Cognitive Disorders Flashcards
tremor, extrapyramidal sx, frontal dizziness, ad sluggish pupillary reflexes
tertiary syphillis
What 2 tests are a part of every initial psychiatric workup
Venereal Disease Research Lab Test (VDRL) and TSH
waxing and waning change in a patient’s level of consciousness
Delirium
Causes of delirium
Alcohol/Drugs toxicity or withdrawl, Electrolyte imbalance, Iatrogenic, Oxygen hypoxia, uremia, Trauma, Infection, Poisons, Seizures, Stroke (AEIOU TIPS)
Risk factors for delirium (9)
Advanced age, preexisting brain damage (dementia, CVA), prior history of delirium, alcohol dependence, diabtes, cancer, sensory impairment or blindness, malnutrion and male gender
2 typical sx of delirium
Visual hallucinations and short attention span
clinical manifestation of delirium
disorientation to time and place rarely person, language distrubances, changes in speech, perceptual disturbances, disturbance in psychomotor activity, emotional disturbance, inability to shift attention appropriately
Most common finding in delirium
impairment in recent memory
delirium plus hemiparesis or other focal neuro signs and sx
CVA or mass lesion
delirium plus elevated blood pressure plus papilledema
hypertensive encephalopathy
delirium plus dilated pupils plus tachycardia
drug intoxication
delirium plus fever plus nuchal rigidity plus photophobia
meningitis
delirium plus tachycardia plus tremor plus thyromegaly
throtoxicosis
which drug class is avoided in treating delirium because it will often exacerbate the delirium
benzos
impairment of memory and cognitive function without alteration in the level of consciousness
Dementia
What should you do if a patient presents with dementia but has a normal CT scan?
order a complete metabolic panel and MRI
Reversible dementia accompanied by depressed mood and lethargy is commonly caused by
hypOthyrodism (elevated TSH)
dementia with stepwise increase in severity plus focal neuro signs
Multi-infarct dementia
Dementia plus cogwheel rigidity plus resting tremor
Lewy body dementia or Parkinson disease
dementia plus gait apraxia plus urinary incontinence plus dilated cerebral ventricles
normal pressure hydrocephalus
Dementia plus obesity plus coarse hair plus constipation plus cold intolerance
hypothyroidism
Dementia plus diminshed position and vibration sensation plus megaloblasts on cbc
Vitamin b12 deficiency
Dementia plus tremor plus abnormal LFTs plus kayser fleisher rings
wilson disease
dementia plus diminished position and vibration sensation plus Argyll Robertson Pupils (Accomadation Response present but response to light absent)
neurosyphilis
most common type of dementia
Alzheimer
Alzheimer affects which gender more?
Women (3x more)
Neurotransmitter disturbance seen in Alzheimer
Decreased ACh due to a loss of noradrenergic neurons in basal ceruleus and decreased choline acetyltransferase
What other changes are seen in alzheimers besides for decline in cognitive function?
personality change, mood swings and paranoia
Motor and sensory impairment in alzheimer disease is seen when?
late in the course of the illness
How do you diagnose Alzheimer disease
Clinical Diagnosis
Major susceptiblity gene for alzheimer
Apolipoprotein e4 (APOe4)
Treatment for Alzheimer
Cholinesterase inhibitors (tacrine, donepezil, rivastigmine, galantamine) and NMDA antagonist (Memantine)
Chronically progressing dementia with multiple small infarcts
Vascular dementia
Risk factors for Vascular Dementia
Hypertension, Diabetes, Strokes, APOe4, and being Male
A stroke in what lobe of the brain can lead to sx of schizophrenia, bipolar I disorder, and depression
Frontal Lobe
Step wise deterioration of cognitive function
Vascular Dementia
Tx for Vascular Dementia
No Cure or truly effective treatment, cholinesterase inhibitors and antihypertensive medications (to prevent onset of vascular dementia)
Pathological aggregation of alpha-synuclein in the brain, primarily in the basal ganglia
Lewy Body Dementia
progressive cognitive decline, waxing and waning of cognition, visual hallucinations (vivid, colorful, well formed images of animals and people), paranoid delusions, parkinsonism, sensitivity to neuroleptics and REM sleep disorder
Lewy Body Dementia
Onset of dementia within 12 months of parkinsonism sx
Lewy body Dementia
Onset of dementia over 12 months of parkinsonism sx
Parkinson disease dementia