Cognitive Complaints and Impairment Flashcards by Tina Jaramillo

cognitive impairment can be

primary manifestation of disorder (altzheimer’s disease)

secondary manifestation and source of excess disability (delirium, medications, brain injury, HIV)

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major DA tracts

nigostriatal (extra pyramidal motor)
mesolimic
mesocortical (cognition, emotion, substance abuse, psychosis)

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DA agonists

movement

depression

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DA antags

psychosis

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where is NE synthesized

locus coreulus

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where does LC project to

cortex
limbic
RAS
spinal cord

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adrenergic agents

depression
MAO-I
tricyclics
venlafaxine

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adrenergic antagonists are for

tremor
anxiety
beta blockers

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setonergic agents used for

dpression

migraine

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5HT synthesized in

raphe nucleus

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5HT project to

cortex
limbic system
striatum
cerebellum
blood vessels

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Ach synthesized in

basal forbrain (nucleus of basalis of Meynert)

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Ach projets to

olfactory bulb
hippocampus
amygdala
cortical association areas
==>ANS, NMJ

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anticholinergic agents

movement disorder

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cholinesterase inhibitors

Alteimers
organophosphates
nerve gases

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GABA A binding sites for

benzos

barbiturates

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GABA B

baclofen

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three attentional networks

alerting
orientating
executive

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alerting brain

thalamic

R frontal and partietal activation

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Orienting brain

superior colliculus
frontal eye fields
temporoparietal
parietal activation

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executive brain

anterior cingluate

DLPFC

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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