Cognitive Disorders (lec 2) Flashcards by Wendy Pitts

Cognitive Disorders affect? (8)

May cause? (2)

Judgement
Initiative
Memory/recall
Orientation
Impulse control
Emotional stability
Attention span
Problem solving

Hallucinations
Confabulation (make up memories)

How well did you know this?

Not at all

Perfectly

Delirium DSM criteria?

ACUTE, rapidly progressive ∆s in cognition

Seen as:
inattention
disturbed consciousness,
sxs fluctuate over 24 hrs

(aka encephalopathy, acute confusional state)

How well did you know this?

Not at all

Perfectly

Delirium sxs? (5 general categories)

1) Arousal: altered levels
2) Memory: impairment
3) Orientation: dis
4) Perception: disturbance
5) Language: disturbance

How well did you know this?

Not at all

Perfectly

Risk factors of delirium? (8)

INFECTION
Existing cognitive impairment
>70 yo
Poor fxnl status
Hearing/visual impairment
Dehydration (e- disturbance)
Sleep deprivation
Polypharmacy

How well did you know this?

Not at all

Perfectly

Delirium DDX?

2° to medical condition or substance
Intoxication
W/drawal
Dementia
Psych disorders
Fakers

How well did you know this?

Not at all

Perfectly

Delirium assessment includes? (3 categories)

Primary survey:
Good hx and physical
Mental status

Secondary survey:
Reassess (delirium ∆s rapidly)

Thorough medical workup:
CBC
CMP
UA (UTI common cause)
EKG
CXR (PNA common cause)

How well did you know this?

Not at all

Perfectly

Delirium tx? (5)

Treat cause/stop offending meds
Stable environment
Ensure they can hear and see
Full-time sitter
Educate family/caregivers

How well did you know this?

Not at all

Perfectly

Common meds that cause delirium? (5)

BZs
Tramadol
Opiates
Anticholinergics
H2 blockers (U pepsid)

How well did you know this?

Not at all

Perfectly

Pharm tx for delirium indicated when? (3)

1) severe agitation
2) combative
3) behavior that interferes w/ care

How well did you know this?

Not at all

Perfectly

Drugs used to treat delirium?

Risk a/w these meds?

Antipsych:
Haloperidol, Zyprexa, Seroquel, Risperdal

↑ risk of sudden death in pts w/ dementia

How well did you know this?

Not at all

Perfectly

Considerations w/ antipsych meds for delirium? (5)

Get baseline ECG (can ∆ QTI)
Correct e-
Start slow/go slow
Watch BP/orthostatics
Educate family

How well did you know this?

Not at all

Perfectly

Benzodiazepines indicated for tx of what type of delirium?

EtOH or drug-induced

How well did you know this?

Not at all

Perfectly

EtOH w/drawal delirium presentation?

EMERGENCY

Extreme auto hyperactivity w/ delirium

How well did you know this?

Not at all

Perfectly

Dementia DSM criteria?

Acquired, CHRONIC, progressive decline in memory w/ assoc’d cognitive/fxnl impairment

IRREVERSIBLE

How well did you know this?

Not at all

Perfectly

Possible Dementia-related cognitive disorders?

1) aphasia (can’t understand and/or express speech)
2) apraxia (loss of motor skills)
3) agnosia (can’t recognize sensory input - don’t know what things are)

How well did you know this?

Not at all

Perfectly

Cannot diagnose Dementia when what?

delirium is present

Causes of Dementia? (4)

Alzheimer’s
Vascular/Multi-infarct
Neurodegeneration
2° to other dzs/conditions

Neurodegenerative process that cause dementia? (3)

1) Lewy Body Dz (protein deposits -> hallucinations that don’t cause concern to the pt)
2) Parkinson’s
3) Frontaltemporal degen/Pick’s Dz (behavioral disturbances/disinhibition, non-fluent aphasia)

Vascular/Multi-infarct dementia U accompanied by or result of?

vascular risks (DM, heart dz, CAD)
U follows CVA

Dementia caused by Creutzfeldt-Jakob Dz:

Etiology?

Epidemiology?

Onset?

Sxs?

Prognosis?

Caused by prion

U 40-60 yo

Rapid onset

Triad of dementia, involuntary mvmt, hallucinations (end up unable to move)

Fatal

Huntington’s dementia:

Etiology?

Epidemiology?

Sxs?

Imaging findings?

Auto dominant

U onset 30-40s

Choreiform mvmts

Boxcar ventricle on imaging

HIV dementia:

Etiology?

Sxs?

Direct result of HIV (find in CSF)

Forgetful, slow, apathy, delirium
Tremors, ataxia

Reversible dementias include? (5)

1) Normal Pressure Hydrocephalus
(sudden falls + urinary incontinence + neurocog decline)

2) B12 deficiencies
3) Hypothyroid
4) Depression
5) Syphilis

Dementia DDX? (4)

Mild cognitive impairment
Reversible dementias
Delirium
Amnestic disorders

Mild Cognitive Impairment is? Presentation? Increases risk for what?

Pre-dementia Subjective memory complaints, objective mild memory impairment, preserved cognitive fxn, intact ADLs ALL types of dementia

Dementia assessment includes? (4)

Hx/physical Labs Neuroimaging Cognitive testing NO definitive test while alive

Dementia labs? (8)

``` CBC/CMP TSH B12 Folate Homocysteine (high levels ↑ strokes) SED rate HIV RPR (rapid plasma reagin for syphilis) ```

Dementia imaging?

CT or MRI to r/o reversible dementias

Mental status testing for dementia?

MMSE

Dementia management? (4)

Tx cognitive sxs Behavior mgmt Educate/support for caregiver Prevention

Tx for dementia-related cognitive sxs?

``` Cholinesterase inhibitors (aricept) NMDA antagonists (memantine) ```

Amnestic Disorders are?

Impaired or inability to: Learn new info Recall learned info or past events Causes marked social/occupational impairment NOT caused by delirium or dementia

Amnestic Disorder presentation?

``` Confused/disoriented Confabulation Rarely disoriented to self (know who they are) Unaware of deficits Apathy of deficits ```

Amnestic Disorders caused by? (8)

``` Head injury Drugs Postictal (seizure) Shock therapy Focal tumors/infarcts Infection Cerebral anoxia Transient global ```

Transient Global Amnesia is?

Abrupt loss of recall or ability to make new memories in healthy people Lasts 6-24 hrs

Types of EtOH-induced amnesia? (2)

1) Wernicke's Encephalophathy | 2) Korsakoff's Syndrome

Wernicke's Encephalophathy result of? Triad of sxs?

ACUTE EtOH-induced thiamine deficiency Ophthalmoplegia (paralysis of ocular mm) Ataxia Nystagmus

Korsakoff's Syndrome results of? Presentation?

CHRONIC EtOH-induced thiamine deficiency Similar triad + (P) psychosis IRREVERSIBLE