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ADPY 7500 > 8. Neurocognitive disorders > Flashcards

8. Neurocognitive disorders Flashcards

1
Q

ICU Triad

A

Delirium
Pain
Agitation

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2
Q

Timing of delirium symptoms

A

Fluctuate throughout the day

Worse at night

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3
Q

Medications that induce delirium

A 
TCAs
Anticholinergics
Benzodiazepines
Nonbenzo hypnotics "Z-drugs"
Corticosteroids
H2 blockers
Meperidine
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4
Q

Most common causes of delirium in kids

A

Fever

Meds

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5
Q

Manifestation of delirium on EEG?

A

Diffuse background slowing

*Exception: delirium tremens (fast activity)

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6
Q

Likely diagnosis: Delirium + hemiparesis or other focal neuro signs

A

cerebrovascular accident or mass lesion

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7
Q

Delirium + elevated BP + papilledema

A

Hypertensive encephalopathy

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8
Q

Delirium + Dilated pupils + tachycardia

A

Drug intoxication

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9
Q

Delirium + fever + nuchal rigidity + photophobia

A

Meningitis

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10
Q

Delirium + Tachycardia + tremor + thyromegaly

A

Thyrotoxicosis

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11
Q

Typical symptoms of delirium

A 
Short attention span
Disorientation
Fluctuations in level of consciousness
visual hallucinations
Impairment in recent memory
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12
Q

Most common type of delirium?

A

Mixed: psychomotor activity remains stable at baseline or fluctuates rapidly between hyperactivity and hypoactivity

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13
Q

Type of delirium most likely to go undetected?

A

Hypoactive: decreased motor activity, drowsiness to lethargy to stupor. More common in elderly.

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14
Q

ICU psychosis type of delirium

A

Hyperactive: agitation, mood lability, uncooperative.

More common in drug withdrawal or toxicity

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15
Q

Tool for evaluation of a patient with suspected delirium. High sensitivity and specificity

A

Confusion Assessment Method (CAM)

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16
Q

Once delirium has been diagnosed, the cause should be sought by obtaining what tests/procedures?

A

Finger-stick blood glucose
Pulse-oximetry
Arterial blood gases
ECG

Labs: BMP
CBC with diff
Urinalysis
Urine culture

Urine drug screen
Blood alcohol level
Therapeutic drug levels (Ex. Lithium, digoxin, antiepileptics)
Hepatic panel
Thyroid hormone levels
CXR depending on presentation

Head imaging: CT or MRI
EEG
LP
*If focal neurological defecits present or cause of delirium cannot be identified with initial workup

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17
Q

Preferred agent for treatment of agitation

A

Haloperidol (D2 antagonist)

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18
Q

Avoid using benzos to treat delirium unless it is due to?

A

Alcohol or benzo withdrawl

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19
Q

Causes of neurocognitive disorders that present like dementia but progression may be halted/reversed with treatment

A

Vit B12 def.
Thyroid dysfunction
Normal pressure hydrocephalus

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20
Q

Likely diagnosis for: cognitive impairment with stepwise increase in severity + focal neurological signs

A

Vascular disease

*Get head CT or brain MRI

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21
Q

Cognitive impairment + cogwheel rigidity + resting tremor

A

Lewy body disease
Parkinson’s disease

*Clinical dx

22
Q

Cognitive impairment + gait apraxia + urinary incontinence + dilated cerebral ventricles

A

Normal pressure hydrocephalus

*Get head CT or brain MRI

23
Q

Cognitive impairment + fatigue + cold intolerance + coarse hair + constipation

A

Hypothyroidism

*Get TSH, free T4

24
Q

Cognitive impairment + parasthesias + diminished position and vibration sensation + megaloblasts on CBC

A

Vitamin B12 deficiency

*Get serum B12

25
Q

Cognitive impairment + tremor + Fleischer rings + abnormal LFTs

A

Wilson’s Disease

*Get ceruloplasmin level

26
Q

Cognitive impairment + diminished position and vibration sensation + Argyll Robertson Pupils (accomodation response present, response to light absent)

A

Neurosyphillis

Get CSF FTA-ABS and VDRL

27
Q

How may hYPERthyroidism present in the elderly?

A

“Apathetic thyrotoxicosis”

Depression and lethargy

28
Q

5 categories of the MMSE

Total points?

A 
Orientation
Registration
Attention
Recall
Language

30 points

29
Q

Most common etiology of major neurocognitive disorder?

A

Alzheimer’s disease

30
Q

Primary cognitive domains affected in Alzheimers?

A

Memory
Learning
Language

31
Q

Found in brain of Alzheimer’s disease?

A

Senile plaques and neurofibrillary tangles

32
Q

Only way to definitively diagnose Alzheimer’s disease

A

Postmortem path exam

33
Q

Accumulation of what (where?) is associated with progressive brain atrophy in Alzheimer’s disease?

A

Extraneuronal Beta-amyloid plaques

Intraneuronal tau protein tangles

34
Q

What protein mutations cause autosomal dominant Alzheimer’s diseae? This makes up 1 % of AD

A

Single gene mutations in either:
Amyloid precursor protein
Presenilin 1
Presenilin 2

35
Q

Risk factor for early onset Alzheimer’s disease?

A

Having the Epsilon-4 variant of the apolipoprotein gene

36
Q

Fraction of patients diagnosed with AD that are women?

A

2/3

37
Q

Class of drugs that is associated with increased mortality in patients with dementia

A

Antipsychotics

38
Q

2nd most common cause of major NCD?

A

Vascular dementia

39
Q

Cognitive domains typically affected in vascular dementia small vessel disease?

A

*These are lacunar infarcts

Complex attention and executive functions

40
Q

Antipsychotics that can be used for psychotic symptoms in Lewy Body Dementia

A

Quetiapine or Clozapine

41
Q

Treatment of REM sleep disorder in Lewy body dementia

A

Melatonin or clonazepam

42
Q

Core features of Lewy body dementia

A

Waxing and waning cognition
Visual hallucinations
Extrapyramidal signs (Parkinonism)

43
Q

Suggestive features of lewy body dementia

A

REM sleep behavior disorder: violent movements during sleep

Pronounced antipsychotic sensitivity

44
Q

Clinical manifestation of frontotemporal dementia

A

defecits in attention, abstraction, planning, problem solving
Behavioral variant: disinhibited verbal, pysical, or sexual behavior, lack of emotional warmth, overeating, apathy, perseveration, decline in social cognition

Language variant: Difficulties with speech and comprehension

45
Q

Treatment of frontotemporal dementia?

A

Serotonergic meds may help reduce disinhibition, anxiety, impulsivity, etc.

46
Q

Most common infectious agent known to cause cognitive impairment

A

HIV

*HAART improves cognition in some patients

47
Q

Inheritance of Huntington Disease

A

Autosomal dominant

48
Q

Primary cognitive domain affected in Huntington Disease

A

Executive function

49
Q

Patient’s often aware of deteriorating mentation

A

Hungtington Disease

50
Q

Symptom tx of Huntington Disease

A

Tetrabenazine

or atypical antipsychotics

51
Q

Rapidly progressive cognitive decline + myoclonus

A

Creutzfeldt Jakob Disease

52
Q

3 W’s of Normal pressure hydrocephalus

A

Wet=urinary incontinence
Wobbly= gait disturbance
Wacky=cognitive impairment

ADPY 7500 (17 decks)

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