Cognitive Disorders Flashcards
Dementia with stepwise increase in severity and focal neurologic signs. Name the type of dementia and the best confirmatory test.
Multi-infarct dementia; CT/MRI
Dementia + cogwheel rigidity + resting tremor. Name likely type of dementia and best confirmatory test
Lewy body dementia or Parkinson’s disease; diagnose clinically
Dementia + gait apraxia + urinary incontinence + dilated cerebral ventricles. Type of dementia and confirmatory test
NPH; CT/MRI
Dementia + diminished position/vibration sense + megaloblasts on CBC. Likely type of dementia and confirmatory test
Vitamin B12 deficiency; Serum B12
Dementia + tremor + abnormal LFTs + Kayser-Fleischer rings
Wilson disease; ceruloplasmin
Dementia + diminished position/vibration sense + Argyll-Robertson pupils
Neurosyphilis (CSF FTA-ABS or CSF VDRL)
Does dementia cause altered consciousness?
No
Most common and second most common types of dementia
Alzheimer’s; Vascular
Alzheimer’s DSM criteria
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.
In what percent of demented patients do delusions/hallucinations occur?
30-40%
In what percent of demented patients do affective symptoms occur?
40-50%
Two causes of reversible dementia?
Hypothyroidism (also associated with depresssed mood, lethargy) and normal pressure hydrocephalus (associated with gait apraxia and urinary incontinence)
Should benzodiazepines be used for emotional disturbances in delirium?
No, they can make delirium worse.
Which drug should be used for delirium in the elderly?
Haloperidol (Haldol)
Which atypical antipsychotic is least likely to exacerbate Lewy Body Dementia?
Quetiapine (Seroquel)
Are there EEG changes with Alzheimer’s?
No, that’s a feature of delirium.
What are two other types of patients in which neurofibrillary tangles and plaques can be seen?
Normal aging patients; Down Syndrome patients (Down syndrome - increased AD risk)
Gross brain autospy findings in Alzheimer’s?
Flattened sulci; enlarged ventricles
Two broad types of drugs for AD?
AChE inhibitors; NMDA antagonists
Symptoms of what three disorders can stroke to frontal lbe mimic?
Schizophrenia; BPAD I; Depression
5 RFs for vascular dementia?
Stroke; DM; HTN; APOe4; male sex (2x more likely)
How does deterioration in vascular dementia manifest itself?
In a step-wise fashion
Two Lewy things in brain in LBD?
Lewy bodies and lewy neurites
Cognition waxes and wanes in LBD. How do you differentiate this from delirium?
Consciousness waxes and wanes in delirium, cognition waxes and wanes in LBD
Are hallucinations and delsuions common in LBD?
Yes - visual hallucinations and paranoid delusions
What is the relationship of the time course of LBD and Parkinson dementia?
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
What drug can we give for REM sleep behaviour disorder, which often happens with LBD and Parkinson’s?
Clonazepam (Klonopin)
What drug can we give for REM sleep behaviour disorder, which often happens with LBD and Parkinson’s?
Clonazepam (Klonopin)
Between what ages does FTD usually present
45-65
Between what ages does FTD usually present
45-65
Which sort of dementia presents with disinhibition in verbal, physical, and sexual behaviour?
FTD
Which deterioration from illness to death is more rapid, Alzheimer’s or FTD?
FTD
Why would you give antidepressants or anticholinergics in FTD?
They improve behavioural symtpoms, even if they do not improve cognition.
What is the most common form of dementia caused by infectious disease?
HIV-associated dementia
Is HIV-associated dementia caused by other infections or HIV itself?
Both
3 RFs for HIV-associated dementia?
Duration of illness, low CD4, high viral load
What good is HAART in HIV-assoc dementia?
It improves cognition and extends life
When does dementia in Huntington Disease present, relative to chorea?
1 year before or 1 year after the chorea
What percent of patients with Parkinson’s disease develop dementia?
30-40%
Dementia symptoms in Alzheimer’s resemble what other type of dementia?
Alzheimer’s (not Lewy Body, interestingly)
List some features of parksonism proper
Bradykinesia, cogwheel rigidity, resting tremor, masklike facial expression, shuffling gait, dysarthria
What effect do antipsychotic medications have on Parkinson’s dementia?
Exacerbate it
What sort of muscle problems accompany Creutzfelt-Jacob disease in 90% of patients?
Myoclonus (sudden spasms of muscles)
Describe the time course of CJD dementia progression?
Rapid progression - to stupor/coma/death in months/years
Tell me the cause of dementia: Enlarged ventricles, increased CSF pressure, dementia reverses upon surgical internvetion
Normal Pressure Hydrocephalus (shunt = shunt from cerebral ventricles into abdomen)
Name the clinical triad of normal pressure hydrocephalus
Gait apraxia; urinary incontinence; dementia of mild/insidious onset
Which of the NPH clinical triad is least likely to improve
Dementia
Name the potential delirium cause: delirium + hemiparesis or other focal neuro signs
CVA or mass lesion; do a brain CT/MRI
Name the potential delirium cause: delirium + high BP + papilledema
Hypertensive encephalopahty; do a brain CT/MRI
Name the potential delirium cause: delirium + tachycardia + dilated pupils
Drug intoxication; do a UDS
Name the potential delirium cause: delirium + fever + nuchal rigidity + photophobia
Meningitis; do a lumbar puncture
Name the potential delirium cause: delirium + tachycardia + tremor + thyromegaly
Thyrotoxicosis; T4 and TSH screen
