18. Major Neurocogn disorder, TNC / PreviouslyDementia

Question 1

Définition de TNC domains 6

Answer 1

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

Question 2

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

Answer 2

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

Question 3

Alzheimer’s caractéristiques

Answer 3

Gradual onset, normal CNS,

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

Question 4

Démence vasculaire caractéristiques

Answer 4

Abrupt, stepwise

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

Question 5

Lewy Body caractéristiques

Answer 5

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

Question 6

Fronto-temporal caractéristiques

Answer 6

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

2. language impairment

Question 7

Memory loss physical exam

Answer 7

Gait

Neurological signs

Extra pyramidal symptoms

Parkinson (cogwheel rigidity, tremors)

Question 8

Extrapyramidal sx

Answer 8

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)

Question 9

Rx to eliminate lros de qqn avec démence

Answer 9

narcotics
anticholinergics
benzodiazepines

Question 10

Common anti-cholinergic Rx (7)

Answer 10

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