Cognitive Disorders Flashcards
Cognitive Disorder
Significant change in cognition from a previous level of functioning. May effect memory, attn, language and judgement. May be associated with abnormalities of the central nervous system, general medical condition or substance abuse.
Typically described as either a Delirium or Dementia
Delirium
A waxing and waning change in a patients level of consciousness. Can be caused by virtually any medical disorder.
AEIOU TIPS
Alcohol/drug tox. Electrolyte abs. Iatrogenic causes (pharm) Oxygen (hypoxia) Uremia --> hepatic encephalopathy
Trauma
Infection
Poison
Seizure
Risk Factors for Delerium
Advanced Age Pre-existing Brain Damage Prior hx of delirium Alcohol Cancer Diabetes Sensory impairment Malnutrition Male Gender
Sx of Delerium
Short attn span Visual Hallucination Disorientation Language disturbances Disturbed psychomotor Emotional disturbance
Tx of Delerium
Fix the underlying cause
Agitation associated : psychotropics given such as Haloperidol.
Benzos rarely given unless delirium due to alcohol
Dementia
impairment of memory or other cognitive functions without alteration in the level of consciousness.
Most forms are progressive and irreversible
Most common is Alzheimers (15-25%)
DSM for Dementia
Multiple cognitive deficits manifested by Memory impairment and at least one of the following:
Aphasia, Apraxia, Agnosia, Disturbance of executive functioning.
MMSE
Orientation (date month year)
Registration (name three objects, repeat)
Attention and Calculation (count back for 100 by 7s)
Recall (repeat 3 items 5 mins later)
Language (Name a pen and clock, Say no if and’s or but’s)
Read and obey the following
Perfect : 30
Dysfunction: less than 25.
Etiology of Alzheimers
Decreased ACh due to loss of Noradrenergic neurons in the basal cereuleus and dec Choline Acetyltransferase.
Genes associated with Alzheimers
Presenilin 1 and 2.
Amyloid Precursor Protein
ApoE4 : If homozygous, 90% chance of getting alzheimers by 85. Heterozygous (45%)
Postmortem findings of Alzheimers
DIffuse atrophy with enlarged ventricles and flattened sulci.
Tx of Alzheimers
No Cure
Cholinesterase Inhibitors: Rivastigmine, Tacrine, Donepezil
NMDA Antagonists: Memantine (Namenda)
Vascular Dementia
2nd most common form of dementia
Produced by multiple small infarcts (lacunar)
Tx of Vascular Dementia
No effective treatment
Control of HTN may help overall.
Lewy Body Dementia
Due to aggregation of Alpha-synuclein –> Lewy Neurites and Lewy Bodies especially in the basal ganglia
Sx: Waxing and waning cognition is core feature
Visual hallucinations (well formed ideas of animals or people)
Paranoid delusions
Parkinsonism (tremor, bradykinesia, shuffling gait)
Sensitivity to neuroleptics
REM disorder is common.
Dx of Lewy Body Dementia
Onset of dementia within 12 months of parkinsonism symptoms,
Tx of Lewy Body Dementia`
Cholinesterase Inhibitors (help visual hallucinations)
Psychostimulants, levodopa/carbidopa, dopamine agonists.
Atypical neuroleptics
Clonazepam for REM sleep behavior
Pick Disease (Fronto-Temporal Dementia)
Typically presents between the ages of 45-65
20-30% is familial and associated with the Progranulin and MAPT Genes
Mean duration is 4-6 years until death.
Marked atrophy of the frontal and temporal lobes
Neuronal loss, microvascularization and astrocytic gliosis in cortical layer II
Pick Dx Sx
PROFOUND changes in personality and social conduct
Disinhibited verbal, physical and sexual behavior
Echolalia, overeating, ORAL EXPLORATION OF INNANIMATE OBJECTS
Poor insight about behavioral changes
Pick Dx Tx
Anticholinergic and Antidepressants
HIV Associated Dementia
Most common dementia caused by infectious disease
Tx of HIV Associated Dimentia
HAART
Psychostimulants
Huntington Disease
Autosomal Dominant. Onset between 35-50 (shows anticipation through generations).
Progressive dementia Choreaform movements Muscular hypertonicity Psychiatric Manifestation Increased rate of suicide.
MRI shows CAUDATE ATROPHY
