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Karinja Neurology > Dementia & Delerium > Flashcards

Dementia & Delerium Flashcards

1
Q

Irreversible Etiologies of Dementia

A 
Alzheimer's Disease
Lewy Body Disease
Normal Pressure Hydrocephalus
Multi-Infarct (aka Vascular Dementia)
Frontotemporal Dementia (aka Pick's Disease)
Creutzfeldt-Jakob Disease (CJD)
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2
Q

Reversible Etiologies of Dementia

A 
B12 Deficiency
Neurosyphilis
Hypothyroidism
Chronic subdural hematomas
Wernicke-Korsakoff Syndrome
Pseudodementia
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3
Q

Work-Up for Reversible Dementia

A 
Hct
MCV
B12 level
Thyroid panel
VDRL in CSF
CT/MRI
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4
Q

Diagnosis of Dementia

A

MMSE

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5
Q

Components of the MMSE

A 
Orientation
Memory
Attention
Language
Visuospatial
Calculation
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6
Q

Frontal release signs

A 
Glabellar
Snout
Palmomental
Suck
Root
Grasp
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7
Q

Symptoms of Vitamin B12 Deficiency

A

Dementia
Megaloblastic anemia
Dorsal column deficits

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8
Q

Dorsal column deficits cause loss of

A

Light touch
Proprioception
Vibration

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9
Q

Diagnosis of Vitamin B12 Deficiency

A

Low:
Hematocrit
Retics
B12

High:
MCV
Homocysteine
Methylmalonic Acid

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10
Q

Diagnosis of Neurosyphilis

A

Positive RPR
then
Positive VRDL in CSF

Treat with high-dose penicillin

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11
Q

Symptoms of Hypothyroidism

A 
Weight gain
Fatigue
Constipation
Hoarseness
Memory changes
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12
Q

Diagnosis of Hypothyroidism

A

High TSH
Low Free T4

Treat with levothyroxine

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13
Q

Symptoms of Chronic Subdural Hematomas

A 
Headache
Loss of consciousness (with insidious onset)
Cognitive & memory deficits
Balance problems
Aphasia
Motor deficits

Treat with evacuation

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14
Q

Symptoms of Wernicke-Korsakoff Syndrome

A

Wernicke:
Ataxia
Ophthalmoplegia
Confusion

Korsakoff:
Confabulation
Amnesia

Treat with Thiamine

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15
Q

Symptoms of Pseudodementia

A

Major Depressive Episode
Trigger
Good insight about memory loss

Treat with SSRI

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16
Q

Risk Factors for Alzheimer’s Disease

A 
>60 yo
F sex
FHx
Head trauma
Down's syndrome
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17
Q

Pathophys of Alzheimer’s Disease

A 
Neurofibrillary tangles (tau)
Senile plaques (apo-E, β-amyloid deposits)

Leads to loss of cholinergic neurons

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18
Q

Early signs and symptoms for Alzheimer’s Disease

A 
Gradual impairment across several cognitive domains
Anterograde progressive memory loss (short>long term)
Visuospatial deficits (lost in the neighborhood)
Language difficulties (word-finding)
Cognitive impairment w/ progressive decline
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19
Q

Late signs and symptoms for Alzheimer’s Disease

A

Neuropsych signs & symptoms (hallucinations, wandering)
Personality changes (apathy or agitation)
Apraxia (difficulty with motor tasks, eg combing)
Lack of insight
Non-cognitive neuro deficits (pyramidal, extrapyramidal motor, myoclonus, seizures)
Urinary incontinence

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20
Q

Terminal signs and symptoms for Alzheimer’s Disease

A

Mutism
Incontinence
Bedridden

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21
Q

End-stage signs and symptoms for Alzheimer’s Disease

A 
Eating problems
Febrile
Dyspnea
Pneumonia
Pain
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22
Q

Alzheimer’s Prognosis

A

Death 5 - 10y after onset of symptoms

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23
Q

Diagnosis of Alzheimer’s

A

MMSE, neuropsych testing & clinical picture

≥2 areas of cognitive deficits
Progressive changes
No change in consciousness
Onset ≥60 years old
No other systemic or neurological symptoms
Diffuse atrophy on MRI (most prominent in parietal and temporal loves, especially hippocampi) with the exclusion of other processes on imaging

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24
Q

Treatment of Alzheimer’s

A

Donezepil (Aricept) - For moderate disease
Acetylcholinesterase inhibitor
5mg PO qd

Memantine (Namenda) - For severe disease
NMDA-R antagonist

25
Q

Donezepil Side Effects

A 
Nausea
Vomiting
Diarrhea
Insomnia
Muscle cramps
26
Q

Memantine Side Effects

A

Dizziness
Headaches
Constipation
Confusion

27
Q

Pathophys of Lewy Body Disease

A

Accumulation of Lewy Bodies (eosinophilic intracellular inclusions) made of α-Synuclein in:

