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cognitive disorders Flashcards

1
Q

delirium: general

A
  • waxing-and-waning change in level of consciousness
  • caused by almost any medical d/o
  • high morbidity and mortality if untreated
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2
Q

delirium: epidem

A
  • 10-30% of admitted medical pts

- common in elderly, ICU, postop, cancer pts

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3
Q

delirium: risk factors

A
  • adv age
  • brain damage
  • prior delirium
  • alcohol dependence
  • cancer
  • sensory impairment, blindness
  • malnutrition
  • male gender
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4
Q

delirium: clinical

A

MOST common: impairment in recent memory

  • disorientation, usually to time/place
  • language disturbances, speech changes
  • perceptual disturbances, esp visual hallucinations
  • sleep disturbances: SUNDOWNING (daytime drowsiness and night-time insomnia)
  • disturbed psychomotor behavior
  • emotional disturbances
  • perseveration
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5
Q

delirium: dx

A
  • disturbance of consciousness w/reduced ability to focus, sustain, shift attn
  • change in cognition or development of perceptual disturbance (can’t be accounted for by dementia)
  • disturbance develops over short period of tie and fluctuates
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6
Q

delirium: tx

A
  • r/o life-threatening cause, find underlying condition
  • hydration, nutrition
  • 1:1, orient patient, good sleep hygiene
  • Haldol for agitation
  • BZOs only for DTs
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7
Q

dementia: general

A
  • impairment of memory and other cognitive fns WITHOUT altered consciousness
  • most forms progressive, irreversible
  • prevalence doubles every 5 years: 1.5% at 60 yrs, 40% at 90 yrs
  • Alzheimer’s most common, vascular dementia 2nd
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8
Q

dementia: dx

A
  • multiple cognitive deficits manifested by BOTH: memory impairment and 1+ of: aphasia, apraxia, agnosia, decreased executive fn
  • cognitive deficits must cause significant impairment and are significant decline
  • do not occur only during delirium
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9
Q

dementia: assoc sx

A
  • delusions and hallucinations: 30%
  • affective sx: 40-50%
  • personality changes
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10
Q

dementia: reversible causes

A
  • workup CBC, electrolytes, TFTs, VDRL/RPR, B12/folate, brain CT/MRI
  • hypothyroidism
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11
Q

Alzheimer: epidem

A
  • most common type of dementia
  • women 3x > men
  • 1st degree relative –> 4x risk
  • Down syndrome –> increased risk
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12
Q

Alzheimer: clinical

A
  • gradual progressive decline in cognitive fn
  • personality chg, mood swings, paranoia common
  • motor and sensory sx absent until late in cours
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13
Q

Alzheimer: dx

A
  • clinical, dx of exclusion unless post-mortem
  • genes: only 5% of cases; APOe4 gene –> homozygotes have 50-90% chance, heterozygotes 45% chance
  • 20% chance overall
  • postmortem: diffuse atrophy with enlarged ventricles, flattened sulci
  • senile plaques and NF tangles
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14
Q

Alzheimer: pathophys

A
  • decrease in ACh - loss of noradrenergic neurons in basal ceruleus and decreased choline acetyltransferase
  • excess of Abeta peptides (overprod, decreased clearance)
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15
Q

Alzheimer: tx

A
  • cholinesterase inhibs for mild-mod dz
    • tacrine, donepezil, rivastigmine, galantamine
  • NMDA antagonists for mod-severe dz
    • memantine
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16
Q

vascular dementia: general

A
  • 2nd most common form
  • microvascular dz in brain –> multiple small infarcts
  • risk factors: stroke, DM, HTN, APOe4, male (2x>women)
17
Q

vascular dementia: clinical

A
  • STEP-WISE deterioration
  • lateralizing signs
  • depression, anger, paranoia common
  • frontal lobe stroke –> SCZ/BiPD/depressive sx
18
Q

vascular dementia: tx

A
  • cholinesterase inhibitors
  • antiHTN tx to prevent onset (?)
  • symptomatic tx
19
Q

