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Psychiatry > Cognitive Disorders > Flashcards

Cognitive Disorders Flashcards

1
Q

What is the FAIR acronym for dementia and delirium?

A

Find, assess, investigate and refer.

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2
Q

Name the causes of cognitive impairment..

A

Neurodegenerative dementia, delirium, depression (pseudo-dementia co-morbid in 20% of other dementias), psychosis, organic brain disease- CVA, encephalitis, effects of systemic or other illness, psychoactive substance misuse.

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3
Q

What is pseudo-dementia?

A

A person who has depression, also has cognitive impairment that looks like dementia.

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4
Q

What are the basic domains assessed in cognitive assessment? (Old tired psychiatrists persevere at creating mnemonic learning codswallop)

A

Orientation, time, place, person, attention, concentration, memory, language, construction

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5
Q

What are some of the tests used for testing attention and concentration?

A

WORLD backwards
Serial Sevens (100-7=93, 93-7=86 etc) o 20 – 1
Months of the year backwards

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6
Q

What is attention?

A

Ability to focus and direct cognitive processes

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7
Q

What is concentration?

A

Ability to focus and sustain attention over time.

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8
Q

What are the two subtypes of memory?

A

Anterograde and retrograde.

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9
Q

What does anterograde mean?

A

This is recalling of new information, recall of words or test address.

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10
Q

What does retrograde mean?

A

Recall of previously learned information, recall of important events, people, dates etc.

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11
Q

What do you look out for when assessing language?

A

Perseveration, confabulation, word finding problems, nominal dysphasia.

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12
Q

What is perseveration?

A

repeat or prolong an action, thought, or utterance after the stimulus that prompted it has ceased.

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13
Q

What is confabulation?

A

A disturbance of memory, defined as the production of fabricated, distorted, or misinterpreted memories about oneself or the world, without the conscious intention to deceive.

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14
Q

What is nominal aphasia?

A

Anomic aphasia (also known as dysnomia, nominal aphasia, and amnesic aphasia) is a mild, fluent type of aphasia where an individual has word retrieval failures and cannot express the words they want to say (particularly nouns and verbs). Anomia is a deficit of expressive language.

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15
Q

How do you test construction/apraxia?

A

Get them to draw simple and complex figures such as intersecting pentagons, intersecting infinity signs, cubes, cylinder, clock face.

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16
Q

What percentage of patients over 65 have dementia?

A

35%

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17
Q

Where are rates of dementia highest in the world?

A

Little and middle income countries

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18
Q

Having a diagnosis of a mental illness reduces your chances of survival, in what order?

A

Dementia then delirium then depression

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19
Q

What is dementia?

A

It is a syndrome due to the disease of the brain with a chronic or progressive nature with disturbance of multiple higher cortical functions (decline in memory and learning new information), but consciousness is not clouded, accompanied by deterioration in judgement and thinking/ processing of new information, emotional control, social behaviour or motivation.

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20
Q

What does ICD-10 class as mild dementia?

A

This is memory loss sufficient to interfere with every day activities, able to live independently.

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21
Q

What does ICD-10 say about moderate dementia?

A

Memory loss is a serious handicap to independent living only highly learned or very familiar material retained and the individual is unable to function without another person in daily living.

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22
Q

What does ICD-10 say about severe dementia?

A

This is a complete inability to retain new information with a virtual absence of intelligible ideation, the mind can no longer tell the body what to do.

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23
Q

How long do you have to have it for to be diagnosed with dementia?

A

6 months

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24
Q

Which pathways does clozapine target?

A

Mesolimbic and mesocortical

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25
Q

How long must you give the depot for until you reach a steady dose in the body?

A

6 months

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26
Q

What is the most common type of dementia in under 65s?

A

Alzheimers and then fronto-temporal

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27
Q

What is the most common type of dementia in over 65s?

A

Alzheimers and then vascular dementia

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28
Q

What are the 5 A’s of dementia?

A

Aphasia, apraxia, amnesia, agnosia and assosiated behaviours (BPSD).

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29
Q

What common delusions are seen in dementia?

A

People are stealing things, delusion of abandonment, delusion of infidelity.

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30
Q

What are the core diagnostic features of fronto-temporal dementia?

A

Insidious onset and gradual progression, early decline in social interpersonal conduct, early impairment of regulation of personal conduct, early emotional blunting and early loss of insight, behaviour changes, apathy and language impairments.

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31
Q

Concerning the cognitive test, what does it usually show in people with fronto-temporal dementia?

A

The memory and visuospatial spared and positive for frontal lobe tests.

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32
Q

What are the three subtypes of FTD?

A

Behavioural, progressive non-fluent aphasia & semantic. (not producing speech but finding the words and also loss of meaning of the words.)

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33
Q

What is the treatment for FTD?

