Cognitive Disorders

Question 1

Cognitive Disorder

Answer 1

Significant change in cognition from a previous level of functioning. May effect memory, attn, language and judgement. May be associated with abnormalities of the central nervous system, general medical condition or substance abuse.

Typically described as either a Delirium or Dementia

Question 2

Delirium

Answer 2

A waxing and waning change in a patients level of consciousness. Can be caused by virtually any medical disorder.

Question 3

AEIOU TIPS

Answer 3

Alcohol/drug tox.
Electrolyte abs.
Iatrogenic causes (pharm)
Oxygen (hypoxia)
Uremia --> hepatic encephalopathy

Trauma
Infection
Poison
Seizure

Question 4

Risk Factors for Delerium

Answer 4

Advanced Age
Pre-existing Brain Damage
Prior hx of delirium
Alcohol
Cancer
Diabetes
Sensory impairment
Malnutrition
Male Gender

Question 5

Sx of Delerium

Answer 5

Short attn span
Visual Hallucination
Disorientation
Language disturbances
Disturbed psychomotor 
Emotional disturbance

Question 6

Tx of Delerium

Answer 6

Fix the underlying cause

Agitation associated : psychotropics given such as Haloperidol.
Benzos rarely given unless delirium due to alcohol

Question 7

Dementia

Answer 7

impairment of memory or other cognitive functions without alteration in the level of consciousness.

Most forms are progressive and irreversible
Most common is Alzheimers (15-25%)

Question 8

DSM for Dementia

Answer 8

Multiple cognitive deficits manifested by Memory impairment and at least one of the following:
Aphasia, Apraxia, Agnosia, Disturbance of executive functioning.

Question 9

MMSE

Answer 9

Orientation (date month year)
Registration (name three objects, repeat)
Attention and Calculation (count back for 100 by 7s)
Recall (repeat 3 items 5 mins later)
Language (Name a pen and clock, Say no if and’s or but’s)
Read and obey the following

Perfect : 30
Dysfunction: less than 25.

Question 10

Etiology of Alzheimers

Answer 10

Decreased ACh due to loss of Noradrenergic neurons in the basal cereuleus and dec Choline Acetyltransferase.

Question 11

Genes associated with Alzheimers

Answer 11

Presenilin 1 and 2.
Amyloid Precursor Protein
ApoE4 : If homozygous, 90% chance of getting alzheimers by 85. Heterozygous (45%)

Question 12

Postmortem findings of Alzheimers

Answer 12

DIffuse atrophy with enlarged ventricles and flattened sulci.

Question 13

Tx of Alzheimers

Answer 13

No Cure

Cholinesterase Inhibitors: Rivastigmine, Tacrine, Donepezil

NMDA Antagonists: Memantine (Namenda)

Question 14

Vascular Dementia

Answer 14

2nd most common form of dementia

Produced by multiple small infarcts (lacunar)

Question 15

Tx of Vascular Dementia

Answer 15

No effective treatment

Control of HTN may help overall.

Question 16

Lewy Body Dementia

Answer 16

Due to aggregation of Alpha-synuclein –> Lewy Neurites and Lewy Bodies especially in the basal ganglia

Sx: Waxing and waning cognition is core feature
Visual hallucinations (well formed ideas of animals or people)
Paranoid delusions
Parkinsonism (tremor, bradykinesia, shuffling gait)
Sensitivity to neuroleptics
REM disorder is common.

Question 17

Dx of Lewy Body Dementia

Answer 17

Onset of dementia within 12 months of parkinsonism symptoms,

Question 18

Tx of Lewy Body Dementia`

Answer 18

Cholinesterase Inhibitors (help visual hallucinations)

Psychostimulants, levodopa/carbidopa, dopamine agonists.

Atypical neuroleptics

Clonazepam for REM sleep behavior

Question 19

Pick Disease (Fronto-Temporal Dementia)

Answer 19

Typically presents between the ages of 45-65

20-30% is familial and associated with the Progranulin and MAPT Genes

Mean duration is 4-6 years until death.

Marked atrophy of the frontal and temporal lobes
Neuronal loss, microvascularization and astrocytic gliosis in cortical layer II

Question 20

Pick Dx Sx

Answer 20

PROFOUND changes in personality and social conduct
Disinhibited verbal, physical and sexual behavior
Echolalia, overeating, ORAL EXPLORATION OF INNANIMATE OBJECTS
Poor insight about behavioral changes

Question 21

Pick Dx Tx

Answer 21

Anticholinergic and Antidepressants

Question 22

HIV Associated Dementia

Answer 22

Most common dementia caused by infectious disease

Question 23

Tx of HIV Associated Dimentia

Answer 23

HAART

Psychostimulants

Question 24

Huntington Disease

Answer 24

Autosomal Dominant. Onset between 35-50 (shows anticipation through generations).

Progressive dementia
Choreaform movements
Muscular hypertonicity
Psychiatric Manifestation
Increased rate of suicide.

MRI shows CAUDATE ATROPHY

Question 25

Genetics of HD

Answer 25

AD

Trinucleotide repeat on short arm of Chromosome 4

Question 26

Parkinson Disease

Answer 26

Progressive disease with neuronal loss in the Substantia Nigra –> decreased DA.

Occurs slightly more in men than in women

Question 27

Pathology of PD

Answer 27

Senile plaques and neurofibrillary tangles, loss of substantial nigra and thus DA

Tx: Levodopa/ Carbidopa

Question 28

Creutzfeld Jakob Disease

Answer 28

Rapidly progressive degenerative prion disease . May be inherited, sporadic or acquired

Rapidly progressive dementia in 6-12 months

Sx:
Myoclonus
Cerebellar/basal ganglia

Question 29

CJD Diagnosis

Answer 29

Spongiform changes of brain tissue

Generalized sharp waves on EEG

Myoclonus, Cortical Blindness, Ataxia, Pyramidal signs, Muscle Atrophy, Mutism

Question 30

Normal Pressure Hydrocephalus

Answer 30

Possible reversible cause of dementia
Have enlarged ventricles with Increased CSF pressure

WET: Often pee themselves
WOBBLY: Gait Disturbance
WACKY: Dementia

Tx is to relieve pressure.