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Psych > 6. Cognitive disorders > Flashcards

6. Cognitive disorders Flashcards

1
Q

What are the 2 main types of cognitive disorders?

A

Delirium and dementia

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2
Q

What are the symptoms of tertiary syphillis? (4)

A

Tremor, EPS, frontal dizziness, sluggish pupillary reflex

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3
Q

How can tertiary syphillis be diagnosed?

A

VDRL test (venereal disease research lab) test

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4
Q

Difference b/w delirium and dementia?

A

Delirium = waxing and waning change in pt’s level of consciousness

Dementia = impairment of memory and other cognitive fxs (language, behavior, personality) WITHOUT alteration in level of consciousness

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5
Q

What are some other terms that refer to delirium? (5)

A
  1. Encephalopathy
  2. Acute organic brain syndrome
  3. Acute confusional state
  4. Acute toxic psychosis
  5. ICU psychosis
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6
Q

What are causes of delirium? AEIOU TIPS

A
  • Alcohol/drug toxicity or withdrawal
  • Electrolyte abnormality
  • Iatrogenic (ex. anticholinergics, benzo, antiepileptics, blood pressure meds, insulin, abx, antiparkinsonians)
  • Oxygen hypoxia (bleeding, central venous, pulmonary)
  • Uremia/hepatic encephalopathy
  • Trauma
  • Infection
  • Poisons
  • Seizures (postictal), Stroke
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7
Q

What are the two typical symptoms of delirium?

A

Visual hallucinations (perceptual disturbance) and short attention span

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8
Q

What is the most common finding in delirium?

A

Impairment in recent memory

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9
Q

What is the difference in EEG in delirium and dementia?

A 
Delirium = EEG changes (fast waves or generalized slowing) 
Dementia = no EEG changes
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10
Q

What is the most common form of dementia?

A

Alzheimer’s (50-70%)

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11
Q

What’s the 2nd most common form of dementia?

A

Vascular dementia (15-25%)

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12
Q

What should you do if a pt presents w/ dementia but has a normal CT scan?

A

Order complete metabolic panel and MRI

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13
Q

What is dementia with stepwise increase in severity + focal neurological signs?

A

Multi-infarct dementia

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14
Q

What is dementia + cogwheel rigidity + resting tremor?

A

Lewy body dementia or Parkinson

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15
Q

Dementia + gait apraxia + urinary incontinence + dilated cerebral ventricles?

A

Normal pressure hydrocephalus

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16
Q

Dementia + obesity + coarse hair + constipation + cold intolerance?

A

Hypothyroidism

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17
Q

Dementia + diminished position and vibration sensation + megaloblast on CBC?

A

Vit B12 deficiency

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18
Q

Dementia + tremor + abnormal LFTs + Kayser-Fleischer rings?

A

Wilson disease

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19
Q

Dementia + diminished position and vibration sensation + Argyll Robertson Pupils (Accommodation Response Present, response to light absent)

A

Neurosyphilis

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20
Q

What is considered dysfunction on mini-mental state exam?

A

Less than 25 (30 is perfect score)

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21
Q

What is the diff. b/w delirium and dementia in terms of symptoms throughout the day?

A 
Delirium = symptoms fluctuate (often worse at night) 
Dementia = symptoms stable throughout day
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22
Q

What is the risk factor for a 1st deg relative of an Alzheimer’s pt to get Alzheimer’s?

A

4fold increase

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23
Q

What is the molecule that is reduced in Alzheimer’s?

A

Ach (due to loss of noradrenergic neurons in the basal ceruleus and loss of choline acetyltransferase - required for ach synthesis)

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24
Q

What are the Alzheimer genes (3)?

A

Presenelin 1, Presenelin 2, APP (amyloid precursor protein)

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25
Q

What % of cases of Alzheimer’s are due to genetic abnormalities?

A

5%

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26
Q

What is the major susceptibility gene in Alzheimer

A 
Apolipoprotein e4 (APOe4) 
- homozygous have 50-90% chance of developing dementia by age 85
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27
Q

What other conditions have senile plaques and neurofibrillary tangles? (2)

A

Down syndrome and normal aging

28
Q

What is the amyloid cascade hypothesis?

A

Excess of AB peptides (either by overproduction or diminished clearance)

29
Q

What postmortem finding correlates with severity of dementia?

A

Neuritic plaques (NOT neurofibrillary tangles)

30
Q

What pharmacotherapy can be used with mild-moderate Alzheimer disease?

A

Cholinesterase inhibitors

ex. donepezil (Aricept), Tacrine (Cognex), rivastigmine (Exelon), galantamine (Razadyne)

31
Q

What pharmacotherapy can be used with moderate-severe Alzheimer disease?

A

NMDA antagonists

ex. Memantine (Namenda)

32
Q

What is a typical finding on CT of a pt w/ vascular dementia?