A

Supportive and carers

34
Q

What are the core features of Lewy body dementia?

A

Fluctuating cognition (attention & alertness), spontaneous motor features of parkinsonism (70%), and 2/3s have visual hallucinations.

35
Q

Name some additional features if LBD…

A

Sleep (REM) disorder, severe neuroepileptic, SPECT/PET changes

36
Q

What other symptoms do patients with lewy body dementia experience?

A

2/3s systemised delusions, 40%-50% have depressive episode, recurrent falls, syncope, LOC

37
Q

What is the treatment for Lewy body dementia?

A

Acetyl cholinesterase inhibitors & psychosocial; carers

38
Q

What is FTD?

A

Dementia with prominent changes in personality, social conduct, language & understanding

39
Q

How does FTD present?

A

It may present as overactive, socially disinhibited, and fatuous, or conversely as apathetic, inert, emotionally blunted.

40
Q

Is FTD common?

A

M=F, 4-15/100,00

41
Q

When is the common presentation of FTD?

A

45-65 years of age

42
Q

What is the ratio of early onset dementia between alzheimer’s and fronto-temporal lobe dementia?

A

3:1

43
Q

What does Behavioural variant FTD constitute?

A

Predominant frontal lobe involvement, changes in personality, behaviour, interpersonal and executive skills.

44
Q

What does progressive non-fluent aphasia (PNFA) of FTD constitute?

A

Temporal lobe involvement, predominant loss of language skills, (inability to produce or understand language).

45
Q

What is the semantic dementia variant of FTD?

A

Loss of semantic memory- knowledge of things and concepts.
The memory system that stores knowledge about objects and concepts based on the individual’s accumulated experience of the world. Typically, semantic dementia initially affects the highly elaborate brain knowledge system that mediates vocabulary— that is, knowledge of the meaning of words.

46
Q

What is seen macroscopically/MRI in Behavioural FTD?

A

Frontal and anterior temporal lob atrophy

47
Q

What is seen macroscopically/MRI in PNFA?

A

Affects the persylvian cortices in the dominant hemisphere mediating speech production- profile of atrophy varies widely in extent and severity.

48
Q

What is seen macroscopically/MRI in semantic dementia?

A

Asymmetric anterioinferior temporal lobe cortical atrophy.

49
Q

Name some early FTD diagnostic features….

A

• Insidiousonsetandgradualprogression
• Early decline in social interpersonal conduct
• Early impairment in regulation of personal conduct
• Earlyemotionalblunting
• Earlylossofinsight
Striking changes in personality and emotional responses (unconcern/emotional blunting)
• Loss of social and personal awareness and changes in conduct (social disinhibition, neglect of affairs and responsibilities, loss of interest in personal appearance & hygiene, poor personal and interpersonal social conduct)
• Apathy, inflexibility and mental rigidity

50
Q

Name the symptoms of FTD?

A
  • Distractibility, impulsivity
  • Loss of libido (sexual disinhibition secondary to general disinhibition)
  • Stereotyped and perseverative behaviour (e.g. rocking, marching on the spot)
  • Hyperorality ( Kluver-Bucy syndrome – ingesting inedible objects)
51
Q

What is kluver-Bucy syndrome?

A

Klüver–Bucy syndrome is a syndrome resulting from bilateral lesions of the medial temporal lobe (including amygdaloid nucleus). Klüver–Bucy syndrome may present with hyperphagia, hypersexuality, hyperorality, visual agnosia, and docility.

52
Q

What is hypersexuality?

A

Characterized by a heightened sex drive or a tendency to seek sexual stimulation from unusual or inappropriate objects

53
Q

What is hyperorality?

A

This was described by Ozawa et al. as “an oral tendency, or compulsion to examine objects by mouth”

54
Q

What are the FTD language symptoms?

A

Progressively impaired and reduced output, eventually mute, empty content, word finding difficulties, poor verbal fluency, echolalia and perseveration.

55
Q

What is echolalia?

A

Repetition of another person’s words, without explicit awareness. (the same person is palilalia).

56
Q

What are the differential diagnoses for FTD?

A

Atypical presentations of functional psychiatric disorders, atypical alzheimer’s disease, cerebrovascular disease, and vascular dementia.

57
Q

What are strong discriminators between FTD, alzheimer’s and vascular dementia?

A

Changes in affect and lack of insight and concern are seen in FTD.

58
Q

What are other discriminators between FTD and alzheimer’s etc?

A

Patients with FTD lack emotions, such as sadness, empathy, and sympathy. As well as this there is the presence of repetitive behaviours.

59
Q

What are some clinical red flags that a patient has FTD rather than alzheimer’s?

A

early prominent behavioural features, especially if the social façade breaks down •insight is lost
episodic (collection of personal experiences, times, place, associated emotions etc) and topographical memory remain relatively intact.

