Cognitive Disorders (lec 2) Flashcards Preview

Q4 Psych > Cognitive Disorders (lec 2) > Flashcards

Flashcards in Cognitive Disorders (lec 2) Deck (38):
1

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)

2

Delirium DSM criteria?

ACUTE, rapidly progressive ∆s in cognition

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

(aka encephalopathy, acute confusional state)

3

Delirium sxs? (5 general categories)

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

4

Risk factors of delirium? (8)

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

5

Delirium DDX?

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

6

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)

7

Delirium tx? (5)

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

8

Common meds that cause delirium? (5)

BZs
Tramadol
Opiates
Anticholinergics
H2 blockers (U pepsid)

9

Pharm tx for delirium indicated when? (3)

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

10

Drugs used to treat delirium?

Risk a/w these meds?

Antipsych:
Haloperidol, Zyprexa, Seroquel, Risperdal

↑ risk of sudden death in pts w/ dementia

11

Considerations w/ antipsych meds for delirium? (5)

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

12

Benzodiazepines indicated for tx of what type of delirium?

EtOH or drug-induced

13

EtOH w/drawal delirium presentation?

EMERGENCY
Extreme auto hyperactivity w/ delirium

14

Dementia DSM criteria?

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

IRREVERSIBLE

15

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)

16

Cannot diagnose Dementia when what?

delirium is present

17

Causes of Dementia? (4)

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

18

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)

19

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

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

20

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

21

Huntington's dementia:

Etiology?

Epidemiology?

Sxs?

Imaging findings?

Auto dominant

U onset 30-40s

Choreiform mvmts

Boxcar ventricle on imaging

22

HIV dementia:

Etiology?

Sxs?

Direct result of HIV (find in CSF)

Forgetful, slow, apathy, delirium
Tremors, ataxia

23

Reversible dementias include? (5)

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

2) B12 deficiencies

3) Hypothyroid

4) Depression

5) Syphilis

24

Dementia DDX? (4)

Mild cognitive impairment
Reversible dementias
Delirium
Amnestic disorders

25

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

26

Dementia assessment includes? (4)

Hx/physical
Labs
Neuroimaging
Cognitive testing

NO definitive test while alive

27

Dementia labs? (8)

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

28

Dementia imaging?

CT or MRI to r/o reversible dementias

29

Mental status testing for dementia?

MMSE

30

Dementia management? (4)

Tx cognitive sxs
Behavior mgmt
Educate/support for caregiver
Prevention

31

Tx for dementia-related cognitive sxs?

Cholinesterase inhibitors (aricept)
NMDA antagonists (memantine)

32

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

33

Amnestic Disorder presentation?

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

34

Amnestic Disorders caused by? (8)

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

35

Transient Global Amnesia is?

Abrupt loss of recall or ability to make new memories in healthy people

Lasts 6-24 hrs

36

Types of EtOH-induced amnesia? (2)

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

37

Wernicke's Encephalophathy result of?

Triad of sxs?

ACUTE EtOH-induced thiamine deficiency

Ophthalmoplegia (paralysis of ocular mm)
Ataxia
Nystagmus

38

Korsakoff's Syndrome results of?

Presentation?

CHRONIC EtOH-induced thiamine deficiency

Similar triad + (P) psychosis
IRREVERSIBLE