Cognitive Disorders Flashcards by heather Fahey

What are the major causes of delerium?

AEIOU TIPS

alcohol/drug toxicity/withdrawal
electrolyte imbalance
iatrogenic- anticholinergic, benzo, antiepileptic, bp meds, insulin, hypoglycemics, roids, nsaids, etc
oxygen [hypoxia]
uremia, hepatic encephalopathy
trauma
infection
poison
seizures, strokes

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What is perseveration?

inability to shift attention appropriately making conversation difficult; repeating words or phrases

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What is the most common finding in delerium?

impairment of recent memory

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Delerium and hemiparesis or focal neuro signs/symptoms makes you think what? What should be ordered?

CVA or mass lesion

-get a CT of the brain or MRI

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Delerium, elevated BP and papilledema makes you think what? What should be ordered?

hypertensive encephalopathy

- get brain CT/MRI

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Delerium with dilated pupils and tachycardia point to what?

What should be ordered?

Drug intoxication– order a UDS

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Delerium, fever, nuchal rigidity, photophobia points to what?
What is ordered?

meningitis

-order lumbar puncture

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Delerium, tachycardia, tremor, thyromegaly points to what?

Order what?

thyrotoxicosis, order T4, TSH

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What is first line treatment for delerium?

supportive care with hydration, nutrition

2. haloperidol b/c PO,IM, IV

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What is the only time benzos should be used in the treatment of delerium?

When the delerium is caused by benzo or alcohol withdrawal

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What happens to the prevalence of dementia with age?

It doubles every 5 years
1.5 percent at 60
40 percent at 90

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What should be ordered if a person presents with dementia but has normal CT?

complete metabolic panel - hypothyroid, hypoxia, b12 def, wilson disease, lead toxicity
MRI

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Dementia with stepwise increase in severity, focal neuro deficits

multi-infarct dementia

- order CT/MRI

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dementia with cogwheel rigidity and resting tremor

lewy body dementia or parkinson disease

-clinical diagnosis

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dementia with gait apraxia, urinary incontinence, dilated cerebral ventricles

normal pressure hydrocephalus

-ct/mri

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dementia obesity coarse hair, constipation, cold intolerance

hypothyroidism

-T4, TSH

dementia, diminished position and vibration sensation, megaloblasts on CBC

B12 deficiency

dementia, tremor, abnormal LFTs, kayser-flescher rings

wilson disease

- ceruloplasmin

dementia, diminished position/vibration sense, argyll-roberston pupils

neurosyphilis

-CSF FTA-ABS, VDRL

What percent of patients with dementia have hallucinations/delusions?
What percent have depression or anxiety?

hallucinations/delusions is 30 percent

anxiety/depression is 40-50 percent

How do you test orientation on MMSE? How many points is given?

date, month, year
state, city hospital

5 points each

How do you test registration on MMSE? How many points is given?

repeat 3 words -3 points

How do you test attention/calculation on MMSE? How many points is given?

Serial 7s, spell world backwards gets 5 points

How do you test recall on MMSE? How many points?

name the 3 words 5 minutes later- 3 points

What score on MMSE signifies dysfunction?

25 or lower

What neurotransmitter change is seen with alzheimers?

decreased Ach due to loss of noradrenergic neurons in the basal ceruleus

What is the major susceptibility gene for alzheimers?

apoe4

What are postmortem findings in the brain for alzheimers?

1. diffuse atrophy with enlarged ventricles and flattened sulci 2. senile plaques with neurofibrillary tangles

What 2 classes of drugs slow alzheimers prgression?

1. cholinesterase inhibitors - tacrine, donepezil, rivastigmine, galantamine 2. NMDA antagonists- memantine

What are the core features of Lewy body dementia? | What drugs are they sensitive to?

1. waxing and waning of cognition 2. parkinsonism 3. visual hallucinations Sensitive to neuroleptics

How do you differentiate lewy body dementia from parkinson disease dementia?

lewy body- dementia is within 12 months of parkinsonism symptoms parkinson disease dementia- dementia after 12 months

What drugs are used to treat the following associated with lewy body dementia? 1. visual hallucinations 2. cognition, apathy, psychomotor slowing 3. delusions agitation 4. REM sleep disorder

1. cholinesterase inhibitors 2. levodopa/carbidopa, stimulants, dopamine agonists 3. atypical antipsychotics 4. clonazepam

What pathology is associated with FTD?

atrophy of frontal/temporal lobes | -neuronal loss, astrocytic gliosis in cortical layer II

When does dementia occur in relation to th chorea for Huntington's disease?

1 year before to 1 year after

What are the major psychiatric manifestations of huntington's disease?

1. depression 2. psychosis 3. alcoholism ultimately increased suicide rate

What does an MRI of huntington disease show?

caudate atrophy

A patient smells strange smells and has a sensation that objects are very small [lilliputian hallucination]. Then he loses consciousness and smacks his lips. What is the diagnosis?

temporal lobe epilepsy

Dementia due to Parkinson disease is exacerbated by what medications?

antipsychotics

How do you make the probable diagnosis of CJD?

1, rapidly progressive dementia (6-12 months) 2. generalized sharp waves on EEG - myoclonus - cortical blindness - ataxia, EPS - muscle atrophy - mutism