60
Q

What is topographic memory?

A

Topographic memory involves the ability to orient oneself in space, to recognize and follow an itinerary, or to recognize familiar places. Getting lost when traveling alone is an example of the failure of topographic memory.[14]

61
Q

What would be seen on a SPECT scan in a patient with FTD?

A

Fronto-temporal hypo perfusion.

62
Q

What is the treatment for FTD?

A

SSRI (NOT acetylcholineesterase inhibitor, this may worsen symptoms)

63
Q

What do cognitive tests say in FTD?

A

Memory & visuospatial spared, frontal lobe tests positive.

64
Q

What histological features are seen in people who have dementia with Lewy bodies?

A

Neocortical lewy bodies, plaques but few neurofibrillary tangles.

65
Q

What proportion of dementia does LBD represent?

A

20%

66
Q

What percentage of post-mortem studies does LBD represent?

A

12-36%

67
Q

What is the ages of onset of LBD?

A

50-85 years of age

68
Q

What is the ratio of LBD in males and females?

A

M:F 1.2:3 M

69
Q

What are the CORE features and how many are needed to be sufficient for the diagnosis of probable LBD ?
(2 for probable, 1 for possible)

A

Fluctuating cognition with pronounced variation in attention and alertness, marked day to day, recurrent visual hallucinations (typically well formed and detailed), and spontaneous features of parkinsonism.

70
Q

What are the CENTRAL features which are essential for a diagnosis of probable or possible LBD?

A

Progressive cognitive decline (sufficient to interfere with normal social or occupational function), prominent or persistent memory impairment (may not necessarily occur in the early stages but more evident with progression), also deficits on tests of attention, executive function, and visuospatial ability.

71
Q

What are the suggestive features of LBD. NB: if one or more of these is present with one or more of the CORE features then a diagnosis of probable LBD can be made.

A

REM sleep behaviour disorder, severe neuroepileptic sensitivity (sedatory side effects etc), low dopamine transporter uptake in basal ganglia demonstrated by SPECT or PET scan (DAT scan normal in AD).

72
Q

What is REM sleep behaviour disorder?

A

Manifested by vivid and often frightening dreams during REM sleep, but without muscle atonia. Patients appear to “act out their dreams” vocalizing, flailing limbs, and moving around the bed (sometimes violently). Vivid visual images are often reported, although the patient may have little recall of these episodes.

73
Q

What is the preferred treatment for LBD?

A

Quitiapine

74
Q

What features are supportive of LBD, ie commonly present but not needed for diagnosis?

A

Repeated falls and syncope, severe autonomic dysfunction (orthostatic hypotension when the bp fall standing up, urinary incontinence), systematised delusions (MOST IMPORTANT IN RED),(MAYBE ASK IN OSCE) transient loss of consciousness, depression, hallucinations in other modalities (sensory etc), relative preservation of temporal lobe on CT/MRI, generalised low uptake on SPECT/PET perfusion scan with reduced occipital activity, prominent slow wave activity on EEG, with temporal lobe transient sharp waves.

75
Q

What is a systematised delusion?

A

A fixed, false system of beliefs with complex logical structure, constructed in order to protect the coherence of a single central delusion.

76
Q

What is seen on a CT of LBD?

A

Generalised atrophy but 40% have preserved medial temporal lobe structures

77
Q

Which drugs should not be used in LBD?

A

There is hypersensitivity to neuroepileptics and anti-emetics that affect dopinergic and cholinergic systems so never use haloperidol, chlorpromazine or thioridazine.

78
Q

Why is LBD a mixture between parkinson’s and alzheimer’s?

A

In DLB, loss of cholinergic (acetylcholine-producing) neurons is thought to account for degeneration of cognitive function (similar to Alzheimer’s), while the death of dopaminergic (dopamine-producing) neurons appears to be responsible for degeneration of motor control (similar to Parkinson’s) – in some ways, therefore, LBD resembles both disorders.

79
Q

What is the treatment for DLB?

A

Acetyl-cholinesterase inhibitors, be careful becauase psychiatric symptoms worse with L-Dopa, neuro symptoms worsen with anti-psychotics- may precipitate deaths, also psycho-social interventions and carer support.

80
Q

What percentage of DLB also have depressive episodes?

A

40-50%

81
Q

Histologically there are two types of DLB, what are they?

A

Picks (20-30%)- this has marked transcortical gliosis, ballooned neurones (picks cells), protein inclusion bodies (picks bodies). Non-picks- this is spongiform (porous structure) microvacuolation, mild gliosis (damage + proliferation of glial cells) .

82
Q

Which tests does the GP use in dementia screening?

A

6-CIT and GPCOG

Psychiatry (24 decks)

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