Cognitive Disorders (lec 2) Flashcards
Cognitive Disorders affect? (8)
May cause? (2)
Judgement Initiative Memory/recall Orientation Impulse control Emotional stability Attention span Problem solving
Hallucinations
Confabulation (make up memories)
Delirium DSM criteria?
ACUTE, rapidly progressive ∆s in cognition
Seen as:
inattention
disturbed consciousness,
sxs fluctuate over 24 hrs
(aka encephalopathy, acute confusional state)
Delirium sxs? (5 general categories)
1) Arousal: altered levels
2) Memory: impairment
3) Orientation: dis
4) Perception: disturbance
5) Language: disturbance
Risk factors of delirium? (8)
INFECTION Existing cognitive impairment >70 yo Poor fxnl status Hearing/visual impairment Dehydration (e- disturbance) Sleep deprivation Polypharmacy
Delirium DDX?
2° to medical condition or substance Intoxication W/drawal Dementia Psych disorders Fakers
Delirium assessment includes? (3 categories)
Primary survey:
Good hx and physical
Mental status
Secondary survey:
Reassess (delirium ∆s rapidly)
Thorough medical workup: CBC CMP UA (UTI common cause) EKG CXR (PNA common cause)
Delirium tx? (5)
Treat cause/stop offending meds Stable environment Ensure they can hear and see Full-time sitter Educate family/caregivers
Common meds that cause delirium? (5)
BZs Tramadol Opiates Anticholinergics H2 blockers (U pepsid)
Pharm tx for delirium indicated when? (3)
1) severe agitation
2) combative
3) behavior that interferes w/ care
Drugs used to treat delirium?
Risk a/w these meds?
Antipsych:
Haloperidol, Zyprexa, Seroquel, Risperdal
↑ risk of sudden death in pts w/ dementia
Considerations w/ antipsych meds for delirium? (5)
Get baseline ECG (can ∆ QTI) Correct e- Start slow/go slow Watch BP/orthostatics Educate family
Benzodiazepines indicated for tx of what type of delirium?
EtOH or drug-induced
EtOH w/drawal delirium presentation?
EMERGENCY
Extreme auto hyperactivity w/ delirium
Dementia DSM criteria?
Acquired, CHRONIC, progressive decline in memory w/ assoc’d cognitive/fxnl impairment
IRREVERSIBLE
Possible Dementia-related cognitive disorders?
1) aphasia (can’t understand and/or express speech)
2) apraxia (loss of motor skills)
3) agnosia (can’t recognize sensory input - don’t know what things are)
Cannot diagnose Dementia when what?
delirium is present
Causes of Dementia? (4)
Alzheimer’s
Vascular/Multi-infarct
Neurodegeneration
2° to other dzs/conditions
Neurodegenerative process that cause dementia? (3)
1) Lewy Body Dz (protein deposits -> hallucinations that don’t cause concern to the pt)
2) Parkinson’s
3) Frontaltemporal degen/Pick’s Dz (behavioral disturbances/disinhibition, non-fluent aphasia)
Vascular/Multi-infarct dementia U accompanied by or result of?
vascular risks (DM, heart dz, CAD) U follows CVA
Dementia caused by Creutzfeldt-Jakob Dz:
Etiology?
Epidemiology?
Onset?
Sxs?
Prognosis?
Caused by prion
U 40-60 yo
Rapid onset
Triad of dementia, involuntary mvmt, hallucinations (end up unable to move)
Fatal
Huntington’s dementia:
Etiology?
Epidemiology?
Sxs?
Imaging findings?
Auto dominant
U onset 30-40s
Choreiform mvmts
Boxcar ventricle on imaging
HIV dementia:
Etiology?
Sxs?
Direct result of HIV (find in CSF)
Forgetful, slow, apathy, delirium
Tremors, ataxia
Reversible dementias include? (5)
1) Normal Pressure Hydrocephalus
(sudden falls + urinary incontinence + neurocog decline)
2) B12 deficiencies
3) Hypothyroid
4) Depression
5) Syphilis
Dementia DDX? (4)
Mild cognitive impairment
Reversible dementias
Delirium
Amnestic disorders
Mild Cognitive Impairment is?
Presentation?
Increases risk for what?
Pre-dementia
Subjective memory complaints,
objective mild memory impairment,
preserved cognitive fxn,
intact ADLs
ALL types of dementia
Dementia assessment includes? (4)
Hx/physical
Labs
Neuroimaging
Cognitive testing
NO definitive test while alive
Dementia labs? (8)
CBC/CMP TSH B12 Folate Homocysteine (high levels ↑ strokes) SED rate HIV RPR (rapid plasma reagin for syphilis)
Dementia imaging?
CT or MRI to r/o reversible dementias
Mental status testing for dementia?
MMSE
Dementia management? (4)
Tx cognitive sxs
Behavior mgmt
Educate/support for caregiver
Prevention
Tx for dementia-related cognitive sxs?
Cholinesterase inhibitors (aricept) NMDA antagonists (memantine)
Amnestic Disorders are?
Impaired or inability to:
Learn new info
Recall learned info or past events
Causes marked social/occupational impairment
NOT caused by delirium or dementia
Amnestic Disorder presentation?
Confused/disoriented Confabulation Rarely disoriented to self (know who they are) Unaware of deficits Apathy of deficits
Amnestic Disorders caused by? (8)
Head injury Drugs Postictal (seizure) Shock therapy Focal tumors/infarcts Infection Cerebral anoxia Transient global
Transient Global Amnesia is?
Abrupt loss of recall or ability to make new memories in healthy people
Lasts 6-24 hrs
Types of EtOH-induced amnesia? (2)
1) Wernicke’s Encephalophathy
2) Korsakoff’s Syndrome
Wernicke’s Encephalophathy result of?
Triad of sxs?
ACUTE EtOH-induced thiamine deficiency
Ophthalmoplegia (paralysis of ocular mm)
Ataxia
Nystagmus
Korsakoff’s Syndrome results of?
Presentation?
CHRONIC EtOH-induced thiamine deficiency
Similar triad + (P) psychosis
IRREVERSIBLE
