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Neurogcognitive D/O Flashcards

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1
Q

DSM divisions for Neurocognitive disorders

A

delirium
mild NCD
major NCD

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2
Q

What are the six cognitive domains?

A

1) attention
2) executive function
3) learning and memory
4) language
5) motor skills
6) social

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3
Q

How serious is delirium?

A

up to 40% of individuals with delirium die within one year of diagnosis

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4
Q

How common is delirium?

A

up to 50% of medically admitted patients in hospital develop delirium

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5
Q

What is the “ICU triad”?

A
  • pain
  • delirium
  • agitation
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6
Q

Where is delirium most common?

A
  • ICU

- postoperative settings

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7
Q

What sex is most at risk of delirium?

A

males

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8
Q

What can cause delirium?

A

almost any drug/ withdraw or any illness

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9
Q

Key clinical manifestations of delirium

A
  • fluctuating orientation
  • sudden onset
  • poor attention
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10
Q

Some common drugs indicated in delirium? (7)

A
  • TCAS
  • BDZ
  • H2 blockers
  • anticholinergics
  • Z drugs
  • corticosteroids
  • meperidine
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11
Q

EEG findings in delirium

A

slowing on EEG

*except in delirium tremens

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12
Q

Three types of delirium + which is MC?

A

hypoactive
hyperactive
mixed (MC)

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13
Q

Describe hypoactive vs hyperactive delirium

A
  • hypo: stupor, drowsiness (may go unrecognized)

- hyper: agitation, mood lability, etc

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14
Q

What type of delirium is common in drug withdraw?

A

hyperactive

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15
Q

Ultimate outcome of delirium?

A

some deficits may persist for months or even indefinitely

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16
Q

Useful tool for dx of delirium?

A

CAM (confusion assessment method)

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17
Q

Labs needed in delirium workup?

A
  • urine (drug, culture)
  • BMP
  • CBC
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18
Q

When should you get brain imaging in delirium?

A
  • no clear cause or no improvement when clear causes are treated
  • head trauma
  • focal deficits
  • patient unable to cooperative with exam
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19
Q

DOC for delirium agitation

A

Haldol

**Note: BDZ worsen delirium unless alcohol withdraw is the cause

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20
Q

Contrast major and minor NCDs

A
  • minor= patients have deficit but are able to maintain independence
  • major= patient requires assistance with most iADLs and ADLs causing total dependence
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21
Q

Screening test for dementia

A

MMSE

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22
Q

Clues to vascular disease NCD

A

stepwise decline

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23
Q

Clues to Lewy Body disease

A

cogwheel rigidity, tremor

hallucinations

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24
Q

Clues to NPH

A

wet wacky wobbly

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25
Clues to hypothyroid based NCD
- fatigue - cold - coarse hair - constipation
26
Clues to B12 deficiency based NCD
- paresthesias - vibration sense - megaloblastic anemia
27
Clues to Wilsons disease based NCD
tremor Kayser Fleischer rings LFTs
28
Neurosyphillis NCD clues
-Arhyll Robertson Pupils | Accomodation Response Present... but not response to light
29
What does the mini cog consist of?
- 3 item recall | - clock drawing
30
In addition to Mini cog and MMSE what screenings for NCDs exist?
- MOCA (montreal cognitive assessment) - BOMC (blessed orientation memory concentration) - FAB (frontal assessment battery)
31
What are the max number of points on MMSE and what score raises concern?
30, 25 or less
32
#1 cause NCD
alzheimers
33
When does death occur in AD?
10 years after dx
34
When are senile plaques and NF tangles found?
- AD - Downs Syndrome - normal aging!! (less burden)
35
Only definitive dx of AD?
post mortem exam of brain
36
Genes assc with CAUSING AD
-presenilin 1 or 2 -APP only 1% is genetic and early (before 65)
37
Gene that increases risk of AD
apoliporotein E4
38
What sex is most at risk of AD?
2/3 are WOMEN!!
39
How effective are AchEi in treating AD?
-slows progression by 6-12 months in 50% of people
40
Risk assc with antipsychotics in AD?
-increases MORTALITY!
41
All treatment plans for AD must include ____
caregiver support
42
How common is vascular NCD?
-20%
43
What domains are most common effected in vascular disease?
- complex attention | - executive function
44
What are lewey bodies made of?
a-synuclein, primarily in basal ganglia
45
Sleep disorder assc with LBD ?
REM sleep behavior disorder
46
Possible vs Probable LBD
- possible 1 core feature | - probable 2 core features
47
What drugs should be used to manage psychotic symptoms of LBD?
- clozapine | - quetiapine
48
What should be used to manage REM sleep disorder in LBD?
- melatonin | - clonazepam
49
How commonly is FTD familial?
-40%, 10% AD inheritance
50
What cognitive domains are spared in FTD?
-learning/memory and motor function | most common deficits are in language and behavior
51
What makes FTD probable?
atrophy on imaging
52
How is disinhibition treated in FTD?
-SSRIs, trazadone
53
MC infectious cause of NCD?
HIV
54
Primary cognitive domain effected in HD?
executive function
55
Treatment for HD
tetrabenazine | atypical antipsychotics
56
Treatment for psychotic symptoms in PD?
- quetiapine | - clozapine
57
How are cognitive symptoms treated in PD?
AchEi
58
How commonly is CJD familial?
15% of cases are AD familial
59
Biggest clue to CJD?
rapid deterioration myoclonus (+/- nystagmus, ataxia... cerebellar dysfunction)
60
CSF is positive for _____ in CJD?
14-3-3 proteins
61
Where are lesions in CJD
caudate and putamen (basal ganglia)

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