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Medical Conditions 3 > cognition > Flashcards

cognition Flashcards

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USMLE® Step 1 flashcards
1
Q

What is cognition

A
  • the process of acquiring knowledge and understanding from thought, experience and exploring the senses
  • attention/awareness
  • orientation
  • concentration
  • memory
  • reasoning
  • judgment
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2
Q

What are the components of cognition

A

executive functioning

  • planning
  • manipulating
  • recognizing errors/problems
  • abstract thoughts
  • initiating and ceasing an activity

perception:

  • neglect
  • agnosias
  • apraxia
  • right-left discrimination
  • visual spatial
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3
Q

What is dementia

and what areas are typically impaired

A
  • it is a global term for a collection of symptoms that can be caused by alterations in the way the brain functions

three of the following areas will be impaired:

  1. language
  2. memory
  3. visuospatial skills
  4. emotion
  5. executive functioning skills
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4
Q

cortical dementia

A
  • dementia where the brain damage primarily effects the cortex
  • tends to cause problems with memory, language, thinking, and social behavior
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5
Q

subcortical dementia

A
  • dementia that affects parts of the brain below the cortex
  • tends to cause changes in emotions and movement in addition to problems with memory
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6
Q

progressive dementia

A
  • dementia that gets worse over time
  • gradually interfering with more and more cognitive abilities
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7
Q

primary dementia vs secondary dementia

A
  • dementia such as AD that does not result from another disease

VS

  • dementia that occurs as a result of a phsyical disease of injury
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8
Q

MCI

mild cognitive impairments

A
  • a syndrome in which cognition decline is > than expected for an individual’s age and education level
  • often noticebale to family and friends
  • 3-19% of those 65 years and older have this diagnosis
  • possible precursor to alzhemiers disease/dementia
  • may not further progress
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9
Q

MCI and gait

A
  • slowing of gait and speed during dual tasking conditions assoicate with poor performance
  • attention
  • execuative function
  • working memory
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10
Q

Alzheimer’s disease

incidence

A
  • most common form of dementia in elderly
  • affects more women than men (first degres relative or head traume)
  • typical onset is 40-90 years of age
  • greatest age group after 65 and risk increases every 5 years after
  • memory and cognitive problems have a slow insidious onset
  • eventually leads to a decline in ability to complete ADLs
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11
Q

Alzheimer’s disease

definition and cause

A
  • progressive, degenerative irreversible disease that affects the hippocampus, neocortex, and transcortical pathways of the brain
  • plaques (beta amyloid) and neurofibrillary tangles (tau protein) progressively impede synpatic connections and cause neuronal death
  • typically begins in hippocampus
  • exact etiology is not known
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12
Q

Alzheimer’s disease

medical diagnosis

A
  • cannot confirm a diagnosis until death
  • diagnostic techniques have improved
  • medical and pscyhological evaluations are critial
  • additional dementia’s need to be ruled out
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13
Q

Alzheimer’s disease

guidelines for diagnosis

A
  • biomarkers for beta-amyloid on PET scans and CSF
  • tau protein in CSF
  • glucose metabolism in brain on PET
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14
Q

Alzheimer’s disease

three identified stages

A
  • dementia due to Alzheimer’s disease - biomarkers changes with noticeable change in funciton
  • mild cognition impairment due to Alzheimer’s disease - biomarkers change but insignificant changes with function
  • preclinical Alzheimer’s disease - biomarkers only change
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15
Q

Alzheimer’s disease

Clinical features

A
  • progressive memory loss
  • decline in cognitive function specifically executive
  • changes in mood/personality (more common with frontotemporal dementia)
  • aphasia
  • agnosia
  • apraxia
  • visual changes
  • motor function may be preserved in early stages
  • gait changes
  • communication deficits
  • diffculty with ADLs
  • primitive reflexes return like grasping
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16
Q

Alzheimer’s disease

behaviors assoicated

A
  • wandering aimless or night time (sundown syndrome)
  • pacing: purposeful wandering)
  • repetitive vocalizations
  • agitation
  • hoarding
  • rummaging
  • resistance usually with personal care
  • sexually inappropriate
17
Q

Alzheimer’s disease

additional symptoms: sundowning

A
  • later afternoon and evening
  • disorientation/hallucinations may heighten
  • possible causes: possibly related to fatigue, lighting, dehyrdation, poor routine/structure
18
Q

Alzheimer’s disease and gait

A
  • increased TUG scores
  • decreased gait speed in 10 meter walk test
  • decreased times in tandem stance with eyes open and with eyes closed compared to those wihtout AD
  • dual tasking typically results in gait disturbances
19
Q

treatment for AD

A
  • primary goal of medications is to slow the disease process
  • it does not prevent
  • types of medication:
  1. cholinesterase inhibitors (prevents breakdown of ACh which aides in learnign and memory) may delay for 6-12 months
  2. NMDA receptor: regulates activity of glutamate involved in learning and memory - side effects: nausea, confusion, dizziness and headaches
20
Q

