Delirium, Dementia and Other Cognitive Disorders Flashcards Preview

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Flashcards in Delirium, Dementia and Other Cognitive Disorders Deck (44):
1

Features of Dementia

Slow to develop
Progressive
Irreversible in most cases

2

Pseudodementia

Condition caused by another psychiatric disorder that mimics dementia (confabulatory)

3

Delirious pt response to questions

Unable to answer
Confused
Frightened
Angry

4

Demented pt response to questions

Tries to answer
Will say, "I don't know."

5

Pseudodemented pt's response to questioning

Will not try to answer
Will say, "I don't know."

6

Amnesic disorder

Memory impairment caused by:
A general medical condition
Persisting effects of substance use.

7

Amnesia

Inability to learn new information or recall old

8

Agnosia

An impaired ability to recognize familiar objects or people

9

Aphasia

Language disturbance in expressing and understanding spoken words

10

Apraxia:

Inability to carry out motor activities despite intact motor function

11

4 early signs of dementia

Amnesia
Agnosia
Aphasia
Apraxia

12

Most common type of dementia

Alzheimer's

13

Predisposing factors for dementia

Familial form of Alz
Huntington's is autosomal dominant on Chromosome 4:
-Risk for children is 50%
Creutzfeldt-Jakob Disease
-Genetic component appears in 10-15% of cases
Pick's Disease
-Linked to genes on chromosomes 3 and 17

14

Vascular Dementia

Caused by TIAs and strokes
Vascular changes related to a number of diseases with known genetic links:
-HTN
-DM
-High cholesterol

15

Alz Neurobiology

Progressive, widespread brain atrophy
Dec availability of ACh
Markedly increased neuritic plaques and neurofibrillary tangles

16

Vascular Dementia Neurobiology

Brain has multiple vascular lesions in the cortex and subcortical areas

17

Pick's Disease Neurobiology

Atrophy of the frontal and anterior temporal lobs of the brain
Swollen neurons with well-defined "Pick's Bodies."

18

Normal Pressure Hydrocephalus Neurobiology

Impaired return of cerebral spinal fluid to the brain from the spinal column
Enlarged ventricles seen on CT or MRI
Reversible if surgery performed soon enough

19

Vitamin B12 deficiency dementia neurobiology

Rare but potentially reversible
Inadequate B12 causes demyelination and axon loss

20

Parkinson's Disease Neurobioloty

50% reduction in neurons in the substantia nigra
Remaining cells containing Lewy bodies

21

Diffuse Lewy Body Disease Neurobiology

Lew bodies in the frontal and temporal cortex primarily
Presence but in lesser frequency in the hippocampus and substantia nigra

22

Creutzfeld-Jakob's Disease Neurobiology

Infecting agent known as a prion that causes spongiform Encephalopathy in which cells are stripped of intracellular material
Transmissible by blood and body fluid
Bovine spongiform encephalopathy is a variant

23

Environmental factors in dementia

Head injury
Down Syndrome
Chronic alcoholism
"Huffing"
Long-term use of BZOs and barbiturates
"Rave" drugs

24

Nun study

Nuns donated brains to science:
-Plaques and tangles present, but no Alz
-Plaques and tangles not enough to explain Alz

25

Order of Sx: Alz

Memory loss
Inability to problem solve in new situations
Decline is gradual

26

Order of Sx: Vascular Dementia

Symptom appearance is more abrupt
Coupled with neurological symptoms
Usually stair-step detioriation

27

Order of Sx: Pick's Dz

Behavioral changes appear first

28

Order of Sx: CJD

Personality changes
Szrs
Myoclonic movements
Course is rapid, death within a year

29

Order of Sx: Lewy Body Dz

Hallucinations
Fluctuating alertness
Tendency to fall appear early in 80% of those with EPS

30

Order of Sx: Huntington's

Insidious behavioral changes
Disruption of attention
Personality
Choreiform movements

31

Order of Sx: Korsakoff's

Wernicke's (reversible with thiamine)
Ataxia
Nystagmus
Confabulation

32

AIDS/Dementia Complex

Subcortical Dementia with infiltration of infected macrophages or microglial cell into the brain

33

AIDS/Dementia Complex: Cognitive Deficits

Memory loss, speech problems

34

ADC: Motor Deficits

Loss of bladder tone is early indication
Paraparesis
Lower-extremity spasticity
Ataxia
Extensor-plantar responses in the absence of spinal cord abnormalities

35

ADC: Behavioral Sx

Early presentation with inability to conduct ADLs

36

ADC: Mood Sx

Severe changes in usual mood, with wide variation from psychosis, or mania, or depression

37

ADC: Differential Dx

Syphilis
B12 and folate
Thyroid
Electrolytes
BUN/Cr

38

Non-pharm interventions in post-TBI dementia

Safety Plan
Follow-up for one year after any suicide attempts
PT for the vestibular dysfunction
OT for traumatic vision syndrome, characterized by scanning and accommodation difficulties

39

Rules for treating depression in persons with dementia (or the elderly in general)

Start low and go slow
TCAs work well in the elderly, but a lot of anticholinergic activity

40

Fluoxetine in the elderly

Don't use it

41

SIADH

Syndrome of inappropriate antidiuretic hormone:
Possible side effect of SSRIs in the elderly

42

EPS with SSRIs

Rare, but can occur

43

First-line drug therapy

Donepezil (Aricept) 5mg orally daily (max 10mg/day)

44

Features of Delirium

Rapid onset
Altered state of consciousness
Presence of a general medical condition
Presence or withdrawal of a substance
Generally reversible
Acute medical emergency