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NSB Lectures > Cognitive impairment and confused states > Flashcards

Cognitive impairment and confused states Flashcards

1
Q

What is confusion?

A

Not being able to think clearly.

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2
Q

What is cognition?

A

The mental processes involved in making sense of and learning about the world around us.

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3
Q

What type of cognition declines with age?

A

Fluid cognition

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4
Q

What is fluid cognition?

A

The ability to process new information to quickly solve problems.

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5
Q

At what age does fluid cognitive abilities start to decline?

A

20.

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6
Q

What is crystallised cognition?

A

Using cumulative skills and memories from cognition processing that has occurred in the past.

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7
Q

What problems may cause young adults to experience cognitive impairment?

A

Acute illness
Post-surgery
Sleep deprivation
Extreme exercise
Alcohol
Drugs
Depression

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8
Q

What is some key features of delirium?

A

Acute onset
Impairment of attention and awareness
Fluctuating
Often worse in the evening

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9
Q

What is delirium usually caused by?

A

Systemic illness

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10
Q

What type of delirium usually presents with agitation, pacing and aggression?

A

Hyperactive delirium.

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11
Q

What type of delirium usually presents with reduced movement, sleepiness and reduced appetite?

A

Hypoactive delirium.

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12
Q

What percentage of hospital inpatients suffer from delirium?

A

20%

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13
Q

Up to how many elderly inpatients are likely to suffer from delirium?

A

Up to half.

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14
Q

Years following a period of delirium, the risk of what condition increases?

A

Dementia.

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15
Q

What types of patients are as risk of delirium?

A

Older adults + young children
Multiple co-morbidities/frailty
Polypharmacy
Pre-existing cognitive impairment
Sensory impairment

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16
Q

How can delirium be prevented?

A

Prevent dehydration + constipation
Treat infections early
Maximise sleep
Encourage mobility
Manage pain
Ensure good nutrition

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17
Q

What term is used for a group of progressive, neurodegenerative brain disorders?

A

Dementia

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18
Q

Which cognitive condition is one of the main causes of disability later in life?

A

Dementia.

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19
Q

What are the main differences between delirium and dementia?

A
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20
Q

What are the main types of dementia?

A
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21
Q

Which three proteins unfolding are linked to dementia?

A

Amyloid
Tau
Synuclein

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22
Q

Which proteins are linked to Alzheimers?

A

Amyloid
Tau

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23
Q

Which protein is linked to Parkinsons/dementia with Lewy bodies?

A

Synuclein

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24
Q

Which protein is linked to frontotemporal dementia?

A

Tau

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25
Q

In particular cases, especially with young onset dementia, what procedure may be done to help with the diagnosis?

A

Lumbar puncture to test for presence of proteins.

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26
Q

What form of dementia is the most common?

A

Alzheimers.

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27
Q

In Alzheimer’s disease, there are usually amyloid ___ and neurofibrillary ___.

A

Plaques
Tangles

28
Q

Are amyloid plaques extra or intracellular?

A

Extracellular

29
Q

Are neurofibrillary tangles extra or intracellular?

A

Intracellular

30
Q

What is vascular dementia caused by?

A

Cerebrovascular disease

31
Q

What are the three subtypes of vascular dementia?

A

Multi-infarct dementia (cortical vascular dementia)
Small vessel dementia (Subcortical vascular dementia)
Strategic infarct dementia

32
Q

What pathological changes are seen in multi-infarct dementia (cortical vascular dementia)?

A

Multiple cortical infarcts.

33
Q

What pathological changes are seen in small vessel dementia (Subcortical vascular dementia)?

A

Lacunes + extensive white matter lesions.

34
Q

What pathological changes are seen in strategic infarct dementia?

A

Infarct in a strategic location (e.g. thalamus)

35
Q

Dementia occurs in 15-30% of people in three months following what type of event?

A

A stroke

36
Q

Dementia with Lewy bodies and Parkinson’s disease dementia are caused by what?

A

Lewy bodies in areas of the brain.

37
Q

In Parkinson’s disease, where are lewy bodies located?

A

In the sub cortex.

38
Q

What is a Lewy body?

A

Intracellular inclusions which consist of the protein a-synuclein.

39
Q

Where are Lewy bodies located in Dementia with Lewy bodies?

A

Cortex

40
Q

Usually, a-secretase cleaves Amyloid Precursor Protein into non-amyloid products. What happens in Alzheimer’s disease instead?

A

APP is cleaved by b and y secretase into b-amyloid.

41
Q

What are some common clinical features of Alzheimers?

A

Amnesia (STM first, LTM later)
Loss of motor skills
Poor recognition of objects + faces
Speech disturbances
Behavioural + psychological disturbances

42
Q

Mutations in amyloid precursor protein and what two genes have been linked to young onset Alzheimer’s disease?

A

PSEN-1
PSEN-2

43
Q

Which gene has been linked to late onset Alzheimer’s disease?

A

APOE e4.

44
Q

What pathological features are common in Alzheimer’s disease on imaging?

A

Global cortical atrophy + hippocampus atrophy.

45
Q

In which type of dementia are visual hallucinations common?

A

Dementia with Lewy bodies.

46
Q

In which type of dementia are MRI/CT scans often normal?

A

Dementia with Lewy bodies

47
Q

What sleep disorder is caused by dementia with Lewy bodies?

A

REM sleep behaviour disorder - a lot of physical movement during REM sleep.

48
Q

What is frontotemporal dementia?

A

Selective progressive atrophy involving the frontal or temporal lobes or both.

49
Q

Which three proteins are responsible for the different types of frontotemporal dementia?

A

Phosophorylated Tau
TDP-43
Fused in sarcome protein (FUS)

50
Q

What is Pick’s disease?

A

A type of FTD caused by Tau

51
Q

In FTD, at what age do symptoms typically present?

A

50-60

52
Q

What are common clinical features of FTD?

A

Behavioural problems
Language difficulties

53
Q

Cognitive ____ therapy has been proven to improve cognition in dementia.

A

Stimulation

54
Q

Which inhibitors blocking the breakdown of ACh can help symptoms in mild-mod Alzheimer’s disease?

A

Cholinesterase inhibitors

55
Q

Memantine is used in mod-severe Alzheimer’s disease and blocks receptors to reduce what type of activity in the brain?

A

Glutamate-mediated excitotoxicity.

56
Q

Donepezil and Memantine are both used in what type of dementia?

A

Alzheimer’s disease.

57
Q

Which drug is not licensed but is widely used for Dementia with Lewy bodies?

A

Rivastigmine.

58
Q

What type of drugs can reduce impulsivity in frontotemporal dementia?

A

Antidepressants.

59
Q

Young onset dementia is typically defined as before what age?

A

<65

60
Q

A higher level of cognitive function reduces the risk of dementia, as the brain is more able to compensate for pathological changes. What is this concept called?

A

Cognitive reserve.

61
Q

Does sudden onset cognitive impairment occur in delirium or dementia?

A

Delirium.

62
Q

Is impaired attention more common in delirium or dementia?

A

Delirium.

63
Q

Are fluctuations in cognition and awareness more common in delirium or dementia?

A

Delirium.

64
Q

In what type of dementia is a gradual decline in cognition, function and memory of recent events affected?

A

Alzheimer’s disease.

65
Q

A gradual change in impulsivity and social disinhibition is common in which type of dementia?

A

Frontotemporal.

66
Q

Are visual hallucinations more common in delirium or dementia?

A

Delirium.

NSB Lectures (48 decks)

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