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Psych > Cognitive Disorders > Flashcards

Cognitive Disorders Flashcards

1
Q

3 causes of a disorientated patitent

A

Amnesia
Dementia
Delirium

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2
Q

Cognition

A

ability to acquire new information and understand it

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3
Q

Impaired cognition AKA

A

Disorientation

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4
Q

Orientation is defined as

A

knowledge of person, time and place

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5
Q

Causes of disorientation

A

Fever/Infection
Alcohol/drugs
Hypoglycaemia
Electrolyte Abnormalities
Delirium
Dementia

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6
Q

Amnesia is defined as

A

loss of memory

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7
Q

What is amnesia often caused by?

A

CNS injury

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8
Q

Types of amnesia

A

Retrograde
Anterograde
Dissociative

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9
Q

Retrograde amnesia

A

Loss of memories in the past
Retained ability to make new memories
E.g. patient wakes up post-concussion and doesn’t remember his close ones

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10
Q

Anterograde amnesia

A

Inability to make new memories
Remembers the past
E.g. patient spends 5 days at the hospital post-concussion but forgets the previous day

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11
Q

Dissociative amnesia

A

Special form not caused by CNS injury
Usually as a result of psychological trauma/stress
Inability to remember autobiographical info

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12
Q

What type of amnesia leads to a loss of past memories, but retains the ability to make new memories?

A

Retrograde

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13
Q

What type of amnesia leads to an inability to make new memories, but remembers the past?

A

Anterograde

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14
Q

What type of amnesia is NOT caused by CNS injury? What is it usually a result of?

A

Dissociative, usually aa result of psychological trauma/stress

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15
Q

What type of amnesia results in an inability to remember autobiographical info?

A

Dissociative amnesia

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16
Q

What can severe dissociative amnesia lead to?

A

Dissociative fugue

NB: Dissociative fugue isa symptom where a person with memory loss travels or wanders. That leaves the person in an unfamiliar setting with no memory of how they got there. This symptom usually happens with conditions caused by severe trauma.

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17
Q

What causes of amnesia are associated with vitamin B1 (Thiamine) deficiency and acoholism?

A

Wernicke-Korsakoff

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18
Q

Triad of Wernicke

A

Confusion, Ataxia and Ophthalmoplegia

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19
Q

Treatment of Wernicke

A

B1 infusion

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20
Q

Difference between wernicke and korsakoff

A

Wernicke causes acute encephalopathy

Korsakoff is a permanent neurologic condition
Korsakoff is ALWAYS preceded by Wernicke

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21
Q

Features of Korsakoff

A

Triad of Wernicke - Confusion, ataxia and opthalmoplegia

+ amnesia (anterograde>retrograde), confabulation (making things up) and personality changes

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22
Q

What type of amnesia is more common in korsakoff?

A

Anterograde

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23
Q

What is confabulation?

A

brain makes up memories to fill in things that their amnesia has caused them to forget

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24
Q

Which of Wernicke-Korsakoff is reversible?

A

Wernicke

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25
Q

What is dementia?

A

Chronic progressive decline in mental state

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26
Q

Is dementia reversible?

A

No

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27
Q

Do you get LOC with dementia?

A

No

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28
Q

Causes of dementia

A

Alzheimer’s (60%)
Vascular dementia (20%)
Lewy Body (HaLEWYcinations)
Rare: Pick’s disease, Creutzfeldts-Jakobs, HIV, vitamin deficiencies, Wilson’s
Pseudodementia

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29
Q

Most common cause of dementia

A

Alzheimer’

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30
Q

2nd most common cause of dementia

A

Vascular

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31
Q

Dementias in order of prevalence

A

Alzheimer’s disease (70% dementia)
Vascular Dementia (VD)
Lewy Body Dementia (DLB)

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32
Q

What part of brain is affected in Alzheimer’s first?

A

Hippocampus

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33
Q

Which brain regions are predominantly involved in Alzheimer’s?

A

Cortex and hippocampus

NOTE: Hippocampus affected first

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34
Q

What proteins are involved in Alzheimer’s?

A

Amyloid, Tau

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35
Q

Biggest risk factor for Alzheimer’s

A

Increasing age

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36
Q

How does Alzheimer’s present?

A

THINK: 4 A’s

Amnesia - Recent memories lost first; disorientation occurs early

Aphasia - Aphasia in finding correct words (Broca’s), speech muddled/disjointed

Agnosia - Typically “Visual” (i.e. prosopagnosia – recognising faces)

Apraxia - Typically “Dressing” (skilled tasks, despite normal motor functioning)

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37
Q

Which memories are lost first in Alzheimer’s?

A

Recent memories lost first, disorientation occurs early

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38
Q

What region of the brain causes the aphasia in Alzheimer’s?

A

Broca’s –> aphasia in finding correct words

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39
Q

Aphasia in finding correct words

A

Broca’s area affected

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40
Q

What type of agnosia is typically seen in Alzheimer’s?

A

“Visual” (i.e. prosopagnosia – recognising faces)

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41
Q

What is prospagnosia? What is it seen in?