lewy body dementia: pathophys

A
  • lewy bodies and lewy neurites = pathologic aggregations of alpha synuclein in brain
  • mostly in basal ganglia
20
Q

lewy body dementia: clinical

A
  • WAXING AND WANING cognition
  • visual hallucinations: animals or people, colorful
  • paranoid delusions
  • parkinsonism
  • SENSITIVITY TO NEUROLEPTICS
  • REM sleep behavior do
21
Q

lewy body dementia: dx

A
  • onset of dementia w.in 12 mos of parkinsonism sx
22
Q

lewy body dementia: tx

A
  • cholinesterase inhibs (help with VH)
  • psychostimulants, levodopa/carbidopa, DA agonists
  • atypical neuroleptics
  • clonazepam for REM do
23
Q

frontotemporal dementia

A
  • diverse group of dos
  • present bw ages 45-65
  • approx 20-30% familial - progranulin or MAPT gene
  • 4-6 years from illness to death
24
Q

FTD: clinical

A
  • profound chg in personality and social conduct
  • disinhibition
  • echolalia, overeating, oral fixation
  • lack emotional warmth, insight
  • cognitive deficits in attn, executive fn
  • memory, language, spatial functions PRESERVED
25
Q

FTD: pathophys

A
  • marked atrophy of frontal and temporal lobes

- neuronal loss, microvacuolization, astrocytic gliosis in cortical layer II

26
Q

FTD: tx

A
  • anticholinergics, antidepressants - for behavioral sx only
27
Q

HIV assoc dementia

A
  • caused by neutropenia–>infx and direct viral effects
  • risk factors: duration of HIV, low CD4, high VL
  • clinical: rapid decline in cognition, behavior, motor; poor memory and concentration, apathy and social w/d, depression
  • language PRESERVED
28
Q

HIV assoc dementia: tx

A
  • HAART

- psychostimulants for fatigue and psychomotor retardation

29
Q

huntington dz: clinical

A
  • onset 35-50 yrs
  • progressive dementia beginning 1 year before/after chorea
  • choreiform movements
  • muscle hypertonicity
  • depression, psychosis, alcoholism
  • INCREASED SUICIDE RATE
30
Q

huntington: dx

A
  • MRI: caudate atrophy, sometimes cortical atrophy

- genetic testing (CAG repeat expansion, chrom 4)

31
Q

parkinson dz: pathophys

A
  • substantia nigra DA neuronal loss –> loss of DA provision to BG
  • senile plaques and NF tangles, loss of choline acetyltransferase
  • causes: idiopathic, traumatic, drugs, toxins, encephalitic, familial
32
Q

parkinson dz: epidem

A
  • 30-40% develp dementia
  • 50% have depression
  • men > women
33
Q

parkinson: clinical

A
  • similar to Alzheimer
  • dementia rarely initial sx
  • parkinsonism
  • dementia EXACERBATED by antipsychotics
34
Q

creutzfeld jakob dz: general

A
  • rapidly progressive, degenerative CNS dz
  • prion accumulation
  • older patients
  • small percentage infected via corneal transplants
35
Q

CJD: clinical

A
  • rapidly progressive dementia 6-12 mos after sx onset
  • > 90% : MYOCLONUS
  • BG and cerebellar dysfn common
  • early sx: personality chg, immature behavior, paranoia
  • rapid progression to stupor/coma/death
36
Q

CJD: dx

A
  • pathological: spongiform chg in brain tissue
  • periodic generalized sharp waves on EEG
  • 2+: myoclonus, cortical blindness, ataxia, pyramidal/EPS, muscle atrophy, mutism
37
Q

normal pressure hydrocephalus

A
  • potentially reversible cause of dementia
  • enlarged ventricles, increased CSF pressure
  • cause: idiopathic or 2/2 CSF obstruction
  • Wobbly (gait disturbance), Wet (urinary incontinence), Wacky (dementia)
  • tx: shunt
  • dementia least likely to improve

psych (15 decks)

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