dementia, delirium, depression Flashcards
(117 cards)
1
Q
what are the functions of glia cells
A
support neurons by providing insulation, supplying nutrients, and removing pathogens
2
Q
what isthe function of epindymal cells
A
create membrane around the brain and spinal cord
3
Q
what are the functions of astrocytes
A
connect the blood vessels and supply nutrients
4
Q
what is the function of microglial cells
A
destroy pathogens and remove cellular debris
5
Q
what are the functions of oligodendrocytes
A
create myelin sheaths that insulate the axon of the neuron
6
Q
what does damage to microglia cells result in
A
chronic pain
7
Q
what are implications of decreased numbers of neurons and increase in size and number of neuroglial cells
A
increased risk for neuro probs including CVA
8
Q
what are implications of change with decline in nerves and nerve fibers
A
- parkinsonism
- slower conduction of fibers across the synapses
9
Q
what are the implications of atrophy to the brain and increase in cerebral dead space
A
- modest decline in short term memory
- alteration in gait pattern
10
Q
what are implications of change with thickened leptomeninges in the spinal cord
A
- increased risk of hemorrhage before symptoms present
11
Q
what does damage to oligodendrocytes result in
A
multiple sclerosis
12
Q
what does damage to neurons result in
A
- ALS
- Alzheimers
- parkinsons
13
Q
what are the results of the normal aging process regarding neurons
A
-neurons decrease in number
-glial cells decrease in size and number
-damage in DNA
-malfunctioning DNA damage response
-decline in nerves and nerve fibers
14
Q
what is cerebral atrophy
A
loss in neurons and the connections between them
15
Q
what is the difference between generalized and focal atrophy
A
- gen - brain shrinks
- focal - affecting only a limited area of the brain
16
Q
what occurs to leptomeninges in the normal aging process
A
they thicken
17
Q
what is a possible result of thickening leptomeninges of the spinal cord
A
compression of nerves
18
Q
what are symptoms of cerebral atrophy
A
- dementia
- seizures
- aphasias
19
Q
what are aspects of normal aging in regards to cognitive function
A
- difficult recalling names or locations
- subtle deficits in memory
20
Q
T/F in normal aging, 3 word recall remains intact
A
TRUE
21
Q
T/F dementia is different in each person
A
True
22
Q
what are the two innermost layers of tissue (meninges) that cover the brain and spinal cord
A
- pia mater (inner layer)
- arachnoid mater (outer layer)
- CSF flows between these
23
Q
how do you obtain hx from a patient w a cog impairement
A
- hx should be obtained from pt and verified from a reliable source
24
Q
t/f you cannot rely on results of a cognitive assessment if the patient as altered levels of consciousness or delirium
A
True
25
what are labs that you should obtain in a patient w cognitive impairment
* Vit B12 and TSH
* Lumbar puncture
26
what diagnostic imaging can be ordered for a patient with cog impairment
* noncontrast CT/MRI to r/o causes of dementia
27
what are possible differential dx for cog dysfunction
-alzheimers
-dementia with lewy body
-depression
-substance abuse
28
what are indications of mild cognitive impairment
* Intermediate -intermediate stage between normal cognition and dementia
* difficulty remembering names, appointments, and solving complex issues
29
what are the test results of mild cognitive impairment
abnormal memory but NO functional impairment
30
what is the management of mild cognitive impairment
* look for reversible causes
* regular exercise
* cognitive training
31
what are some reversible causes of mild cognitive impairment
* medication side effects
* sleep disturbances
* depression
* vitamin B12 deficiency
* hypothyroidism
32
what is dementia
the general term used to describe various conditions in which there are deficits in multiple areas of cognitive function resulting in impairment in daily functioning
33
at what age does the prevelance of dementia start doubling every 5 years
60 years
34
35
what are the types of dementia
* alzheimers
* vascular dementia
* dementia with lewy bodies
* frontotemporal dementia
36
what is alzheimers disease
neurodegenerative disorder of uncertain etiology and pathogenesis resulting in cognitive and behavioral impairment
37
where does the damage of alzheimers appear
hippocampus and entorhinal cortex
38
what occurs to the size of the brain in alzheimers brain
it shirn ks:)
39
what are the 2 types of cerebral cortex lesions associated with alzheimers
* amyloid plaques
* neurofibrillary tangles
40
what are amyloid precursor protein
protein found on the membrane of various cells throughout the body and concentrated in the synapse of the neuron
41
what is beta amyloid protein
sticky fragment of the APP that is released when various enzymes are present
42
what is beta amyloid plaque
lesion consisting of beta amyloid proteins that occurs between neurons and thought to affect neuronal communication
43
what is the result of amyloid plaque formation
inhibition of dendrites from communicating w eachother
44
what are the jobs of the microtubules in the axon
transport nutrients, organelles, and other messages from the cell to the tip of the axon
45
what are tau proteins
glue that holds the microtubules in place, allowing them to function appropriately
46
what are neurofibrillary tangles
tau proteins breakdown and adhere to each other instead of adhering to the microtubules, resulting in inadequate transport from the cell body to the end of the axon , preventing neurons from communicating.
