Neurocognitive disorders Flashcards by Lindsey Dutton

How are AMS classified

change in consciousness and cognition
*important to make sure to know what their baseline is

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What are the two major pathways of AMS

diffuse dysfunction compromise and focal lesions

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What are red flags for AMS

sudden onset
elderly
headache
drug use
trauma
fever
AMS - symptom not diagnosis

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What needs to be assessed for a patient presenting with AMS

great history
great physical exam - naked, accurate temp, GLUCOSE

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what is AVPU

Assessment of mental status
Alter, or responsive to Verbal stimuli
Unresponsive, or responsive only to Painful stimuli

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what are the baseline labs used for AMS

IMMEDIATE BGL
CBC
CMP - sodium/uremia(kidney), Liver
Lactate
UA
Urine drug screen
Urine pregnancy
ABG or VBG
TSH
LP
PT/PTT

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What is delirum

acute change in attention/awareness and cognitive status with disturbance of sleep-wake cycle

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Dementia

chonic state of AMS with slow, progressive onset

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psychosis

patient will have delusions, hallucinations, disorganized thinking, abnormal behavior or negative symptoms

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What are the common causes of delirium

Drugs
ETOH/Drug withdrawal
metabolic disorder
TBI
encephalitis

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What is the reticular activating system

source of consciousness (wakefulness, sleep/wake and attention)
consists of the nuclei within the brain as well as fibers that send the sensory input to the cerebral cortex

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What is the pathophysiology of hyperactive delirium

hyperactive autonomic system
decreased ach and melatonin
excess dopamine, norepi, glutamate
will affect specific areas of the brain leading to the expressed symptoms

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what happens when there is increased excitability with change in neurotransmitters?

inflammation. decreased BBB function, change in CBF and CNS metabolic derangements

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what is hyperactive delirium with

associated with withdrawal, infection, sepsis, electrolyte, abnormalities, metabolic abnormalities

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what is hyperactive delirium presentation

tremor
hallucinations
difficulty concentrating
insomnia
irritability
restlessness
dilated pupils
tachycardia
fever
sweating

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what is Agitated Delirium

aka excited delirium syndrome
increased dopamine activity - cocaine, thyroid storm, methamphetamines
AMS, combative, aggressive, high temp, poor awareness, superhuman strength, indefatigable
Can lead to death

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what is hypoactive delirium

often associated with right-sided frontal-basal ganglion disruption
associated with CNS depressants, metabolic disorders
will have decreased levels of alterness, decreased attention span, forgetful and apathy
intact perception and interpretation of surroundings

What is the active form of Thyamine

TTP

what is Wernicke-korsakoff syndrome

lack of sufficient thiamine - complication of long term ETOH abuse
hallmarked by paralysis of eye movement, ataxic gait, changes in consciousness
acute syndrome

What is Korsakoff’s syndrome:

hallmarked by memory loss, confusion, confabulation - lesions in mammillary body
Chronic result

what is the pathophysiology of Wernicke encephalopathy

decreased thiamine
increased vascular congestion
increased macrophage activation
petechial hemorrhages
demyelination
neuronal damage is most common in the thalamus
atrophy of mamillary bodies

What is Wernickes encephalopathy triad

encephalopathy
oculomotor dysfunction
gait ataxia (often first symptom)

what is dementia

acquired decline in cognition. may affect many facets including memory, learning, executive functioning, social cognition, motor skills

What is the pathophysiology of dementia

genetic predisposition with environmental triggers

what does dementia lead to

neuron degeneration compression/deformation of brain parenchyma head trauma vascular abnormalities infectious etiologies inflammatory issues will ultimately lead to nerve degeneration and brain atrophy

What is broca's aphasia

expressive - cannot find words. comprehension is intact - unable to repeat or write supplied by MCA

What is wernickes aphasia

receptive aphasia. will have meaningless, inappropriate expression. cannot recognize errors. comprehension impaired, cannot repeat, cannot read or write affects left posteriosuperior temporal lobe fed by inferior division of MCA

What is alzheimers disease

most common cause of severe dementia affects elderly plaques and tangles are most common in cerebral cortex and hippocampus - frontal and temporal lobe atrophy

what are risk factors for alzheimers

family history DM female HTN TBI sedentary lifestyle

What is vascular dementia

associated with decreased vascular flow in the brain may be associated with ischemia or hemorrhagic infarcts similar in presentation to Alzheimers

what is the presentation of vascular dementia

memory more intact (initially) associated with other CVA symptoms (focal weakness, ambulatory disfunction) anxiety and apathy presents with cognitive slowing

What is frontotemporal dementia

aka picks disease onset <60 yo 3 varients: behavioral, progressive nonfluent aphasia (bracas aphasia), semantic dementia associated with degenerative changes in the frontal lobe mutation in the tau protein

what is the presentation of frontotemporal dementia

loss of language difficulty with understanding speech prior to memory deficitis emotional disturbances with apathy, emotional blunting, inappropriate conduct and loss of judgement and depression

What is Lewy Body dementia

similar presentation to vascular dementia or alzheimers brain atrophy - frontal, temporal and parietal lobes

how do you diagnose lewy body dementia

histology post mortum

what is the presentation of Lewy Body depenta

initial loss of concerntation/attention memory and cognition will follow increased risk of delirium may have visual hallucinations, sleep disorder may have motor deficits similar to Parkinsons

What is Creutzfeldt-Jakob disease

"mad cow disease" considered a rapidly progressive degenerative dementia prion related disease pts typically die wtihin a year

what are priors

infectious misfolded protein particles - they replace normal prion proteins thought to typically play a role in memory and sleep

what are the types of Creutzfeldt-jakob disease

Sporadic CJD variant CJD genetic CJD latrogenic CJD

what is the presentation of CJD

mental status change is variable may have frontal/executive dysfunction memory impairment depression, anxiety and decreased cognitive function