A

Inability to recognise faces, seen in Alzheimer’s

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42
Q

What type of cognitive deterioration is seen in Alzheimer’s?

A

Gradual

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43
Q

What condition is Alzheimer’s linked HEAVILY with?

A

Depression

44
Q

Table showing common dementia pathologies and how to differentiate them

A
45
Q

What type of cognitive deterioration is seen in vascular dementia?

A

Stepwise

NOTE: Gradual deterioration seen in Alzheimer’s

46
Q

RFs for vascular dementia

A

CVD Hx or RF

47
Q

Features of Lewy Body Dementia

A

Fluctuating confusion with lucid intervals
Visual hallucinations – often small people/animals
Parkinsonism

48
Q

What type of hallucinations are seen in lewy body dementia?

A

Visual hallucinations – often small people/animals

49
Q

Which type of dementia presents with parkinsonism?

A

lewy body dementia

50
Q

What is seen in frontotemporal dementia?

A

Change in behaviour and personality

51
Q

Frontotemporal dementia AKA

A

Pick’s Disease

52
Q

How to differentiation Lewy body and Pick’s disease?

A

Visual hallucination –> lewy body
Auditory hallucination –> Pick’s disease (frontotemporal dementia)

53
Q

What vitamin deficiency can cause dementia?

A

B12

54
Q

What autosomal recessive GI condition can cause dementia?

A

Wilson’s: kaiser’-Fleischer rings + dementia

55
Q
A
56
Q

What is pseudodementia?

A

reversible dementia that occurs secondary to severe depression –> treat depression and will treat dementia

57
Q

How to treat pseudodementia?

A

Treat depression and dementia will resolve

58
Q

What bedside tests can be done to investigate for dementia?

A

AMTS - <7 indicates cognitive impairment, MMSE, MOCA

NOTE: MoCA –> Montreal Cognitive Assessment

59
Q

What Bloods can be done to test for dementia?

A

FBC
U&Es and dipstick (infection, diabetes)
TFTs (hypothyroid → cognitive decline)
LFTs (Korsakoff’s)
HbA1c (diabetes)
Vitamin B12 and folate, Calcium,

60
Q

IMPORTANT STI TO EXCLUDE IF PRESENTING WITH DEMENTIA WITH RISK FACTORS

A

Syphillis –> neruosyphillis can cause dementiaW

61
Q

What imaging/further tests may be done for dementia?

A

Alzheimers - MRI; check for grey matter atrophy, wide ventricles,
Vascular - ECG, CT/MRI
Memory Assessment Clinic - Risk assess patient and conduct MMSE for cognition assessment

62
Q

What may be seen on MRI in Alzheimer’s?

A

check for grey matter atrophy, wide ventricles

63
Q

Can dementia be diagnosed in primary care? Where do they need assessment?

A

NO, NEED ASSESSMENT IN A MEMORY ASSESSMENT CLINIC

64
Q

Biological Management of Alzheimer’s

A

1st line: Anticholinesterases - Donezapil, Galantamine, Rivastigmine (THINK: Dementia Got Real)

2nd line: NDMA (glutamate receptor) antagonist – Memantine

65
Q

What are the 1st line medication for Alzheimer’s? Give examples

A

Anticholinesterases - Donezapil, Galantamine, Rivastigmine (Dementia Got Real)

66
Q

Besides Alzheimer’s, what else can anticholinesterases be used for? Give examples of Acetycholinesterases

A

Used for mild alzheimers, lewy body and parkinsons dementia

Donezapil, Galantamine, Rivastigmine (Dementia Got Real)

67
Q

SEs of acetylcholinesterases

A

GI effects (N+V, diarrhoea, sweating), muscle spasm, bradycardia, miosis

NOTE: Used for mild alzheimers, lewy body and parkinsons dementia

68
Q

2nd line management for Alzheimer’s, when is it used?

A

NDMA (glutamate receptor) antagonist – Memantine

Used for severe Alzheimers, usually for behavioural and psych symptoms or if they’re resistant to acetylcholinesterases

69
Q

PACES: Psycho/Social management for Alzheimer’s

A

Psycho
Structural group cognition stimulation sessions, group reminiscence therapy, validation therapy
CHARITIES TO HELP WITH CARER SUPPORT (dementia UK uses admiral nurses)
Mental health issues can arise due to dementia dx so provide appropriate aid and sign posting here.

Social
Optimise current health
Identify future wishes and discuss LPA, advanced directives
Care package involvement
Identify any other social support measures (meal support, ADL support, day centre availability, alt accom)
Orient the patient (e.g. visible clocks and calendars)
Safety measures (e.g. changing gas to electricity, door mat buzzers).
Follow up every 6 months with dr and named care manager

70
Q

PACES: Useful charity for dementia

A

Dementia UK

71
Q

PACES: Ways to orient patient with dementia

A

visible clocks and calendars

72
Q

PACES: Safety measures for patients with dementia

A

changing gas to electricity, door mat buzzers

73
Q

How often is follow up needed in Alzheimer’s? Who by?

