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Neuro 2 (Mo) > Dementia. Delirium > Flashcards

Dementia. Delirium Flashcards

1
Q

Delirium

A 
Acute 
Fluctuating level of consciousness
Impaired attention
Incoherent speech
Toxic and metabolic causes usually found
Typically reversible
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2
Q

Dementia

A 
Chronic 
Normal level of consciousness
Normal attention
Aphasia
Toxic/ metabolic causes usually not found
Typically irreversible
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3
Q

Treatment of Delirium, Provision of adequate sleep

A
  1. Avoid daytime sedation and naps

2. Trazodone, zolpidem QHS

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4
Q

Treatment of Delirium, drugs

A
  1. Atypical antipsychotics PRN

2. Benzodiazepines PRN

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5
Q

The Syndrome of Dementia

A

*memory, language, visuospatial skills, complex cognition, and emotion or personality - that is of sufficient severity to interfere with usual social and occupational function. *Need 3+

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6
Q

Dementia Etiology- Reversible

A

Drugs and toxins – prescription, etoh
Mass lesions
Systemic illness – e.g. hypothyroidism, vitamin B12 deficiency

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7
Q

Dementia Etiology- Irreversible

A 
Alzheimer’s Disease
Frontotemporal lobar degeneration
Vascular dementia
Lewy Body Dementia 
Parkinson’s Disease
Huntington’s Disease
Creutzfeldt-Jakob Disease
HIV-associated dementia
Moderate/ severe TBI
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8
Q

Neuroanatomic

Classification of Dementia

A

cortical – e.g. Alzheimer’s Disease
subcortical – e.g. Parkinson’s Disease
white matter – e.g. Binswanger’s Disease
mixed – e.g. multi-infarct dementia

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9
Q

Loss of dopaminergic cells in the midbrain substantia nigra (SN)
80% develop dementia within 15 years of onset
Standard PD drugs can modestly help cognition
A cholinergic deficit is also present, and there is evidence for use of cholinesterase inhibitors

A

Parkinson’s Disease

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10
Q

An autosomal dom disease w/ dementia and chorea
Onset usually in mid-life
Early personality changes – disinhibition, poor judgment, antisocial behavior
Diagnosis is accurate with the CAG triplet repeat test
Caudate atrophy may not be present in the early years of the disease

A

Huntington’s Disease (HD)

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11
Q

potentially reversible dementia, complete reversibility uncommon
Classic triad: dementia, gait disorder, and urinary incontinence
High-volume lumbar “tap test” (30-50 cc) improves gait and sometimes cognition

A

Normal Pressure Hydrocephalus (NPH)

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12
Q

A rapidly progressive dementia, acute confusion, hallucinations, and delusions
ends in death within one year
Etiology is a novel agent known as a prion (proteinaceous infectious agent)

A

Creutzfeldt-Jakob Disease (CJD)

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13
Q

mad cow disease -consumption of infected beef in 1980s
Earlier age of onset, longer duration, and more psychiatric features early in the course
chronic wasting disease (CWD) of deer and elk is not transmissible to humans

A

Variant CJD

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14
Q

Treatment of Dementia – General Principles

reversable

A

Reversible causes - Treatment depends on etiology, and the earlier the treatment, the greater the chance for full recovery

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15
Q

Treatment of Dementia – General Principles

non reversable

A

Irreversible causes - Regular medical care is essential: informed counseling, avoidance of drugs that can worsen dementia, and careful use of medications for specific symptoms

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16
Q

Treatment of Dementia – Cognitive Impairment

A

AD is the only degenerative dementia with FDA-approved drug treatment
Cholinesterase inhibitors

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17
Q

Early memory and visuospatial problems- get lost (can’t find novel or familiar places)
Dressing apraxia-inability to do a skilled movement (putting on a sweater)
Most cases are sporadic
neuritic (amyloid) plaques and neurofibrillary tangles

A

Alzheimer’s disease

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18
Q 
Young onset (under 40) cases typically associated with  \_\_\_\_\_\_\_\_\_
Alzheimer’s disease
A

presenilin 1 mutation

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19
Q

Early behavioral, executive and/or language
Diminished judgement, appropriate movement and memory
Neurofibrillary tangles (tau protein deposition)
Ubiquitin inclusions

A

Frontotemporal dementia (FTD)

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20
Q

Parkinson’s disease

A

Tremor, rigidity, bradykinesia

“Pill rolling” tremor, stiff, slow

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21
Q

Lewy Body dementia

A

Early parkinsonian features, psychosis, fluctuating consciousness
Delusional, hallucinations

22
Q

Progressive supranuclear palsy (PSP)

A

Bradykinesia, rigidity, falls, abnormal vertical eye movements
Lost “riding” reflexes and eye reflex (can’t follow finger w/ only eyes)

23
Q

Amyotrophic lateral sclerosis

A

Weakness and atrophy, fasciculations, both upper and lower motor neuron signs

24
Q

Huntington’s disease

A

Dementia, depression, chorea- fast twitchy movements
Start cheating, stealing, substance abuse, often felony charges

More characteristic gross changes in the brain
Clinically see marked caudate atrophy on CT/MRI

25
Q

Creutzfeldt-Jakob disease

A

Rapidly progressive dementia, myoclonus- faster twitchy movements
A prion disease
Age at onset of disease is usually between 55 and 65 years
Dementia with myoclonus

