Cognitive Disorders Flashcards
What are the most common causes of delirium?
infection, medications, substance intoxication or withdrawal, and electrolyte imbalances
What are the core features of delirium?
- acute and fluctuating course
- inattention
- disorder thinking or altered level of consciousness
What is the treatment for delirium?
- treatment of the underlying cause
- ensuring patient safety in the form of one-on-one observation and keeping shades open/not napping
- haloperidol for severe agitation (benzodiazepines will likely worsen delirium)
What is the most likely diagnosis when the following are present: dementia with a stepwise increase in severity and focal neurological signs.
multi-infarct, vascular dementia
What is the most likely diagnosis when the following are present: dementia, cogwheel rigidity, and resting tremor.
Lewy body dementia or Parkinson disease
What is the most likely diagnosis when the following are present: dementia, gait disturbance, urinary incontinence, and dilated cerebral ventricles.
normal pressure hydrocephalus
What is the most likely diagnosis when the following are present: dementia, obesity, coarse hair, constipation, and cold intolerance.
hypothyroidism
What is the most likely diagnosis when the following are present: dementia, diminished position and vibration sensation, and megaloblastic anemia.
B12 deficiency
What is the most likely diagnosis when the following are present: dementia, tremor, abnormal LFTs, and Kayser-Fleischer rings.
Wilson disease
What is the most likely diagnosis when the following are present: dementia, diminished position and vibration sensation, and Argyll Robertson Pupils.
neurosyphilis
What are the neurotransmitter and pathological changes are associated with Alzheimer disease?
- a decrease in acetylcholine due to a loss of noradrenergic neurons in the basal cerulean and a decrease in choline acetyltransferase
- gross examination of the brain reveals central atrophy, narrowing of the gyri, widening of the sulci, and dilation of the ventricles
- histology reveals neuritic plaques with an AB amyloid and entangled neuritic processes in addition to the presence of intracellular, hyperphosphorylated tau protein deposits
- dementia correlates with the number of neurofibrillary tangles
How is Alzheimer disease differentiated from many of the other types of dementia?
motor and sensory symptoms are affected very late if at all in the course
What are the genetic risk factors for Alzheimer’s?
- ApoE4 increases one’s susceptibility
- presenilin 1 and 2 mutations as well as trisomy 21 are associated with early onset Alzheimer disease
How can Lewy body dementia and Parkinson disease be differentiated?
- dementia is a late feature of Parkinson disease whereas Lewy body has parkinsonian features with early onset dementia and hallucinations
- often dementia with Lewy bodies is a diagnosis made if the dementia has an onset within 12 months of the parkinsonism symptoms
How does Lewy body dementia present?
- a dementia that is more waxing and waning
- parkinsonism
- visual hallucinations
- REM sleep behavior disorder
What is the treatment for Lewy body dementia?
- cholinesterase inhibitors improve hallucinations
- atypical neuroleptics are added to stop delusions and agitation
- psychostimulants, levodopa/carbidopa, and dopamine agonists are used to improve cognition, apathy, and psychomotor slowing
- clonazepam is used to treat REM sleep behavior disorder
What are the core features of pick disease?
it is a frontotemporal dementia characterized by changes in personality and social conduct, disinhibition, cognitive deficits, and poor insight into their condition
What are the pathological features of Lewy body dementia?
lewy neurites, which are pathologic aggregations of alpha-synuclein, primarily in the basal ganglia
What are the pathological features of pick disease?
- marked frontal and temporal atrophy
- neuronal loss, micro vacuolization, and astrocytic gloss in cortical layer II
What is the treatment for pick disease?
anticholinergics and antidepressants
What are the risk factors, clinical manifestation, and treatment for HIV-associated dementia?
- risk increases with duration of illness, low CD4 count, and high viral loads
- presents with a rapid decline in cognition, poor memory, psychomotor retardation, social withdrawal, and depression
- treat with HAART and psychostimulants for fatigue/psychomotor retardation
What are the core features of huntington disease?
- progressive dementia
- choreiform movements and muscular hypertonicity
- depression, psychosis, and alcoholism; they have a high rate of suicide
What is the pathologic change associated with Huntington disease?
atrophy of the caudate
What is the cause of Huntington disease?
a CAG trinucleotide repeat
What are the core features of Parkinson disease?
- bradykinesia
- cogwheel rigidity
- resting tremor
- manlike facies
- shuffling gait
- dysarthria
- depression is extremely common
- REM sleep movement disorder is a common preceding sign
What are the pathologic features associated with Parkinson disease?
a loss of dopaminergic neurons in the substantial nigra, which typically project to the basal ganglia
Periodic sharp waves on an EEG are indicative of what disease process?
Creutzfeldt-Jakob disease
What are the core features of NPH?
“wet, wobbly, and wacky” = incontinence, ataxia, and dementia
