Dementia Flashcards Preview

Clin Med: Neurology > Dementia > Flashcards

Flashcards in Dementia Deck (81):
1

___ is a more profound deficit that includes: disorientation, bewilderment, and difficulty following commands

confusion

2

___consists of severe drowsiness in which the patient can be aroused by moderate stimuli and then drift back to sleep.

lethargy

3

---is a state similar to lethargy in which the patient has a lessened interest in the environment, slowed responses to stimulation, and tends to sleep more than normal with drowsiness in between sleep states

OBTUNDATION

4

____means that only vigorous and repeated stimuli will arouse the individual, and when left undisturbed, the patient will immediately lapse back to the unresponsive state

stupor

5

Coma is___

is a state of unarousable unresponsiveness.

6

dolls eye response what is it and sign of?

Fixed on a single point in space when head is moved side to side - coma

7

______ responses to painful stimuli are consistent with coma, and some patients have no response at all

flexion and extension responses

8

a ____ pts eyes will roll with the head as the ___ and __ CN are no longer innervated

dead
CN3
CN6

9

localizing responses to pain after you pinch

is not consistent with a coma

10

_____is a form of paralysis from injury to the anterior brainstem with sparing of the RAS, leaving the patient awake and aware but with limited ability to communicate.

locked in syndrome

11

catatonic states and abulia are syndromes that prevent a patient from responding correctly due to

limited impairment of the brain

12

in ___ pts should have spared vertical gaze and can follow commands

locked in syndrome

13

___ pts will have occasional spontaneous and purposeful movements

abulic patients

14

___ pts often have limb position postures that are not typical of a coma

catatonic patients

15

3 H of delirium

hallucincation
hyper or hypoactive

16

highest rate of delirium is found in ___

ICU patients - up to 70%

17

what are 3 theories behind delirium pathophys?

role of acetylcholine
cortical findings and
subcortical findings

18

cortical findings for delerium

may be due to change in brain waves on EEG

19

subcortical findings for delerium

due to acetylcholine pathway changes

20

Common causes of delerium

Drugs and toxins
Infections
Metabolic derangements
Brain disorders
Systemic organ failure
Physical disorders

21

what is best test for delirium evaluation?

CAM - Confusion Assessment Method

22

Main categories of findings/questions of CAM

1. Acute onset and fluctuating course of confusion?
2. Inattention - does the pt have difficulty focusing
3. Disorganized thinking?
4. Alterted level of consciousness?

23

Delirium requires what on CAM for diagnosis?

features 1 and 2 (acute onset and inattention)

plus 3 or four (disorganized thinking or altered level of consciousness)

24

Most common delirium causes

1. fluid electrolyte problems: dehydration, hypo/hypernatremia
2. infections: UTI, URI, skin and soft tissue
3. Metabolic: hypoglycemia, hypercalcemia, uremia, liver failure, thyrotoxicosis
4. withdrawal from alcohol, barbiturates, benzodiazepines, SSRI
5. shock - HF

MAIN POINT: REVIEW MEDS LIST AND LABS

25

delirium exam findings should be

non focal - no one sided weakness etc..

26

asterixis

twitching of extended arms - sign of liver failure and possible delirium cause

27

If I have a delirious pt what do I have to rule out?

Focal neurological syndrome
NCSE
Dementia
Praimery psychiatric illness (think og pts age)

28

No convulsive status epilepticus sx

bilateral facial twitching, unexplained nystagmoid eye mvmts during obtunded periods
prolonged post ictal state
acute aphasia
automatisms - lip smacking, chewing or swallowing mvmts etc

29

hyperactive delirium is ___

hard to treat and manage yet most common form of delirium

30

how to prevent delirium

busy vests, orientation protocols ..hi my name is rose it is Monday etc..
visual and hearing aids etc

31

delirium leads to ___ long term

prolonged hospitalizations
long term functional/ cognitive decline
higher mortality
higher risk for institutionalization

32

MOCA test score below ___ = dementia

14 or below

33

Labs to order for dementia pts

B12
thyroid function
blood count
metabolic panel
additional tests:
- lumbar puncture
- HIV/ autoimmune testing/ T. pallidum/ RPR

34

what image preferred for dementia?

MRI
- shows old infarcts
atrophy
ventricular size
better resolution

35

___ is on the early AD spectrum?

mild cognitive impairment
not all cases progress to AD

36

how to treat dementia?

Powerpoint - no successful interventions

37

___ help predict progression of MCI to AD

Signs of medial temporal lobe atrophy
Hypometabolic pattern consistent with AD on FDG PET
Positive amyloid scan
Carreirs of APOE4 gene

38

AD risk factors

family history
rare dominant disorders with amyloid problems
trauma, lifestyle, T2DM, HTN

39

early onset AD due to ___

dominant inheritance
alterations in amyloid beta protein production, aggregation or clearances
highly penetrant

40

late onset AD linked to...

