18. Major Neurocogn disorder, TNC / PreviouslyDementia Flashcards

1
Q

Définition de TNC domains 6

A

1) Evidence of significant cognitive decline in one or more cognitive domains (6)

Learning/memory

Language

Executive function

Complex attention

Perceptual-motor

Social cognition

2) impairs function:
AVQ - ADLs (dressing, eating/self-feeding, ambulating/transferring, toileting, hygiene/grooming, bath/shower)

AVQ - IADLs (shopping, housework, accounting/finances, food prep, telephone, transportation, taking meds)

3) Not better explained by other disorder

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2
Q

DDX perte de mémoire (6 +2) - TNC majeur

A

Alzheimer (most common 50%)

Mixed Alzheimer and vascular (20%)

Vascular (15%)

Lewy Body (5%)

Frontotemporal (1%)

Parkinson disease with dementia

Progressive supranuclear palsy (vertical supranuclear gaze palsy and postural instability)

Huntington disease

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3
Q

Alzheimer’s caractéristiques

A

Gradual onset, normal CNS,

initial and most prominent deficit = amnestic (associated with impairment in learning and recall of recently learned information)

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4
Q

Démence vasculaire caractéristiques

A

Abrupt, stepwise

Cardiovascular risks (HTN, DLP), dysexecutive syndrome, focal neurological features

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5
Q

Lewy Body caractéristiques

A

Core features: Fluctuating cognition, detailed visual hallucinations, REM sleep behaviour disorder, Parkinsonism (bradykinesia, rest tremor, rigidity)

Other suggestive: Severe neuroleptic sensitivity (irreversible parkinsonism, impaired consciousness), postural instability, falls, syncope, autonomic dysfunction, hypersomnia, hyposmia, delusions, apathy, anxiety, depression

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6
Q

Fronto-temporal caractéristiques

A

1.Behavioural problems (disinhibition, loss of social awareness)

  1. language impairment
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7
Q

Memory loss physical exam

A

Gait

Neurological signs

Extra pyramidal symptoms

Parkinson (cogwheel rigidity, tremors)

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8
Q

Extrapyramidal sx

A

Extrapyramidal refers to the localization of the motor dysfunction in the spinal tracts.

  1. Parkinsonian-like symptoms (stiffness, tremor, shuffling gait),
  2. acute dystonia (abrupt spasms of head and neck)
  3. akathesia (physical restlessness)
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9
Q

Rx to eliminate lros de qqn avec démence

A

narcotics
anticholinergics
benzodiazepines

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10
Q

Common anti-cholinergic Rx (7)

A
  1. Antihistamines:
    Diphenhydramine (Benadryl):
    Chlorpheniramine
  2. Antidepressants: TCAs
    Amitriptyline: Used for depression and sometimes chronic pain.
    Doxepin: Used for depression, anxiety, and sleep problems.
  3. Antipsychotics: Older antipsychotic
    Olanzapine and clozapine
  4. Bladder Medications
    Oxybutynin: Used to relieve urinary incontinence.
    Tolterodine (Detrol): Used to manage symptoms of overactive bladder.
  5. Motion Sickness Medications:
    Scopolamine: Often used as a patch to prevent motion sickness.
  6. Parkinson’s Disease Medications:
    Benztropine and trihexyphenidyl: Used to reduce tremors and rigidity in Parkinson’s patients.
  7. GI rx for IBS
    Hyoscyamine
    Dicyclomine
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