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Clin Med: Neurology > Dementia > Flashcards

Dementia Flashcards

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1
Q

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

A

confusion

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2
Q

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

A

lethargy

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3
Q

—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

A

OBTUNDATION

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4
Q

____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

A

stupor

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5
Q

Coma is___

A

is a state of unarousable unresponsiveness.

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6
Q

dolls eye response what is it and sign of?

A

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

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7
Q

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

A

flexion and extension responses

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8
Q

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

A

dead
CN3
CN6

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9
Q

localizing responses to pain after you pinch

A

is not consistent with a coma

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10
Q

_____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.

A

locked in syndrome

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11
Q

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

A

limited impairment of the brain

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12
Q

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

A

locked in syndrome

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13
Q

___ pts will have occasional spontaneous and purposeful movements

A

abulic patients

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14
Q

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

A

catatonic patients

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15
Q

3 H of delirium

A

hallucincation

hyper or hypoactive

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16
Q

highest rate of delirium is found in ___

A

ICU patients - up to 70%

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17
Q

what are 3 theories behind delirium pathophys?

A

role of acetylcholine
cortical findings and
subcortical findings

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18
Q

cortical findings for delerium

A

may be due to change in brain waves on EEG

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19
Q

subcortical findings for delerium

A

due to acetylcholine pathway changes

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20
Q

Common causes of delerium

A 
Drugs and toxins 
Infections 
Metabolic derangements  
Brain disorders 
Systemic organ failure 
Physical disorders
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21
Q

what is best test for delirium evaluation?

A

CAM - Confusion Assessment Method

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22
Q

Main categories of findings/questions of CAM

A
  1. Acute onset and fluctuating course of confusion?
  2. Inattention - does the pt have difficulty focusing
  3. Disorganized thinking?
  4. Alterted level of consciousness?
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23
Q

Delirium requires what on CAM for diagnosis?

A

features 1 and 2 (acute onset and inattention)

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

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24
Q

Most common delirium causes

A
  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

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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 ```

Clin Med: Neurology (5 decks)

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