Flashcards in Dementia Deck (81):
___ is a more profound deficit that includes: disorientation, bewilderment, and difficulty following commands
___consists of severe drowsiness in which the patient can be aroused by moderate stimuli and then drift back to sleep.
---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
____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
is a state of unarousable unresponsiveness.
dolls eye response what is it and sign of?
Fixed on a single point in space when head is moved side to side - coma
______ responses to painful stimuli are consistent with coma, and some patients have no response at all
flexion and extension responses
a ____ pts eyes will roll with the head as the ___ and __ CN are no longer innervated
localizing responses to pain after you pinch
is not consistent with a coma
_____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
catatonic states and abulia are syndromes that prevent a patient from responding correctly due to
limited impairment of the brain
in ___ pts should have spared vertical gaze and can follow commands
locked in syndrome
___ pts will have occasional spontaneous and purposeful movements
___ pts often have limb position postures that are not typical of a coma
3 H of delirium
hyper or hypoactive
highest rate of delirium is found in ___
ICU patients - up to 70%
what are 3 theories behind delirium pathophys?
role of acetylcholine
cortical findings and
cortical findings for delerium
may be due to change in brain waves on EEG
subcortical findings for delerium
due to acetylcholine pathway changes
Common causes of delerium
Drugs and toxins
Systemic organ failure
what is best test for delirium evaluation?
CAM - Confusion Assessment Method
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?
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)
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
delirium exam findings should be
non focal - no one sided weakness etc..
twitching of extended arms - sign of liver failure and possible delirium cause
If I have a delirious pt what do I have to rule out?
Focal neurological syndrome
Praimery psychiatric illness (think og pts age)
No convulsive status epilepticus sx
bilateral facial twitching, unexplained nystagmoid eye mvmts during obtunded periods
prolonged post ictal state
automatisms - lip smacking, chewing or swallowing mvmts etc
hyperactive delirium is ___
hard to treat and manage yet most common form of delirium
how to prevent delirium
busy vests, orientation protocols ..hi my name is rose it is Monday etc..
visual and hearing aids etc
delirium leads to ___ long term
long term functional/ cognitive decline
higher risk for institutionalization
MOCA test score below ___ = dementia
14 or below
Labs to order for dementia pts
- lumbar puncture
- HIV/ autoimmune testing/ T. pallidum/ RPR
what image preferred for dementia?
- shows old infarcts
___ is on the early AD spectrum?
mild cognitive impairment
not all cases progress to AD
how to treat dementia?
Powerpoint - no successful interventions
___ 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
AD risk factors
rare dominant disorders with amyloid problems
trauma, lifestyle, T2DM, HTN
early onset AD due to ___
alterations in amyloid beta protein production, aggregation or clearances
late onset AD linked to...
carriers of one e4 allele = 2-3 times risk
two e4 genes =8-12 times risk
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
3 tests to measure AD progression
Clinical Dementia Rating Scale
___ is second most common form of dementia after AD
dementia with lewy bodies
Dementia with lewy bodies sx
also rem sleeping disorders - will act out their dreams
DWLB has ___ and ___ show up together instead of at different points in disease progression
dementia + parkinsons
DLB treatment includes
neuroleptics + AD treatment
Acetylcholinesterase inhibitors: taurine, donepezil etc
Memantine: NMDA receptor antagonist
Parkinsons has death of __ _and aggregation of ___
death of substantia nigra cells
aggregations of alpha synuclein
4 cardinal features of parkinsons are ..
impaired visuospatial function
less prominent memory deficits
relatively preserved language function
how to treat parkinsons dementia
no specific treatment found yet
frontotemporal dementia is
secondary to degeneration of frontal lobe of brain and may include temporal lobe
see changes in behavior/personality and memory
frontal lobe sx of frontotemporal dementias
euphoria, apathy, disinhibition, compulsive disorders
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
will see __ reflexes with frontotemporal dementias
___ is most common subtype of frontotemporal dementia
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
nonfluent primary progressive aphasia
semantic primary progressive aphasia
impaired comprehension/ naming
___ is most common form of human prion disease
Creutzfeldt-Jakob disease - form of rapidly progressing dementia
- sporadic, variant, familial, iatrogenic
mean age onset of Creutzfeldt Jakob disease
sporadic, variant, familial, iatrogenic
see: neuronal loss, lots glial cells, no inflammatory response
*presence vacuoles within neuropil = spongiform appearance
CJD 2 main sx
rapid decline in congitiion
Mycolnus startle: jump and every muscle twitches
MRI findings of CJD
T2 hyperintensities in the putamen and head of caudate
none - dx of exculsion
orders for rapidly progressing dementia
brain MRI - flair and DWI with and without gadolinium enhancement
Liver and thyroid function tests
UA, and culture
Most RP dementia pts will also get a
vascular dementia aka
Normal pressure hydrocephalus is most common in
adutls over 60 years - equal across genders
large ventricular size with normal LP pressures, due to impaired CSF reabsorption
3 W of NPH
wet, wacky, wobbly
temporal course of NPH
gait difficulty, incontinence then cognitive changes
progresses over a year or so
LP to aid diagnosis
Can improvemee sytmpoms
what score is used to determine if fit for shunt?
chronic post conscussion syndrome
when symptoms persist more than 1 year after injury
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?
for concussion Glasgow coma scale emergency services anything less than
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
____ is long term neurologic consequence of repetitive mild TBI
dementia pugilistica aka chronic traumatic encephalopathy
__ is potential risk factor for CTE
CTE histology reveals
neuritic threatds and neurofibrillary tangles in various locations