Cognitive disorders Flashcards
cognitive disorder
affect memory, orientation, attention, judgment. from 1o, 2o ban of CNS. Categories: dementia, delirium, amnestic D
dementia
impair mem, cog function, language, behavior, personality w/o altering lvl of consciousness. most are progressive and irreversible.
dementia epi
20% over 80yo have severe dementia. associate with delusion and hallu in 30%. affective sx (depression) in 50%
causes of dementia
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
dementia dd
depression, delirium, schizophrenia, malingering
B12 def dementia
dementia+ decr positional and vibration sensation + megaloblast on CBC. get serum B12
wilson’s disease
dementia + tremor, + abn LFT, kayser, fleischer rings. ceruloplasmin.
delirium
waxing/ waning consciousness.
delirium types
1) quiet- seem depressed or failure to thrive. MMSE done to dd from depression
2) agitated- obvious pulling out lines, may hallucinate
delirium dx
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
DD delirium AEIOU TIPS
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)
delirium v dementia
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
alzheimer tx
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
vascular v alzieher
more focal neuro sx, more abrupt and greater preservation of personality than alz
cortical v subcortical dementia
former: alz, pick’s, cud. decline in intellect. subcortical- HD, parkinson, NPH, vascular- affective and mvt sx.
amantadine
eMANcipates dopaMINE. tx parkinson’s
NPH triad
gait disturbance (often first), urinary incontinence), dementia (mild, insidious onset)- of triad, least likely to improve
delirium dd
dementia, fluent aphasia, acute amnestic syndrome, psychosis, depression, malingering
delirium causes I’M DELIRIOUS
impaired delivery of brain substrate ~ vascular, metabolic, drug, endocrinopathy, liver disease, infrastructure ( structural disease of cortical neurons), renal failure, infection, oxygen, UTI, sensory deprivation
hypertensive encephalopathy
delirium + incr BP + papilledema
meningitis
delirium, fever, nuchal rigidity, photophobia
thyrotoxicosis
delirium + tachy, + tremor + thyromegaly. t4 TSH
amnestic D
memory impairment w/o other cog prob or altered consciousness. always 2o to underlying medical condition
delirium tx FEUD
fluids/nutrition, environment, underlying cause, drug w/d. avoid benzo bc will exacerbate
