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Mod4 Psychiatry > Cognitive Disorders > Flashcards

Cognitive Disorders Flashcards

1
Q

Dementia with stepwise increase in severity and focal neurologic signs. Name the type of dementia and the best confirmatory test.

A

Multi-infarct dementia; CT/MRI

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2
Q

Dementia + cogwheel rigidity + resting tremor. Name likely type of dementia and best confirmatory test

A

Lewy body dementia or Parkinson’s disease; diagnose clinically

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3
Q

Dementia + gait apraxia + urinary incontinence + dilated cerebral ventricles. Type of dementia and confirmatory test

A

NPH; CT/MRI

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4
Q

Dementia + diminished position/vibration sense + megaloblasts on CBC. Likely type of dementia and confirmatory test

A

Vitamin B12 deficiency; Serum B12

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5
Q

Dementia + tremor + abnormal LFTs + Kayser-Fleischer rings

A

Wilson disease; ceruloplasmin

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6
Q

Dementia + diminished position/vibration sense + Argyll-Robertson pupils

A

Neurosyphilis (CSF FTA-ABS or CSF VDRL)

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7
Q

Does dementia cause altered consciousness?

A

No

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8
Q

Most common and second most common types of dementia

A

Alzheimer’s; Vascular

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9
Q

Alzheimer’s DSM criteria

A

Development of multiple cognitive defects manifested by both 1.) memory impairment and 2.) at least one of the following: aphasia, apraxia, agnosia, or disturbance in executive function. Finally, deficits must cause problem in functioning and not occur exclusively during delirium.

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10
Q

In what percent of demented patients do delusions/hallucinations occur?

A

30-40%

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11
Q

In what percent of demented patients do affective symptoms occur?

A

40-50%

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12
Q

Two causes of reversible dementia?

A

Hypothyroidism (also associated with depresssed mood, lethargy) and normal pressure hydrocephalus (associated with gait apraxia and urinary incontinence)

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13
Q

Should benzodiazepines be used for emotional disturbances in delirium?

A

No, they can make delirium worse.

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14
Q

Which drug should be used for delirium in the elderly?

A

Haloperidol (Haldol)

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15
Q

Which atypical antipsychotic is least likely to exacerbate Lewy Body Dementia?

A

Quetiapine (Seroquel)

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16
Q

Are there EEG changes with Alzheimer’s?

A

No, that’s a feature of delirium.

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17
Q

What are two other types of patients in which neurofibrillary tangles and plaques can be seen?

A

Normal aging patients; Down Syndrome patients (Down syndrome - increased AD risk)

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18
Q

Gross brain autospy findings in Alzheimer’s?

A

Flattened sulci; enlarged ventricles

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19
Q

Two broad types of drugs for AD?

A

AChE inhibitors; NMDA antagonists

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20
Q

Symptoms of what three disorders can stroke to frontal lbe mimic?

A

Schizophrenia; BPAD I; Depression

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21
Q

5 RFs for vascular dementia?

A

Stroke; DM; HTN; APOe4; male sex (2x more likely)

22
Q

How does deterioration in vascular dementia manifest itself?

A

In a step-wise fashion

23
Q

Two Lewy things in brain in LBD?

A

Lewy bodies and lewy neurites

24
Q

Cognition waxes and wanes in LBD. How do you differentiate this from delirium?

A

Consciousness waxes and wanes in delirium, cognition waxes and wanes in LBD

25
Q

Are hallucinations and delsuions common in LBD?

A

Yes - visual hallucinations and paranoid delusions

26
Q

What is the relationship of the time course of LBD and Parkinson dementia?

A

If sx start within 1 year of parkinsonism sx, it’s lexy body dementia; if they begin more than 1 year after; it’s Parkinson disease dementia

27
Q

What drug can we give for REM sleep behaviour disorder, which often happens with LBD and Parkinson’s?

A

Clonazepam (Klonopin)

27
Q

What drug can we give for REM sleep behaviour disorder, which often happens with LBD and Parkinson’s?

A

Clonazepam (Klonopin)

28
Q

Between what ages does FTD usually present

A

45-65

28
Q

Between what ages does FTD usually present

A

45-65

29
Q

Which sort of dementia presents with disinhibition in verbal, physical, and sexual behaviour?

A

FTD

30
Q

Which deterioration from illness to death is more rapid, Alzheimer’s or FTD?

A

FTD

31
Q

Why would you give antidepressants or anticholinergics in FTD?

A

They improve behavioural symtpoms, even if they do not improve cognition.

32
Q

What is the most common form of dementia caused by infectious disease?

A

HIV-associated dementia

33
Q

Is HIV-associated dementia caused by other infections or HIV itself?

A

Both

34
Q

3 RFs for HIV-associated dementia?

A

Duration of illness, low CD4, high viral load

35
Q

What good is HAART in HIV-assoc dementia?

A

It improves cognition and extends life

36
Q

When does dementia in Huntington Disease present, relative to chorea?

A

1 year before or 1 year after the chorea

37
Q

What percent of patients with Parkinson’s disease develop dementia?

A

30-40%

38
Q

Dementia symptoms in Alzheimer’s resemble what other type of dementia?

A

Alzheimer’s (not Lewy Body, interestingly)

39
Q

List some features of parksonism proper

A

Bradykinesia, cogwheel rigidity, resting tremor, masklike facial expression, shuffling gait, dysarthria

40
Q

What effect do antipsychotic medications have on Parkinson’s dementia?

A

Exacerbate it

41
Q

What sort of muscle problems accompany Creutzfelt-Jacob disease in 90% of patients?

A

Myoclonus (sudden spasms of muscles)

42
Q

Describe the time course of CJD dementia progression?

A

Rapid progression - to stupor/coma/death in months/years

43
Q

Tell me the cause of dementia: Enlarged ventricles, increased CSF pressure, dementia reverses upon surgical internvetion

A

Normal Pressure Hydrocephalus (shunt = shunt from cerebral ventricles into abdomen)

44
Q

Name the clinical triad of normal pressure hydrocephalus

A

Gait apraxia; urinary incontinence; dementia of mild/insidious onset

45
Q

Which of the NPH clinical triad is least likely to improve

A

Dementia

46
Q

Name the potential delirium cause: delirium + hemiparesis or other focal neuro signs

A

CVA or mass lesion; do a brain CT/MRI

47
Q

Name the potential delirium cause: delirium + high BP + papilledema

A

Hypertensive encephalopahty; do a brain CT/MRI

48
Q

Name the potential delirium cause: delirium + tachycardia + dilated pupils

A

Drug intoxication; do a UDS

49
Q

Name the potential delirium cause: delirium + fever + nuchal rigidity + photophobia

A

Meningitis; do a lumbar puncture

50
Q

Name the potential delirium cause: delirium + tachycardia + tremor + thyromegaly

A

Thyrotoxicosis; T4 and TSH screen

Mod4 Psychiatry (4 decks)

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