APOE genes:
carriers of one e4 allele = 2-3 times risk
two e4 genes =8-12 times risk

41

what would AD MRI show?

generalized and focal atrophy
reduced hippocampal volume
atrophic medial temporal lobe

areas of low metabolism/ hypoperfuciton
- hippocampus, precuneus, lateral parietal and posterior temporal cortex

42

3 tests to measure AD progression

MMSE
MoCA
Clinical Dementia Rating Scale

43

___ is second most common form of dementia after AD

dementia with lewy bodies

44

Dementia with lewy bodies sx

dementia plus

fluctuating cognition
visual hallucinations
parkinsonism
also rem sleeping disorders - will act out their dreams

45

DWLB has ___ and ___ show up together instead of at different points in disease progression

dementia + parkinsons

46

DLB treatment includes

neuroleptics + AD treatment

47

AD treatment

treat insomnia/agitation/depression

Acetylcholinesterase inhibitors: taurine, donepezil etc
Memantine: NMDA receptor antagonist

48

Parkinsons has death of __ _and aggregation of ___

death of substantia nigra cells
aggregations of alpha synuclein

49

4 cardinal features of parkinsons are ..

executive dysfunction
impaired visuospatial function
less prominent memory deficits
relatively preserved language function

50

how to treat parkinsons dementia

symptomatic
no specific treatment found yet

51

frontotemporal dementia is

secondary to degeneration of frontal lobe of brain and may include temporal lobe

see changes in behavior/personality and memory

52

frontal lobe sx of frontotemporal dementias

euphoria, apathy, disinhibition, compulsive disorders

53

frontotemporal dementias include what 2 kinds of aphasia

nonfluent - insidious onset of language deficits over time
semantic - loss of word memory and meaning both verbal and nonverbal

54

will see __ reflexes with frontotemporal dementias

primitive reflexes
palmomental
palmar grasp
rooting reflex

55

___ is most common subtype of frontotemporal dementia

behavioral variant

56

primary progressive aphasia

insidious onset and gradual progression of a language impairment (ie, aphasia) manifested by deficits in word finding, word usage, word comprehension, or sentence construction

57

nonfluent primary progressive aphasia

articulation problems

58

semantic primary progressive aphasia

impaired comprehension/ naming

59

___ is most common form of human prion disease

Creutzfeldt-Jakob disease - form of rapidly progressing dementia

4 subtypes
- sporadic, variant, familial, iatrogenic

60

mean age onset of Creutzfeldt Jakob disease

sporadic, variant, familial, iatrogenic

61

spongiform encephalopathy

CJD
see: neuronal loss, lots glial cells, no inflammatory response
*presence vacuoles within neuropil = spongiform appearance

62

CJD 2 main sx

rapid decline in congitiion
Mycolnus startle: jump and every muscle twitches

63

MRI findings of CJD

T2 hyperintensities in the putamen and head of caudate

cortical ribbon

64

CJD treatment

none - dx of exculsion

65

orders for rapidly progressing dementia

brain MRI - flair and DWI with and without gadolinium enhancement
Serum electrolytes
Liver and thyroid function tests
B12, homocysteine
UA, and culture

66

Most RP dementia pts will also get a

LP
EEG

67

vascular dementia aka

multi-infarct dementia

68

Normal pressure hydrocephalus is most common in

adutls over 60 years - equal across genders

69

NPH definition

large ventricular size with normal LP pressures, due to impaired CSF reabsorption

70

3 W of NPH

wet, wacky, wobbly

71

temporal course of NPH

gait difficulty, incontinence then cognitive changes

progresses over a year or so

72

NPH treatment

LP to aid diagnosis
Ventriculoperitoneal shunt
Can improvemee sytmpoms

73

what score is used to determine if fit for shunt?

Tinetti score

74

chronic post conscussion syndrome

when symptoms persist more than 1 year after injury

75

in field workup at time of injury

ABC: airway, breathing, circulation
seizure? - pretty common at time of trauma - watch overnight
Evidence of cervical spine disease - whiplash?
EMS!!

76

for concussion Glasgow coma scale emergency services anything less than

15

77

when to use image with concussion?

if see focal sx such as tingling or weakness - otherwise don't order

do a f/u within 24 hours for full neuro exam

78

____ is long term neurologic consequence of repetitive mild TBI

dementia pugilistica aka chronic traumatic encephalopathy

79

__ is potential risk factor for CTE

APOE *E4

80

CTE histology reveals

neuritic threatds and neurofibrillary tangles in various locations

81

CTE gross pathological findings

diffuse brain atrophy
ventricular dilatation
cavum septum pellucidum with fenestrations
scarring
depigmentation of substantia nigra