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Psychiatry - Crash Course > Cognitive impairment > Flashcards

Cognitive impairment Flashcards

(60 cards)

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1
Q

Explicit memory

A

Declarative memory - all stored material of which the individual is consciously aware

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2
Q

Implicit memory

A

Procedural memory - all material that is stored without the individual’s conscious awareness e.g. the ability to speak a language or ride a bike

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3
Q

Semantic memory

A

Knowledge of facts e.g. world capitals

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4
Q

Episodic memory

A

Knowledge of autobiographical events

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5
Q

Dysphasia/aphasia

A

Loss of language abilities despite intact sensory and motor function

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6
Q

Receptive dysphasia

A

Difficulty in understanding commands or other words

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7
Q

Expressive dysphasia

A

Difficulty using words with the correct meaning

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8
Q

Nominal dysphasia

A

Not being able to name items despite knowing what they are - subtype of expressive dysphasia

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9
Q

Dyspraxia/apraxia

A

Loss of ability to carry out skilled motor movements despite intact motor function

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10
Q

Dysgnosia/agnosia

A

Loss of ability to interpret sensory information despite intact sensory organ function e.g. not able to recognise faces as familiar

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11
Q

Amnesia

A

Loss of ability to learn or recall new information, or to retrieve memories that have previously been stored

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12
Q

Executive function

A

Ability to plan and sequence complex activities or to manipulate abstract information (e.g. to plan the preparation of a meal)

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13
Q

Anterograde amnesia

A

Occurs after an amnesia-causing event; the patient is unable to store new memories from the event onwards, but ability to retrieve memories from before is unimpaired

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14
Q

What part of the brain is usually damaged, resulting in anterograde amnesia?

A

Medial temporal lobes, especially the hippocampal formation

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15
Q

Retrograde amnesia

A

Being unable to retrieve memories stored before an amnesia-causing event, although able to store new memories from the event onwards

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16
Q

What part of the brain is usually damaged, resulting in retrograde amnesia?

A

Frontal or temporal cortex

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17
Q

Risk factors for delirium (4)

A
  • An abnormal brain (e.g. dementia or previous serious head injury)
  • Age
  • Polypharmacy
  • Sensory impairment
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18
Q

Delirium

A

Acute and fluctuating cognitive impairment +/- psychotic features

High mortality - 1/3rd due during the presentation

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19
Q

Causes of delirium (systemic illnesses)

A

Infections and sepsis

Anoxia:

  • Respiratory failure
  • Heart failure
  • MI
Metabolic and endocrine:
-Electrolyte disturbances
-Uraemia
-Hepatic encephalopathy
-Porphyria
-Hypoglycaemia
-Hyper/hypothyroidism
-Hyper/hypoparathyroidism
-Cushings/Addisons
Hypopituitarism

Nutritional:

  • Thiamine deficiency (Wernicke’s encephalopathy)
  • Vitamin B12 deficiency
  • Folic acid deficiency
  • Niacin deficiency (pellagra)
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20
Q

Causes of delirium (drugs or their discontinuation)

A

Prescribed:

  • Anticholinergics
  • Benzodiazepines
  • Opiates
  • Antiparkinsonian drugs
  • Steroids

Recreational:

  • Alcohol withdrawal
  • Opiates
  • Cannabis
  • Amphetamines

Poisons:

  • Heavy metals (lead, mercury, manganese)
  • Carbon monoxide
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21
Q

Causes of delirium (intracranial)

A

Space-occupying lesions:
-Tumours, cysts, abscesses, haematomas

Head injury (especially concussion)

Infection:

  • Meningitis
  • Encephalitis

Epilepsy

Cerebrovascular disorders:

  • TIA
  • Cerebral thrombosis or embolism
  • Intracerebral or subarachnoid haemorrhage
  • Hypertensive encephalopathy
  • Vasculitis
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22
Q