Substantia Nigra
Locus Ceruleus
Dorsal Raphe
Substantia Innominata

28
Q

Signs & Symptoms of Lewy Body Disease

A 
Gradually progressive dementia (Appears first, before parkinsonism)
Impaired learning
Impaired attention
Impaired visuospatial > memory
Fluctuating cognition
Visual hallucinations
Parkinsonism

+/- REM sleep disorder, vivid dreams, falls, autonomic dysfunction, depression

29
Q

Diagnosis of Lewy Body Disease

A

Clinical pictures

+/- SPECT or PET showing low dopamine transporter uptake in basal ganglia

30
Q

Treatment of Lewy Body Disease

A

Rivastigmine (Exelon)

+/- Atypical antipsychotics for hallucinations

31
Q

Pathophys of Normal Pressure Hydrocephalus

A 
Transient increase in ICP
Decreased CSF absorption at the arachnoid villi (communicating hydrocephalus)
Ventricle dilation
Return to normal pressure
Periventricular brain matter distortion
32
Q

Normal Pressure Hydrocephalus - Triad of Symptoms/Signs

A 
Abnormal Gait (slow, broad-based, shuffling) - Presents first
Dementia (gradual memory loss w/o cognitive deficits)
Urinary incontinence
33
Q

Diagnosis of Normal Pressure Hydrocephalus

A

Hydrocephalus & enlarged sulci on MRI
Normal opening pressure on LP
Radionucleotide CSF studies

34
Q

Treatment of Normal Pressure Hydrocephalus

A

Serial large volume LPs

If this helps, consider a VP shunt

35
Q

Risk factors for Vascular Dementia

A

Stroke risk factors

36
Q

Pathophys of Vascular Dementia

A

Large vs. Small vessel cerebral ischemia

37
Q

Signs & Symptoms of Vascular Dementia

A 
Stepwise deterioration (2/2 accumulation of multiple strokes) w/ focal neuro deficits
Executive function deficits > Memory
38
Q

Diagnosis of Vascular Dementia

A

Multiple hypodense regions on MRI (cerebral infarcts)

39
Q

Epi of Frontotemporal Dementia

A

40 - 60 years old

40
Q

Early Signs & Symptoms of Frontotemporal Dementia

A

Behavioral/Personality Changes (apathy to social disinhibition)
Fixation
Emotional Lability

41
Q

Late Signs & Symptoms of Frontotemporal Dementia

A

Dementia

42
Q

Diagnosis of Frontotemporal Dementia

A

Marked frontotemporal atrophy on MRI/CT

43
Q

Treatment of Frontotemporal Dementia

A

Trazadone
SSRIs
Sinemet (for symptomatic relief)

44
Q

Pathophysiology of CJD

A

Transmissable Spongiform Encephalopathy (TSE)

Caused by a prion

45
Q

Signs & Symptoms of CJD

A 
Rapidly progressive dementia
Myoclonus and/or seizures
Akinetic mutism
Cerebellar or visual changes
Pyramidal/Extrapyramidal dysfunction (eg hypokinesia)
46
Q

Prognosis of CJD

A

Death within 1 year of symptomatic onset

47
Q

Diagnosis of CJD

A

EEG shows sharp, triphasic synchronous discharges
Positive 14-3-3 CSF assay
Brain biopsy shows spongiform changes
PRNP gene mutation

48
Q

Delirium

A

Waxing and waning alterations in consciousness

49
Q

Risk factors for Delirium

A 
Dementia
Parkinson's
Prior stroke
Age
Sensory impairment
50
Q

Etiologies of Delirium

A 
Drugs
Infections
Electrolyte disturbances
Metabolic derangements
Systemic illness
CNS
51
Q

Drugs causing delerium

A 
Narcotics
Sedatives
Anti-histamines
Muscle relaxers
Polypharmacy
52
Q

Infections causing delerium

A

PNA
UTI
Meningitis

53
Q

Electrolyte disturbances causing delerium

A

Hyponatremia

Hypercalcemia

54
Q

Metabolic derangements causing delerium

A

Vitamin depletion
B12 deficiency
Hyperglycemia

55
Q

Systemic illneses causing delerium

A

CHF
Liver Failure
Malignancy

56
Q

CNS illnesses causing delerium

A

Seizure
Stroke
Head injury
Subdural hematoma

57
Q

Clinical presentation of delerium

A 
Acute confusion
Decreased/fluctuating consciousness
Inability to sustain attention
\+/- anxiety
\+/- agitation
\+/- hallucinatinos
58
Q

Delerium workup

A 
Focused H&P
Med review
CBC
BMP
UA
CT (to r/o stroke or ICH)
59
Q

Delerium treatment

A

Treat underlying cause
If agitated, low-dose haloperidol
DO NOT USE BENZOS

Karinja Neurology (4 decks)

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