A

Follow up every 6 months with dr and named care manager

74
Q

Difference between delirium and depresssion

A

Delirum is reversible, Depression is not

75
Q

Features of Delirum

A

Loss of focus and attention
Disorganized thinking
Hallucinations (usually visual)
Sleep-wake disturbance i.e. up at night, sleeps during the day (classic for inpatients)

76
Q

What type of hallucinations are typically seen in delirium?

A

Visual

77
Q

Causes of delirium

A

Infection is the classic one
Alcohol use or withdrawal
Certain drugs: HIGH YIELD, especially in elder population e.g. anticholinergics, benzodiazepines, antihistamines, antidepressants

78
Q

MOST COMMON CAUSE OF DELIRIUM IN ELDERLY PATIENTS

A

UTI

79
Q

What drugs can cause delirium? Why?

A

anticholinergics, benzodiazepines, antihistamines, antidepressants

NOTE: Can cross BBB

80
Q

Difference on EEG between delirium and dementia

A

EEG is normal in dementia, abnormal in delirium

81
Q

Management of delirium

A

Fix the underlying cause
Abx for infection
Meds for withdrawal
Treat pain
Hydrate, calm and quiet environment
Haloperidol (Vitamin H) if everything has failed

82
Q

What medication can be used in delirium if all else fails?

A

Haloperidol

83
Q

What must be done before giving haloperidol in an agitated patient with delirium?

A

try and get patient to calm down, isolate them, de-escalate them

84
Q

Which lobes in the brain are most affected by Alzheimer’s?

A

Temporal

85
Q

Medical management of Lewy body dementia

A

Donepezil or rivastigmine should be given to patients with mild- to- moderate dementia with Lewy bodies.

Galantamine can be considered only if treatment with both donepezil or rivastigmine is not tolerated. Memantine can be considered if acetylcholinesterase inhibitors are contra-indicated or not tolerated.

86
Q

What are lewy bodies made of?

A

alpha-synuclein protein deposits in the brainstem and neocortex

87
Q

Where in the brainstem is predominantly affected in lewy body dementia?

A

brainstem and neocortex

88
Q

What do the lewy body plaques lead to reduced levels of in the brain?

A

Alpha-synuclein deposits (Lewy Body) lead to reduced levels of acetylcholine and dopamine in the brain.

89
Q

Which lobes are affected in Pick’s Disease

A

Involves atrophy of the frontal and temporal lobes, without features of Alzheimer’s.

90
Q

What are pick’s bodies in frontotemporal dementia?

A

Neurones in this area are abnormal and swollen: Pick’s bodies

91
Q

What protein is affected in Pick’s disease?

A

Concerns a mutation in the tau gene of the microtubules.

92
Q

Subtypes of frontotemporal dementia

A

Frontal type presents with emotional and behavioural changes. This can include criminal or sexual behaviours.

Progressive non-fluent aphasia presents with a progressive difficulty in language. This indicates a dominant peri-sylvian atrophy.

Semantic dementia is a loss of the meaning of words. It is a fluent aphasia, suggesting damage to the dominant temporal lobe.

93
Q

Sub-type of Pick’s disease that presents with emotional and behavioural changes

A

Frontal type presents with emotional and behavioural changes. This can include criminal or sexual behaviours.

94
Q

Sub-type of Pick’s disease that presents with progressive difficulty in language

A

Progressive non-fluent aphasia presents with a progressive difficulty in language. This indicates a dominant peri-sylvian atrophy.

95
Q

Sub-type of Pick’s disease that leads to a loss of the meaning of words

A

Semantic dementia is a loss of the meaning of words. It is a fluent aphasia, suggesting damage to the dominant temporal lobe.

96
Q

Management of Pick’s disease

A

No reccomended medical management –> mainly supportive

97
Q

What is charles-bonnet syndrome characterised by?

A

persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness.

98
Q

Is consciousness altered in Charles Bonnet syndrome?

A

No, occurs in a clear consciousness

99
Q

What is there a background of in Charles Bonnet syndrome?

A

background of visual impairment:
Age related macular degeneration
Glaucoma
Cataracts

100
Q

What must charles bonnet syndrome occur in the absence of?

A

any other significant neuropsychiatric disturbance

101
Q

Table showing difference between normal and abnormal grief reaction

A
102
Q

Features of a normal grief reacftion

A

Follows cycle: denial, anger, depression, bargaining, acceptance
Can last up to 2 years but diagnosed generally if lasting >6months

103
Q

Features of an abnormal grief reaction

A

Delayed onset of grief (e.g. after 1 year)
Greater intensity
Not ‘progressing’ through cycle of grief so ‘stuck’ in grief
Suicidal/psychotic symptoms
More likely if sudden death/problematic relationship/lack of support

104
Q

What are pseudohallucinations? Who are they most often seen in?

A

false sensory perception in the absence of external stimuli when the affected is aware that they are hallucinating. This phenomenon is common in grieving people.W

105
Q

What is adjustment disorder? When are they often seeen in response to?

A

Subjective distress <6months, usually interfering with social functioning, arising in the period of adaption (1month) to a significant life change e.g. divorce, death, unemployment, moving

106
Q

Phenomenons that can occur in grief reactions

A

Pseudohallucinations
Adjustment disorder

107
Q
A

Psych (11 decks)

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