26
Q

Kuru

A

Papua New Guinea among the Fore people
“Trembling with fear”
Early tremor and ataxia
Dementia late in the course of the illness
Disappeared with end of ritual cannibalism

27
Q

Memory, language, executive function, visuospatial, Depression, apathy, sociopathy

A

Dementia Clinical presentation

28
Q

Bradykinesia, rigidity

Chorea, tremor

A

Parkinson’s, PSP, CJD, Huntington’s

-Movement disorders

29
Q

Genetic causes

A

Alzheimer’s, frontotemporal dementia, Lewy body dementia, Parkinson’s, PSP, ALS, CJD

30
Q

Sporadic

A

Alzheimer’s, frontotemporal dementia, Lewy body dementia, Parkinson’s, PSP, ALS, CJD

31
Q

Motor problems

Weakness, muscle atrophy

A

Motor problems

ALS, ALS/FTD

32
Q

Amyloid plaques + neurofibrillary tangles
Acetylcholine deficit
Early memory and visuospatial problems

A

Alzheimer’s

33
Q

Autosomal dominant
Increased polyglutamine repeats (CAG) in Huntington gene on chromosome 4
Caudate atrophy
Chorea, depression, dementia

A

Huntington’s disease

34
Q

Lewy bodies with synuclein protein
Dopamine deficit
Tremor, rigidity, bradykinesia

A

Parkinson’s

35
Q

Lewy bodies with synuclein protein
Dopamine and acetylcholine deficit
Early parkinsonian features, psychosis, fluctuating consciousness

A

Lewy Body dementia

36
Q 
Time course	Acute
Level of consciousness	Fluctuating
Attention	Impaired
Memory	Poor registration
Speech and language	Incoherent speech
Toxic and metabolic causes	Typical
Reversibility	Common
A

Delirium

37
Q 
Time course	Chronic
Level of consciousness	Normal
Attention	Normal
Memory	Amnesia
Speech and language	Aphasia
Toxic and metabolic causes	Unusual
Reversibility	Uncommon
A

Dementia

38
Q

Consults for “confusion” may be complicated with a broad differential; __________ will help work through this

A

neuropsychiatric assessment with attention to cognition

39
Q

_________ is brain failure: identify and treat the underlying cause

A

Delirium

40
Q

Most prominent disturbances in delirium involve______________

A

fluctuating arousal and attention

41
Q

Higher cognitive functions are impaired in a bottom up manner in __________

A

Delirium

42
Q

Use drugs sparingly and only when agitation is severe; start with low dose ________ or an atypical neuroleptic

A

Haldol

43
Q

_________ involves impairment of multiple cognitive domains, but arousal and basic aspects of attention are relatively intact

A

Dementia

44
Q

Rule-out delirium and look for_________; both should be treated aggressively

A

depression

45
Q

Treatment of dementia is tailored to underlying cause, but always:

A

support, educate, and ensure safety

46
Q

__________ and memantine may slow progression of certain dementias (AZ)

A

Cholinesterase inhibitors

47
Q
  1. A 72-year old retired attorney comes to you because he believes that his mental capacity is deteriorating. He complains of memory loss over the past year and answers many questions with “I don’t know.” His wife recounts that he has shown decreased interest in hobbies and social activities, lost his appetite, and that he is having problems sleeping. Although a neurodegenerative dementia is possible, which of the following conditions might better explain his presentation?
    a. multiple strokes in the right cerebral hemisphere
    b. bacterial meningitis
    c. Wernicke’s aphasia
    d. depression
A

d. depression

48
Q
  1. An 80-year old woman who lives alone has exhibited progressive forgetfulness over the past year, misses appointments made for her, dwells on the past, has increasingly difficulty with shopping, and has a poorly maintained apartment. Her neurological examination is normal except for her having virtually no idea of any current events, inability to recall three simple objects in five minutes, and uncertainty why she is even seeing a doctor. Which of the following best summarizes the situation and your subsequent course of action?
    a. she has Alzheimer’s Disease and should be placed in a nursing home
    b. she has vascular dementia and should be placed on aspirin
    c. her mental incapacity is most likely due to depression, which is best handled by referral to a psychiatrist
    d. drug toxicity, chronic subdural hematoma, hypothyroidism, and chronic CNS infection are possible here and should be excluded before proceeding further
A

d. drug toxicity, chronic subdural hematoma, hypothyroidism, and chronic CNS infection are possible here and should be excluded before proceeding further

49
Q
  1. Which of the following is the most common cause of dementia in the elderly?
    a. Alzheimer’s Disease
    b. repeated ischemic strokes
    c. Huntington’s Disease
    d. frontotemporal dementia
A

a. Alzheimer’s Disease

50
Q
  1. A 34-year old alcoholic man is brought to the hospital after being found down in a dumpster. He is admitted in stupor, but over two days recovers to the point of being alert. On the third hospital day, he is noted to be confused, restless, tremulous, and hallucinating. What is the most likely diagnosis?
    a. delirium tremens
    b. brainstem infarct
    c. Guillain-Barre syndrome
    d. subarachnoid hemorrhage
A

a. delirium tremens

51
Q
  1. Which of the following is not consistent with the syndrome of delirium?
    a. acute onset
    b. inattention
    c. normal level of consciousness
    d. etiology is usually toxic or metabolic
A

c. normal level of consciousness

Neuro 2 (Mo) (25 decks)

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