Impaired cognitive function in delirium

A
  • Short-term and recent memory impairment with relative preservation of remote memory.
  • Almost always disorientated to time, often to place, rarely to person
  • Language abnormalities: rambling, incoherent speech and receptive dysphasia
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23
Q

Perceptual and thought disturbance in delirium

A
  • Misinterpretations, illusions and hallucinations (especially visual)
  • Transient persecutory delusions and delusions of misidentification
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24
Q

Sleep-wake cycle disturbance in delirium

A

Range from daytime drowsiness and night-time hyperactivity, to a complete reversal of the normal cycle

Nightmares may continue as hallucinations after awakening

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25
Mood disturbance in delirium
Depression, euphoria, anxiety, anger, fear and apathy are all common
26
Dementia
A syndrome of acquired progressive generalised cognitive impairment associated with functional decline (difficulties with ADL). Consciousness level is normal
27
How long do symptoms need to be present before a diagnosis of dementia can be made?
6 months
28
Basic ADLs
Self-care tasks such as eating, dressing, washing, toileting, continence and mobility
29
Instrumental ADLS
Tasks which are not crucial to life but allow someone to live independently e.g. cooking, shopping and housework
30
BPSD
Behavioural and psychological symptoms of dementia - non-cognitive symptoms associated with dementia - Behavioural symptoms are common: pacing, shouting, sexual disinhibition, aggression and apathy - Depression and anxiety in up to 50% - Delusions (especially persecutory) in up to 40% - Hallucinations in 30% (visual most common)
31
What percentage of patients with dementia will experience seizures?
``` Between 10-20% Primitive reflexes (e.g. grasp, snout, suck), as well as myoclonic jerks ```
32
Early onset dementia
Beginning before 65yrs old
33
Causes of dementia other than neurodegenerative or cerebrovascular disease
Space-occupying lesions • Tumours, cysts, abscesses, haematomas Trauma • Head injury • Punch-drunk syndrome (dementia pugilistica) Infection • Creutzfeldt–Jakob disease (including ‘new variant CJD’) • HIV-related dementia • Neurosyphilis • Viral encephalitis • Chronic bacterial and fungal meningitides Metabolic and endocrine • Chronic uraemia (also dialysis dementia) • Liver failure • Wilson’s disease • Hyper- and hypothyroidism • Hyper- and hypoparathyroidism • Cushing’s syndrome and Addison’s disease Nutritional • Thiamine, vitamin B12, folic acid or niacin deficiency (pellagra) Drugs and toxins • Alcohol, benzodiazepines, barbiturates, solvents Chronic hypoxia Inflammatory disorders • Multiple sclerosis • Systemic lupus erythematosus and other collagen vascular diseases Normal pressure hydrocephalus
34
Alzheimer's disease
62% Gradual onset with progressive cognitive decline Early memory loss
35
Vascular dementia
17% Focal neurological signs and symptoms Evidence of cerebrovascular disease or stroke May be uneven or stepwise deterioration in cognitive function
36
Mixed dementia
10% | Features of both Alzheimer’s disease and vascular dementia
37
Lewy body dementia
4% Day-to-day (or shorter) fluctuations in cognitive performance Recurrent visual hallucinations Motor signs of parkinsonism (rigidity, bradykinesia, tremor) (not drug-induced) Recurrent falls and syncope Transient disturbances of consciousness Extreme sensitivity to antipsychotics (induces parkinsonism)
38
Frontotemporal dementia
2% (includes Pick's disease) Early decline in social and personal conduct (disinhibition, tactlessness) Early emotional blunting Attenuated speech output, echolalia, perseveration, mutism Early loss of insight Relative sparing of other cognitive functions
39
Parkinson's disease with dementia
2% Diagnosis of Parkinson’s disease (motor symptoms prior to cognitive symptoms) Dementia features very similar to those of Lewy body dementia
40
Ddx for cognitive impairment