Lewy Body dementia

A
  • a progressive degenerative form of dementia that is named after the round lumps found in the nuceli of the cerebral cortex and brainstem
  • difficulty to get a dx on this early on
  • the cerebral cortex degenerates
  • limbic cortex degenerates
  • build up of protein within the cells - alpha-synuclein
  • neurons die in midbrain similar to parkinsons
  • affects production of neurotransmitter, dopamine and brain protein alpha-synuclein
21
Q

Dx criteria for LBD

A

3 must be present

  • progressive cogntive decline that interferes with normal, social and occupational activities
  • memory problems
  • difficulties with attention, logical thinking, perceptions of space and time

2 of the following exist

  • fluctuating cognition
  • visual hallucinations
  • parkinsonism

Other

  • repeated falls, fainting, delusions, BP issues, sensitivity to certain drugs (antipsychotics)
22
Q

how to differentiate with LBD and parkinsons

A
  • cognitive issue is the primary symptoms with LBD vs motor symptoms in parksons
  • hallucinations occur in early stages, frequently and are vivid
  • timing of motor vs cognitive symptoms
  • tremor is less pronouced in LBD vs parkinsons
  • patients with LBD respond less dramatically to Levadopa than those with parkinsons
23
Q

Motor preformance of those with LBD, AD, and PDD

A
  • research has shown that those with LBD walked with decreased stride lengths
  • did no preform as well on tinetti, berg, and dual task activites as those wtih PD and/or AD
  • additional sutdies of the 9-hole PEG test - those with LBD has the lowest scores compared to those with PD and AD
24
Q

Vascular dementia

A
  • dementia that is directly related to cerebrovascular disease
  • previously referred to as a multi-infarct dementia
25
Q

diagnosis

vascular dementia (VD)

A
  • CT and MRI brain scans
  • guidelines vary per criteria used
  • per NINDS-AIREN criteria
  • dementia, CVA
  • relationship between dementia and CVA
  • onset of dementia within 3 months of CVA
  • abrupt deterioration in cognition functions or fluctuating
26
Q

Clinical features of VD

A
  • gait disturbances
  • frequency falls
  • urinary frequnecy, urgency, incontinence
  • focal neurological signs
  • personality/mood changes
  • frequently present with delayed processing, persveration, motor and sensory disturbances
  • impulsivness, neglect and or aphasia
27
Q

VD - ADDTC criteria

A

ischemia VD will include

  • dementia
  • 2 or more ischemic strokes or one stroke with clearly documented temporal relationship to the onset of dementia
  • CT or MRI reveals infact of the cerebellum
  • multiple infarcts or TIA’s may be assoicated with Ischemic vascular disease
  • History of HTN, CAD, DM
28
Q

Normal pressure hydrocephalus

A
  • typically occurs in elderly
  • a malfunction in brain ventricles that leads to poorly controlled lower extremity movement and bladder control

Diagnosis: CT scan

Presentation:
- acute cogntive chagnes (memory)
- unsteady shuffling gait
- urinary incontinence

Treatment: shunt placement

rehab implications: falls, change in ADLs

29
Q

Delirium (acute)

A
  • acute disorder of dementia
  • toxic psychosis, metabolic encephalopathy, peudodementia
  • an abrupt onset of
  • alterations in attention that fluctuate within the day
  • disorganized thinking, rambling speech r incorherent that may change within the day/hour
  • disturbed psychomotor activity
  • changes in level of consciousness
  • cause: illness, stress, age related changes medications
30
Q

Complications of delirium

A
  • falls
  • malnutrition
  • dehydration
31
Q

rehab implications fo delirium

A
  • mobilize as soon as able
  • minimize use of restraints
  • ADL training
32
Q

depresison/anxiety

A
  • 25-50% suffer from depression 70% goes undetected
  • altered mood with loss of interest in all pleasureable activities
  • Dx; decreased appetite, insomina, agitation, loss of interest, fatigue, feelings of worthlessness, guilt, decreased concentration, recurrent deaths of suicide/death
  • giriatric depression scale = short survey 15-30 questions a score of 5 or higher may = depression
33
Q

Wernicke-korsakoff syndrome

A
  • vitamin B thiamine deficiency
  • typically assoicated with chronic alcoholism
  • two differnet condtions occuring simultaneously (wernicke’s disease and koraskoff psychosis)
  • affects STM more than LTM
34
Q

Wernicke-korsakoff syndrome: presentation and treatment

A

presentation

  • gradual
  • apathy/passivity/confabulation
  • gait is ataxic, decreased cadence

treatment:

  • thiamine replacement
  • cessation of ETHO
  • memory loss may recover if early stages
35
Q

rehab focus for those with cognitive disorders

A
  • maintain physical and emotional health
  • find activities that are meaningful/self-worth
  • fall prevention - home safety
  • caregiver support and training
  • always maintain dignity and be mindful of the patients wishes

Medical Conditions 3 (14 decks)

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