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Neuro Quiz 5 > Cognitive Impairment > Flashcards

Cognitive Impairment Flashcards

1
Q

More sensitive assessment scales

A

MOCA (Montreal cognitive assessment)

SLUMS (St. Louis University Mental Status)

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2
Q

Less sensitive assessment scales

A

Clock Drawing Test

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3
Q

Assessment test sensitive vs specific

A

Can detect cognitive impairment, but cannot identify the cause

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4
Q

Reversible Cognitive Impairment

A
  • Delirium/acute confusional states
  • Pseudo-dementia of depression
  • Drug induced
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5
Q

Irreversible Cognitive Impairment

A
  • Mild cognitive impairment

- Dementia

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6
Q

Cortical dementia

A

Alzheimer’s Disease
Frontal- Temporal
Pick’s Disease

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7
Q

Sub-cortical dementia

A 
Parkinson's Disease
Huntington's 
Normal pressure hydrocephalus
Progressive supranuclear 
AIDS
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8
Q

Cortical presentations

A

Outer layers of the brain

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9
Q

Define Amnesia

A

The acquistion (learning) and storage (memory) of new information

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10
Q

Define Executive Function Deficits

A

Ability to employ insight, judgement, problem solving or abstract thought

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11
Q

Define Apraxia

A

Ability to perform skilled acts or use tools

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12
Q

Define Aphasia

A

Speech and language

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13
Q

Define Agnosia

A

Ability to recognize/naming objects or people

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14
Q

Sub-cortical presentations

A

Refer to deep structures within the brain

  • higher level executive function, language skills, and memory
  • Motor function, voice function, slowed cognitive processing, control of bowel/bladder, autonomic symptoms
  • Behavioral/psychotic symptoms!!
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15
Q

Anticholinergic Drugs as Primary offenders for drug induced CI

A 
o	Atropine, benztropine
o	Antihistamines
o	TCAs, paxil, olanzapine
o	Cyclobenzaprine
o	Ditropan
o	Hyoscamine
o	Benzodiazepines, barbiturates, opiate, antipsychotics/depressants, AntiPD, corticosteroids, NSAIDs, FQ,
o	Clonidine, digoxin, amiodarone
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16
Q

Define Primary Offender

A

Drug with a MOA that is directly related to the potential for cognitive impairment

17
Q

Define Secondary Offender

A

Drug without a mechanisms BUT

1) Interact with or in a way to enhance side effect potential of drug in primary category OR
2) Drug for which inappropriate use, dose, or disease state interactions compromise stability

18
Q

Define Pseudo-dementia

A

Changes in cognitive functions are part of the cluster of symptoms that can present with depression
- Always asses mood status with cognitive status

19
Q

Tip on dementia vs depressed patients

A

Dementia patients will typical deny forgetfulness and compensate for the deficient but depressed patients will complain about it

20
Q

Delirium is…

A

NOT a disease state, it is a disease presentation!!

21
Q

Define Delirium

A

Cluster of symptoms that are caused by an underlying illness that the patient cannot articulate experiencing
• EITHER altered level of consciousness or LOC (hyper or hypo)
• OR disorganized thinking PLUS inattention, acute changes in mental status, fluctuating course

22
Q

Define Inattention

A

Inability to focus, concentrate or appropriately respond to external stimuli

23
Q

ICU Delirium

A

Critically ill pts in ICU are at a high risk especially ventilated patients
Use of sedatives, analgesics, sepsis presentation, brain injury all contribute to this

24
Q

Risk Factors for Delirium

A
  • Advanced age
  • Hospitalization
  • Surrogate markers of fraility (low body weight, malnutrition, dependence, etc)
  • Underlying dementia
  • Polypharmacy
25
Q

Precipitating Factors of Delirium

A

Infection, malignancy, pain, sleep deprivation, dementia, trauma
Exacerbation of underlying illness (HF, COPD, renal failure, MI, stroke)
Electrolyte/metabolic distrubances
Hypo/hypernatremia/kalemia
Alcohol or illicit/prescription drugs (ADR, indirect effect, withdrawal)

26
Q

Delirium is assessed through what test?

A

CAM

- Hand squezzing, nodding or blinking

27
Q

How do you treat delirium? NonPharm?

A 
Temperature and noise control
Orientation cues
Reassuring presence
Avoid sensory stripping
No physical restraints
28
Q

How do you treat delirium? Pharm?

A

Withdrawal preciptating meds

Optimize comfort: Haldol 0.5-1 mg PO or buccal, other antipsychotics (olanzapine), or Lorazepam for alcohol wihtdrawal

29
Q

Pitfalls of Pharm treatment of Delirium

A

No cocktails
No excessive dosage
Inappropriate frequency
Failure to d/c meds upon resolution

Neuro Quiz 5 (4 decks)

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