``` Delirium Dementia Mild cognitive impairment Subjective cognitive impairment Stable cognitive impairment post insult, e.g. stroke, hypoxic brain injury, traumatic brain injury Depression (‘pseudodementia’) Psychotic disorders Mood disorders Intellectual disability Dissociative disorders Factitious disorder and malingering Amnesic syndrome ```
41
Mild cognitive impairment
Objective cognitive impairment (confirmed with a standardised test) Around 10-15% of patient convert to dementia each year, but in some cases impairment remains stable, or even improves
42
Subjective cognitive impairment
When a patient complains of cognitive problems but scores normally on standardised tests. Can reflect anxiety or depression, or represent early deterioration in a highly educated individual
43
Stable cognitive impairment
Impairment of one or more aspects of cognition caused by a 'one-off' insult, without progressive deterioration (e.g. CVA, hypoxic brain injury, viral encephalitis, traumatic brain injury)
44
Amnesic syndrome
Severe disruption of memory (anterograde and retrograde, with recent memories most affected), with minimal or no deterioration in the other cognitive functions. Also confabulation, lack of insight and apathy Usually results from damage to the hypothalamic-diencephalic system or hippocampal region - commonest cause is Wernicke's encephalopathy
45
Confabulation
Filling of gaps in memory with details which are fictitious, but often plausible
46
Causes of amnesic syndrome (Diencephalic damage)
``` Vitamin B1 (thiamine) deficiency, i.e. Korsakoff’s syndrome: - Chronic alcohol abuse - Gastric carcinoma - Severe malnutrition - Hyperemesis gravidarum Bilateral thalamic infarction Multiple sclerosis Post subarachnoid haemorrhage Third ventricle tumours/ cysts ```
47
Causes of amnesic syndrome (hippocampal damage)
Bilateral posterior cerebral artery occlusion Carbon monoxide poisoning Closed head injury Herpes simplex virus encephalitis Transient global amnesia
48
What are you looking for in a physical examination when you suspect dementia?
- Reversible causes of impairment (hypothyroidism, space occupying lesion) - Risk factors for dementia (hypertension, AF) - Evidence of past CVA - Complications of impairment (self-neglect, injuries from a fall)
49
AMT (Advantages and disadvantages)
Abbreviated Mental Test A: Fast D: Not sensitive to mild-moderate impairment
50
MMSE (Advantages and disadvantages)
Mini Mental State Exam A: Covers most cognitive domains D: Not sensitive to mild impairment, does not test executive function, influenced by premorbid IQ, language and culture
51
Clock Drawing Test (Advantages and disadvantages)
A: Tests praxis and executive function, resistant to influence from premorbid IQ, culture and language D: Not sensitive to mild impairment, very influenced by poor motor control or visual impairment
52
ACE-R (Advantages and disadvantages)
Addenbrooke's Cognitive Examination-Revised A: Tests all cognitive domains, sensitive to mild impairment D: Lengthy, influenced by premorbid IQ, language and culture
53
What investigations should you perform (according to NICE) to exclude reversible causes of dementia?
Vitamin B12/folate level TFTs, calcium, glucose, U&Es CT/MRI head scan
54
CT appearance of normal ageing
Progressive cortical atrophy and increasing ventricular size
55
CT appearance of Alzheimer's disease
Generalized cerebral atrophy Widened sulci Dilated ventricles Thinning of the width of the medial temporal lobe (in temporal lobe-oriented CT scans)
56
CT appearance of vascular dementia
Single/multiple areas of infarction Cerebral atrophy Dilated ventricles
57
CT appearance of frontotemporal dementia
Greater relative atrophy of frontal and temporal lobes Knife-blade atrophy (appearance of atrophied gyri)
58
CT appearance of Huntington's disease
Dilated ventricles | Atrophy of caudate nuclei (loss of shouldering)
59
CT appearance of Creutzfeldt-Jakob disease
Usually appears normal
60
CT appearance of nvCJD
Bilaterally evident high signal in the pulvinar (post-thalamic) region

Psychiatry - Crash Course (11 decks)

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