Cognitive Disorders Flashcards
Dementia of Alzheimer’s Type
DSM
Insidious onset and gradual progression of impairment in one or more cognitive domains.
Either:
- Evidence of genetic mutation from FHx or genetic testing
- All 3 of decline in memory and learning; steadily progressive, gradual decline; no evidence of mixed aetiology
Dementia of Alzheimer’s Type
Risk Factors
Female
Head trauma
FHx - 1st degree relative
Down’s Syndrome
Dementia of Alzheimer’s Type
Pathology
Diffuse atrophy Flattened cortical sulci Enlarged cerebral ventricles Senile plaques Neurofibrillary tangles (esp. in the cortex, hippocampus, substantia nigra and locus ceruleus) Neuronal loss Synaptic loss
Dementia of Alzheimer’s Type
Clinical Presentation
Steady and progressive decline in memory and learning
Nominal dysphasia
?Hallucinations
Dementia of Alzheimer’s Type
Management
Supportive Cholinesterase inhibitors (slow cognitive decline but don't alter disease process) Adjunct therapy (e.g. antidepressants, antipsychotics)
Vascular Dementia
DSM
Vascular aetiology suggested by:
- onset of cognitive deficits is temporarily related to a CV event
- evidence for decline is prominent in complex attention and frontal-executive function
Evidence of CV disease from Hx, Ex and/or imaging
Vascular Dementia
Risk Factors
Dementia from vascular injury is influenced by education, physical exercise and mental activity
Vascular Dementia
Clinical Presentation
Onset and decline is a decremental, stepwise deterioration
Cognitive impairment may be patchy, with some areas still intact
Stroke-like symptoms
Gait abnormalities
HTN
Symptoms are often due to disruption of the frontal lobe
Vascular Dementia
Management
Prevention of further CVA’s
- lifestyle
- aspirin
- anti-HTN
- statins
- warfarin (if AF)
Dementia with Lewy Bodies
DSM
Insidious onset and gradual progression 2 core: - fluctuating cognition with variations in attention and alertness - visual hallucinations - parkinsonism, with onset after cognitive decline ≥1 suggestive: - REM sleep behaviour disorder - neuroleptic sensitivity
Dementia with Lewy Bodies
Clinical Presentation
Symptoms of dementia and parkinsonism together
Visual hallucinations
REM sleep behavioural disturbances (acting out dreams, etc.)
Dementia with Lewy Bodies
Management
Behavioural disturbances - benzodiazepines
Psychosis - anti-cholinesterases, risperidone or olanzapine. DON’T GIVE TYPICAL ANTIPSYCHOTICS
Frontotemporal Dementia
DSM
Insidious onset and gradual progression Sparing of learning and memory and perceptual motor functioning Either behavioural or language variants. Behavioural: - prominent decline in social cognition/executive abilities, + ≥3 of: - behavioural disinhibition - apathy - loss of sympathy or empathy - compulsive/ritualistic behaviour - hyperorality and dietary changes Language: - decline in language ability
Frontotemporal Dementia
Pathological diagnosis
FTD-tau - intraneuronal and glial inclusions composed of the microtubule protein tau
FTD-U: cytoplasmic and intranuclear inclusions that are immunoreactive to ubiquitin (and negative for tau)
Frontotemporal Dementia
Clinical Presentation
Primitive reflexes - disinhibition
Incontinence
Akinesia, rigidity and tremor
Low and labile BP
Coarsening of personality, social behaviour and habits
Progressive loss of language fluency or comprehension
Delirium
DSM
Disturbance in attention and awareness (impairment of consciousness)
Develops of a short period of time (hours to days)
Change in baseline attention and awareness
Tends to fluctuate in severity during the course of a day
Additional disturbance in cognition
Evidence that the disturbance is a direct physiological consequence of another medical condition, substance intoxication or withdrawal
Delirium
Risk factors
Hospitalisation Nursing home residents Childhood Old age Severe illness Pre-existing cognitive impairment/brain pathology Recent anaesthesia Substance abuse
Delirium
Causes
DELIRIUM Drugs (acute effects or withdrawal) Electrolyte imbalance Lack/change in medication drugs (EtOH withdrawal) Infections Renal/liver failure Intracranial trauma/pathology/stroke Urinary/fecal retention Myocardial (MI, pneumonia) & Malignancy
Delirium
Clinical Presentation
Depressed conscious state Swinging conscious state Agitation/fear Hallucinations and illusions Delusions that don't make sense Disorientation Memory (and attention) impairment Illogical speech Reversed sleep-wake cycle Psychomotor disturbance
Delirium
Investigations
FBE UEC ESR LFT Urinalysis ECG CT head LP if needed Blood cultures B12
MMSE score in Alzheimer’s
<12
Severe dementia
MMSE score in Alzheimer’s
13-20
Moderate dementia
MMSE score in Alzheimer’s
20-24
Mild dementia
Dementia
BPSDs
Behavioural and psychological symptoms of dementia Aggression Agitation Anxiety Depression Psychosis Repetitive vocalisation Sleep disturbances Shadowing Sundowning Wandering
Answering “I don’t know” to all questions
Pseudodementia
