Cognitive disorders

Question 1

cognitive disorder

Answer 1

affect memory, orientation, attention, judgment. from 1o, 2o ban of CNS. Categories: dementia, delirium, amnestic D

Question 2

dementia

Answer 2

impair mem, cog function, language, behavior, personality w/o altering lvl of consciousness. most are progressive and irreversible.

Question 3

dementia epi

Answer 3

20% over 80yo have severe dementia. associate with delusion and hallu in 30%. affective sx (depression) in 50%

Question 4

causes of dementia

Answer 4

1) alzheimer, 2) vascular 3) major depression = pseudo dementia. 15% potentially reversible. min workup to exclude reversible causes - CBC, electrolytes, TFT, VDRL/PR, B12 folate, brain CT/MRI

Question 5

dementia dd

Answer 5

depression, delirium, schizophrenia, malingering

Question 6

B12 def dementia

Answer 6

dementia+ decr positional and vibration sensation + megaloblast on CBC. get serum B12

Question 7

wilson’s disease

Answer 7

dementia + tremor, + abn LFT, kayser, fleischer rings. ceruloplasmin.

Question 8

delirium

Answer 8

waxing/ waning consciousness.

Question 9

delirium types

Answer 9

1) quiet- seem depressed or failure to thrive. MMSE done to dd from depression
2) agitated- obvious pulling out lines, may hallucinate

Question 10

delirium dx

Answer 10

r/o life threatening cases. tx reversible (hypothyroidism, electrolyte imbalance, UTI), 1st line= antipsychotics (seroquel), haloperidol.
1:1 nurising, freq reorient, avoid napping. day/night distinction. hold sedation

Question 11

DD delirium AEIOU TIPS

Answer 11

alc, electrolytes, iatrogenic (anti-chl, benzo, anti-epileptics, BP med, insulin, NSAIDS, antibiotics, antiparkinsons), O2 hypoxia, uremia/hepatic encephalopahty.
trauma, infection, poisons, seizure (post ictal)

Question 12

delirium v dementia

Answer 12

1) clouding of consciousness v loss of me/intellectual ability
2) acute onset v insidious onset
3) last days-wks v mo-y
4) orientation impaired v often impaired
5) immediate / recent mem repaired v recent and remote me impaired
6) hallu common v less common
7) sx fluctuate worse at night vs stable during day
8) usually reversible v 15% reversible
9) awareness reduced v awareness clear
10) EEG changes (fast waves or generalized slowing) v no EEG change

Question 13

alzheimer tx

Answer 13

memantine- NMDA R antagonist
cholinesterase inhibitor slows progression- tacrine (cognex), donepezil (aricept), Rivastigmine (Exelon)
tx of sx as necessary
low-dose, short acting bento for anxiety, low dose antipsycho for agitation (quetiapine), antidepressants for depression if fulfill criteria for MDD

Question 14

vascular v alzieher

Answer 14

more focal neuro sx, more abrupt and greater preservation of personality than alz

Question 15

cortical v subcortical dementia

Answer 15

former: alz, pick’s, cud. decline in intellect. subcortical- HD, parkinson, NPH, vascular- affective and mvt sx.

Question 16

amantadine

Answer 16

eMANcipates dopaMINE. tx parkinson’s

Question 17

NPH triad

Answer 17

gait disturbance (often first), urinary incontinence), dementia (mild, insidious onset)- of triad, least likely to improve

Question 18

delirium dd

Answer 18

dementia, fluent aphasia, acute amnestic syndrome, psychosis, depression, malingering

Question 19

delirium causes I’M DELIRIOUS

Answer 19

impaired delivery of brain substrate ~ vascular, metabolic, drug, endocrinopathy, liver disease, infrastructure ( structural disease of cortical neurons), renal failure, infection, oxygen, UTI, sensory deprivation

Question 20

hypertensive encephalopathy

Answer 20

delirium + incr BP + papilledema

Question 21

meningitis

Answer 21

delirium, fever, nuchal rigidity, photophobia

Question 22

thyrotoxicosis

Answer 22

delirium + tachy, + tremor + thyromegaly. t4 TSH

Question 23

amnestic D

Answer 23

memory impairment w/o other cog prob or altered consciousness. always 2o to underlying medical condition

Question 24

delirium tx FEUD

Answer 24

fluids/nutrition, environment, underlying cause, drug w/d. avoid benzo bc will exacerbate