47
what are risk factors for alzheimers
* age
* female
* hx of head trauma
* diabetes
* family history
* vascular disease
48
what are clinical presentations of alzheimers disease
* difficulty learning and recalling information
* visuospatial problems
* language impairment
49
what is the order of disorientation of alzheimers
1. time
2. place
3. person
50
t/f alzheimers patients often have insight into their symptoms
False
51
what are behavior changes in alzheimer
* early: depression, apathy, irritability
* later: agitation and psychotic symptoms
52
presentation of mild alzheimers
* recalling new names
* word recall
* losing items
* recognizing familiar faces
53
what is the presentation of moderate alzheimers
* disoriented to place and time
* behavioral changes
* psychotic symptoms
* difficulty recognizing family and friends
* easily lost
54
what is the presentation of severe alzheimers
* completely dependent on others for care
* death
55
how is alzheimers diagnosed
clinical diagnosis with with evidence of cognitive dysfunction leading to functional impairment after ruling out other causes of dementia
56
t/f imaging of alzheimers is not diagnostic
True
57
what is the 1st line therapy for alzheimers disease
acetylcholinesterase inhibitors
58
MOA of acetylcholinesterase inhibitors
increases acetylcholine at the neuronal synapses in the brain
59
what is the effect of acetylcholinesterase inhibitors
slows progression of alzheimers
60
what are the acetylcholinesterase inhibitors
* donepezil
* Rivastigmine
* galantamine
61
SE of acetylcholinesterase inhibitors
* nausea
* anorexia
* sleep disturbances
* diarrhea
62
what is the most serious SE of acetylcholinesterase inhibitors
bradycardia
63
what is the counseling point for acetylcholinesterase inhibitors
take with food
64
what is the MOA of NMDA receptor antagonists
reduces to destruction of cholinergic neurons and may inhibit B-amyloid production, thereby preserving memory
65
what are the NMDA antagonists
memantine
66
what are SE of memantine
* dizziness
* HA
* Confusion
* Constipation
67
what is the combo drug for donepezil and memantine
namzaric
68
nonpharmacologic interventions for alzheimers
* physical activity
* mentally stimulating activities
* social activities
69
what should you do when the patient is unable to express their needs?
discontinue AchEI and NMDA
70
how do you test for executive functions in vascular dementia
one minute semantic test
71
Behavioral management of alzheimers disease
* SSRIs
* Trazodone
72
what does advanced alzheimers lead to
* poor nutritional intake
* urinary incontinence
* skin breakdown
* infections
73
what are the s/s of spontaneous parkinsonism
* bradykinesia
* shuffled gait
* tremors
* very visual dreams
74
first symptoms that helps differ dementia with lewy bodies from alzheimers
delusional misidentification
75
what is the criteria for diagnosing dementia w lewy bodies
Probable
-two or more core clinical features of DLB with or without biomarkers
-only one clinical feature with biomarkers
Possible
-one clinical feature with no biomarkers
-one or more biomarker with no clinical features
76
what would you see on an MRI w lewy bodies
-hippocampus atrophy
-atrophy of the basal ganglia structures and the dorsal midbrain
77
what is the definitive diagnostic study of dementia w lewy bodies
lewy bodies present on autopsy
78
t/f frontotemporal dementia has a strong family history component
True
79
what is frontotemporal dementia
clinical syndrome that results from degeneration of the frontal and temporal lobes of the brain
80
what is the clinical presentation of frontotemproal dementia
-behavioral variant
-semantic primary progressive aphasia variant
-primary progressive aphasia
81
what is "behavioral variant" in frontotemporal dementia
* changes in personality
* apathy
* compulsivity
* loss of empathy
82
how to diagnose behavioral frontotemporal dementia
medial and orbital frontal degeneration on MRI
83
how to diagnose primary frontotemporal dementia
lateral frontal lobe and precentral gyrus atrophy
84
how do you manage frontotemporal dementia
* regular exercise
* speech therapy
* behavioral therapy
85