A

Multiple small lacunar infarcts (small vessel disease)

33
Q

A stroke to which area of the brain can lead to symptoms of schiz, BP1 disorder, and depression?

A

Frontal lobe

34
Q

What is the gender prevalence of vascular dementia?

A

M>W (2 times)

35
Q

What are 4 risk factors for vascular dementia?

A
  1. Stroke
  2. DM
  3. HTN
  4. APOe4
36
Q

Which dementia shows “step-wise” loss of function?

A

Vascular dementia (as microinfarcts build up)

37
Q

What is the treatment for vascular dementia?

A

No cure or truly effective tx

  • cholinesterase inhibitors sometimes successful
  • antiHTNs to prevent onset of vascular dementia
38
Q

What is the pathogenesis of Lewy Body dementia?

A

Lewy bodies and Lewy neurites (pathologic aggregation of alpha-synuclein) in the brain

39
Q

What is the primary brain location of Lewy Body dementia?

A

Basal ganglia

40
Q

What are core features of Lewy body dementia? (4)

A

Waxing and waning
Parkinsonism
Visual hallucinations
Sensitivity to neuroleptics

41
Q

What is the diff. b/w Lewy body dementia and Parkinson disease dementia?

A

Lewy body = onset of dementia within 12 months of parkinsonism symptoms

Parkinson disease dementia = onset of dementia AFTER 12 months of parkinsonism symptoms

42
Q

Which is more closely linked to the clinical symptoms of lewy body dementia? Lewy neurites vs. Lewy bodies?

A

Lewy neurites

43
Q

What tx can be used for lewy body dementia to help with visual hallucinations?

A

Cholinesterase inhibitors

44
Q

How does psychostimulants, levodopa/carbidopa, and dopamine agonists help pts with lewy body dementia?

A

Helps improve cognition, apathy and psychomotor slowing

45
Q

What is the progression of pick disease (frontotemporal dementia) compared to Alzheimer?

A

More rapid progression to death

46
Q

Where is the gene mutation found in familial pick disease?

A

Progranulin or MAPT gene

47
Q

What is the typical age presentation of pick disease?

A

45-65 yo

48
Q

What is the brain pathology of pick disease?

A
  • Marked atrophy of the frontal and temporal lobes

- Neuronal loss, microvacuolization, and astrocytic gliosis in cortical layer II

49
Q

What are some clinical manifestations of pick disease?

A
  • profound changes in personality and social conduct
  • disinhibited verbal, physical, and sexual behavior
  • Echolalia, overeating, oral exploration of inanimate objects
  • lack of emotional warmth, empathy, or sympathy
  • cognitive deficits in attention, abstraction, planning, and problem solving
  • memory, language, and spatial fxs well preserved
50
Q

How does anticholinergic and antidepressants help in pts with pick disease?

A

Helps improve behavioral symptoms but not cognition

51
Q

What are the risk factors for HIV associated dementia? (3)

A
  • duration of illness
  • low CD4
  • high viral loads
52
Q

What are the movement disorders seen in Huntington?

A
  • choreiform movements (dancelike)
53
Q

What are some psychiatric manifestations seen in Huntington? (3)

A
  • depression, psychosis, alcoholism
54
Q

What is shown on MRI of Huntington pts?

A

Caudate atrophy (sometimes cortical atrophy too)

55
Q

What is the pathology of Huntington?

A

Trinucleotide repeat on short arm of chromosome 4

56
Q

What is lilliputian hallucination?

A

Sensation that objects appear very small

57
Q

What brain structure is affected in Parkinson disease?

A

Substantia nigra (neuronal loss)

58
Q

What % of Parkinson pts develop dementia?

A

30-40%

59
Q

What is the pathogenesis of Creutzfeldt-Jakob disease? (CJD)

A

Accumulation of abnormal forms of prions (proteinaceous infectious particles that are normally expressed by healthy neurons)

60
Q

What is the definitive dx of Creutzfeldt-Jakob disease?

A

Pathological demonstration of spongiform changes in brain tissue (brain bx)

61
Q

What are some clinical features of CJD? (5)

A
  • Myoclonus (sudden spasms of muscles)
  • Cortical blindness
  • Ataxia, pyramidal signs, EPS
  • Muscle atrophy
  • Mutism
62
Q

What are early signs of CJD? (3)

A

Personality changes, immature behavior, paranoia

63
Q

What is the progression of CJD?

A

Rapid progression to stupor, coma, death (from months to few yrs)

64
Q

What are some other prion diseases? (4)

A
  • kuru
  • Gerstmann-Straussler syndrome
  • fatal familial insomnia
  • bovine spongiform encephalopathy (mad cow disease)
65
Q

What are the 3 symptoms of NPH (normal pressure hydrocephalus)?

A

3Ws

  • wobbly = gait disturbance
  • wet = urinary incontinence
  • wacky = dementia
66
Q

What is the brain findings of NPH?

A

Enlarged ventricles w/ increased CSF pressure

Psych (17 decks)

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