Lecture 23 - Neurocognitive Disease (Dementia) Flashcards Preview

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Flashcards in Lecture 23 - Neurocognitive Disease (Dementia) Deck (13):
1

Criteria for major NCD

Substantial impairment in Cognition
Independence Loss

2

what are some IADLs

(shopping, finances, cooking, transportation, telephone use, housekeeping

3

what are some cognitive domains -

Learning and memory, language, attention, executiive function, social cognition,

4

Criteria for Minor NCD

1) Modest Cognitive Decline
2) Intact IADLs but there is increased difficulty

5

most Common cause of NCD
how does it present
Criteria for this dx

Alz -- 2/3s
Insidious and gradual
Memory decline

-- known AD FMHx
--OR Memory decline + Progressive + no other attributable cauase

6

Imaging for Alz

How does it compare to imaging for Normal pressure hydrocephalus

Ventricular enlargement with sulcal widening
Global brain atrophy

NPH -- Ventricular enlargemnut but no sulcal widening

7

Common Presenstaion for NCD

what other symptoms are usually present?

CC -- forgetfulness, losing things, repeating in converstiaon, getting lost, loss of interest in usual activityies, decline in hygiene, paranoia, depression


- 88% of AD patients have measurable emotional and behavioral changes (non-cognitive)

8

Assessment for suspected NCD


which of the questionaires is more sensitive

History ; need a Collateral Informant
Questionnaires -- MMSE, MoCA (more sensitive)

labs -- Standard (minimum) -- CBC, Serum Electrolytes, Calcium, Glucose, Bun/CR, LFTs
B12 -- treatable cause of dementia
Thyroid
Syphilis -- impt for baltimore (RPR)

9

Differences in presentation and imaging of NCD due to vascular disease

5-10% of all demented patients
Sudden onset --
Stepwise deteriorate with subsequent vascular events
Accompanied by focal neurological signs -- DTRs, babinski, gait abnormalities
Imaging with evidence of previous strokes
Evidence of stroke risk factors and systemic vascular disease

10

Advanced Neurosyphilis --- what is the positive lab? what is the imaging look like?

white matter hyper intensities on MRI
Positive RPR

11

Normal Pressure hydrocephalus

- classic triad of symptoms
Imaging
Treatment

Triad of Shuffling Gait, Urinary Incontinence and Cognitive Impairment

CT -- Ventricular Enlargement without Sulcal Widening

Tx- Shunt

12

B12 Deficiency --
- imaging?
- labs?
treatment?

Demyelination of the CNS and the PNS
MRI -- severe diffuse periventricular white matter demyelination
Starts in the brain stem


Don’t have to have macrocytic anemia to have NCD


Treatable -- can give PO, IM B12

13

what are some contraindicated medications for NCD patients?

anti-cholinergics

Oxybutin (ditropan) -- used for urinary incontinence
Benzotropine
Benadryl
Paxil --
Amitripyline (