what is the primary progressive aphasia variant of frontotemporal dementia
* inability to produce words
* affects brocas area
86
what is the diagnostic finding for semantic frontotemporal dementia
anterior temporal degeneration on MRI
87
what is the semantic primary progressive aphasia variant of frontotemporal dementia
the loss of ability to recall words or objects
88
what is normal pressure hydrocephalus
accumulation of CSF that causes enlargement of the ventricles in the brain and compression of surrounding structures
89
what is the pathophysiology of normal pressure hydrocephalus
CSF builds up in the brain
90
what is hte clinical presentation of nromal pressure hydrocephalus
* abnormal gait
* urinary incontinence
* dementia
91
after intervention for normal pressure hydrocephalus, _________ often improves but ______ do not
gait; dementia and incontinence
92
what is the diagnostic finding of normal pressure hydrocephalus
* MRI shows ventriculomegaly (HALLMARK)
* high volume lumbar puncture
93
where is the most common area to shunt CSF to in normal pressure hydrocephalus?
abdomen
94
how do you manage normal pressure hydrocephalus
ventricular shunting
95
clinical presentation of delirium
-acute onset
-attention deficits
-cognitive impairment
96
what is vascular dementia
gradual or acute onset of cognitive dysfunction with clinical or radiographic evidence of cerebrovascular disease
97
what is the pathophysiology of vascular dementia
pathophysiologic, small, micro-ischemic changes in the brain
98
clinical presentation of vascular dementia
-memory impairment less severe than AD
-difficulty of times activities and executive functions
-behavioral symptoms
-depression
99
what does imaging show in vascular dementia
MRI showing small infarcts and white matter lesions
100
how do you manage vascular dementia
same as alzheimers
101
what things are important to identify and treat in vascular dementia
* HTN
* smoking
* DM
* statins
* antiplatelets
102
what is dementia with lewy bodies
dementia identified by the presence of lewy bodies on histopathology of the brain tissue
103
what is the etiology of dementia w lewy bodies
deposits of alpha-synuclein in the cell body
104
what is the average onset for dementia w lewy bodies
75
105
t/f dementia with lewy bodies has a strong family history component
false! its sporadic
106
what is the hallmark sign of dementia w lewy bodies
spontaneous parkinsonism
## Footnote
bradykinesia, BIL limb rigidity, flat affect, gait changes, postural instability
107
what is the clinical presentation of dementia w lewy bodies
* insidious onset
* memory is less affected
* visuospatial abilities, problem solving, and processing speed are more severe
* parkinson like symptoms
* visual hallucinations
* delusional misidentification
108
t/f there is more atrophy of the medial temporal lobe in dementia with lewy bodies than alzheimers
False
In lewy bodies you will see greater atrophy in the basal ganglia structures and the dorsal midbrain as well as more pronounced cortical atrophy.
109
what would a SPECT of dementia with lewy bodies show
reduction in dopamine uptake and perfusion
110
what is the clinical course of dementia with lewy bodies
* decrease in MMSE by 4-5 years per year
* mean survival is 10 years
111
how do you manage dementia w lewy bodies
cholinesterase inhibtors
## Footnote
memantine +/-
antipsychotics if psychosis is severe
SSRI for depression
melatonin for REM disorder
Sinemet for parkinsonsim
fludrocortisone for orthostatic hypotension
112
what are risk factors for higher mortality in dementia with lewy bodies
* older age
* hallucinations
* greater degrees of fluctuation
* neuroleptic sensitivity
113
what is the MCC of early onset dementia
frontotemporal dementia
114
what is delerium
disorder characterized by an acute change in attention and cognition
115
what is the greatest predisposing risk for delirium
preexisting cognitive impairment
116
what is the management of delirium
* identification and treatment of the underlying medical cause
* eradication of contributing factors
* management of delirium
117
goal for management of delirium symptoms
an awake and manageable patient, not a sedated patient
