18. Major Neurocogn disorder, TNC / PreviouslyDementia Flashcards
Définition de TNC domains 6
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
DDX perte de mémoire (6 +2) - TNC majeur
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
Alzheimer’s caractéristiques
Gradual onset, normal CNS,
initial and most prominent deficit = amnestic (associated with impairment in learning and recall of recently learned information)
Démence vasculaire caractéristiques
Abrupt, stepwise
Cardiovascular risks (HTN, DLP), dysexecutive syndrome, focal neurological features
Lewy Body caractéristiques
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
Fronto-temporal caractéristiques
1.Behavioural problems (disinhibition, loss of social awareness)
- language impairment
Memory loss physical exam
Gait
Neurological signs
Extra pyramidal symptoms
Parkinson (cogwheel rigidity, tremors)
Extrapyramidal sx
Extrapyramidal refers to the localization of the motor dysfunction in the spinal tracts.
- Parkinsonian-like symptoms (stiffness, tremor, shuffling gait),
- acute dystonia (abrupt spasms of head and neck)
- akathesia (physical restlessness)
Rx to eliminate lros de qqn avec démence
narcotics
anticholinergics
benzodiazepines
Common anti-cholinergic Rx (7)
- Antihistamines:
Diphenhydramine (Benadryl):
Chlorpheniramine - Antidepressants: TCAs
Amitriptyline: Used for depression and sometimes chronic pain.
Doxepin: Used for depression, anxiety, and sleep problems. - Antipsychotics: Older antipsychotic
Olanzapine and clozapine - Bladder Medications
Oxybutynin: Used to relieve urinary incontinence.
Tolterodine (Detrol): Used to manage symptoms of overactive bladder. - Motion Sickness Medications:
Scopolamine: Often used as a patch to prevent motion sickness. - Parkinson’s Disease Medications:
Benztropine and trihexyphenidyl: Used to reduce tremors and rigidity in Parkinson’s patients. - GI rx for IBS
Hyoscyamine
Dicyclomine