lesions – usually pustular or vesiculopustular), and polyarthralgias (small or large joints – usually asymmetric)
  • 2) purulent arthritis without skin lesions – usually one joint affecting knees, wrist, or ankles


  • Clinical suspicion – thorough history of physical
  • Blood cultures
  • Specimen from mucosal sites – urogenital, rectal, pharyngeal
  • Synovial fluid – only positive 50% of the time – NAAT testing better than cultures


  • Ceftriaxone 7-14 days (can give IM if non-purulent arthritis)
  • Remember to co-treat for chlamydia with azithromycin