Cognitive Complaints and Impairment Flashcards
cognitive impairment can be
primary manifestation of disorder (altzheimer’s disease)
secondary manifestation and source of excess disability (delirium, medications, brain injury, HIV)
major DA tracts
nigostriatal (extra pyramidal motor)
mesolimic
mesocortical (cognition, emotion, substance abuse, psychosis)
DA agonists
movement
depression
DA antags
psychosis
where is NE synthesized
locus coreulus
where does LC project to
cortex
limbic
RAS
spinal cord
adrenergic agents
depression
MAO-I
tricyclics
venlafaxine
adrenergic antagonists are for
tremor
anxiety
beta blockers
setonergic agents used for
dpression
migraine
5HT synthesized in
raphe nucleus
5HT project to
cortex limbic system striatum cerebellum blood vessels
Ach synthesized in
basal forbrain (nucleus of basalis of Meynert)
Ach projets to
olfactory bulb hippocampus amygdala cortical association areas ==>ANS, NMJ
anticholinergic agents
movement disorder
cholinesterase inhibitors
Alteimers
organophosphates
nerve gases
GABA A binding sites for
benzos
barbiturates
GABA B
baclofen
three attentional networks
alerting
orientating
executive
alerting brain
thalamic
R frontal and partietal activation
Orienting brain
superior colliculus
frontal eye fields
temporoparietal
parietal activation
executive brain
anterior cingluate
DLPFC
episodic memory
minutes to years
explicit
declarative
ex) short story, what you had for dinner last name, what you did on your last bday
–medial temporal lobes, anterior thalamic nucleus mammillary body, fornix, PFC
semantic memory
minutes to years explicit declaritive ex) knwing who the first president was inferolateral temporal lobe
procedural memory
minutes to years explicit/implicit nondeclaritive ex) driving a car basal ganglia cerebellum, supplementary motor area
working memory
seconds to minutes
explicit
declarative
ex) phonological- phone number in your head before dialing-PFC, Broca’s areas, wernicke
ex) spatial- mentally following a route or rotating an object in your mind-PFC, visual-association areas
3 NT of arousal
cholinergic
catecholaminergic
glutamatergic
executive functions
volition/initiative
planning
purposeful action
performance
dorsolateral PFC
executive function
working memory
lateral orbitofrontal
social intellifence
medial/ventral frontal lobe
apathy, amotivation
anterior cingulate
akinetic mutism
abulia
FDA approved medication in cognition treatment
none with altz and ADD being major expections
prominence of altz
11% in individuals >65
32-50% in individuals >85
Donepezil/Aricept lass
acetylcholinesterase inhibitor
adverse rxns donepezil
nausea/vomiting
sinus brady
1st degree AV block
donepezil used for
altz
donepezil avaiable as
single daily dose
Memantine not recommended
alone
Galantamine is available as
extended-release capsule
rivastigmine is available as
patch
methylphenidate class
CNS stimulant
methylphenidate action
blocks reuptake of NE and DA
may also enhance release of catecholamines
methylphenidate adverse reactions
nervousness
insomnia
abuse potential
do not use methylphenidate with
MAOIs
methylphenidate may increase effects of
tricyclics
antiparkinsoniam agents
what frequently works when methylphenidate wont and what does it benefit in addition?
dextroamphetamine
cognition, depression, anergia impaired motivation
Atomoxetine class
selective NE reuptake inhibitor
Atomoxetine action
inhibition of NE transporter
atmoxetine metbaolism
CYP2D6 (interactswith quinidine)
atomoxetine adverse reactions
liver toxicity
suicidal ideation
Amantadine and Memantine
- moderate-affinity uncompetitive NMDA receptor antagonists
- dopamine agonists
- increase DA release
- decrease presyn DA reuptake
- stimulate DA receptors
- enhance post-syn dopamine R sensitity
neurotransmitter reuptake inhibitors
atomoxetine (strattera)-ADD
duloxetine (cymbalta)-antidepressant
Modafinil uses
excessive daytime somnolence in patients with narcolepsy
-may have a role in treatment of post-TBI fatigue and impairment
treatment of impaired cognition has two major forms
catecholaminergic agents
pro-cholinergic agents
