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Licensure > Delirium, Dementia and Other Cognitive Disorders > Flashcards

Delirium, Dementia and Other Cognitive Disorders Flashcards

1
Q

Features of Dementia

A

Slow to develop
Progressive
Irreversible in most cases

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2
Q

Pseudodementia

A

Condition caused by another psychiatric disorder that mimics dementia (confabulatory)

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3
Q

Delirious pt response to questions

A

Unable to answer
Confused
Frightened
Angry

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4
Q

Demented pt response to questions

A

Tries to answer

Will say, “I don’t know.”

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5
Q

Pseudodemented pt’s response to questioning

A

Will not try to answer

Will say, “I don’t know.”

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6
Q

Amnesic disorder

A

Memory impairment caused by:
A general medical condition
Persisting effects of substance use.

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7
Q

Amnesia

A

Inability to learn new information or recall old

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8
Q

Agnosia

A

An impaired ability to recognize familiar objects or people

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9
Q

Aphasia

A

Language disturbance in expressing and understanding spoken words

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10
Q

Apraxia:

A

Inability to carry out motor activities despite intact motor function

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11
Q

4 early signs of dementia

A

Amnesia
Agnosia
Aphasia
Apraxia

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12
Q

Most common type of dementia

A

Alzheimer’s

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13
Q

Predisposing factors for dementia

A

Familial form of Alz
Huntington’s is autosomal dominant on Chromosome 4:
-Risk for children is 50%
Creutzfeldt-Jakob Disease
-Genetic component appears in 10-15% of cases
Pick’s Disease
-Linked to genes on chromosomes 3 and 17

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14
Q

Vascular Dementia

A 
Caused by TIAs and strokes
Vascular changes related to a number of diseases with known genetic links:
-HTN
-DM
-High cholesterol
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15
Q

Alz Neurobiology

A

Progressive, widespread brain atrophy
Dec availability of ACh
Markedly increased neuritic plaques and neurofibrillary tangles

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16
Q

Vascular Dementia Neurobiology

A

Brain has multiple vascular lesions in the cortex and subcortical areas

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17
Q

Pick’s Disease Neurobiology

A

Atrophy of the frontal and anterior temporal lobs of the brain
Swollen neurons with well-defined “Pick’s Bodies.”

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18
Q

Normal Pressure Hydrocephalus Neurobiology

A

Impaired return of cerebral spinal fluid to the brain from the spinal column
Enlarged ventricles seen on CT or MRI
Reversible if surgery performed soon enough

19
Q

Vitamin B12 deficiency dementia neurobiology

A

Rare but potentially reversible

Inadequate B12 causes demyelination and axon loss

20
Q

Parkinson’s Disease Neurobioloty

A

50% reduction in neurons in the substantia nigra

Remaining cells containing Lewy bodies

21
Q

Diffuse Lewy Body Disease Neurobiology

A

Lew bodies in the frontal and temporal cortex primarily

Presence but in lesser frequency in the hippocampus and substantia nigra

22
Q

Creutzfeld-Jakob’s Disease Neurobiology

A

Infecting agent known as a prion that causes spongiform Encephalopathy in which cells are stripped of intracellular material
Transmissible by blood and body fluid
Bovine spongiform encephalopathy is a variant

23
Q

Environmental factors in dementia

A 
Head injury
Down Syndrome
Chronic alcoholism
"Huffing"
Long-term use of BZOs and barbiturates
"Rave" drugs
24
Q

Nun study

A

Nuns donated brains to science:

  • Plaques and tangles present, but no Alz
  • Plaques and tangles not enough to explain Alz
25
Q

Order of Sx: Alz

A

Memory loss
Inability to problem solve in new situations
Decline is gradual

26
Q

Order of Sx: Vascular Dementia

A

Symptom appearance is more abrupt
Coupled with neurological symptoms
Usually stair-step detioriation

27
Q

Order of Sx: Pick’s Dz

A

Behavioral changes appear first

28
Q

Order of Sx: CJD

A

Personality changes
Szrs
Myoclonic movements
Course is rapid, death within a year

29
Q

Order of Sx: Lewy Body Dz

A

Hallucinations
Fluctuating alertness
Tendency to fall appear early in 80% of those with EPS

30
Q

Order of Sx: Huntington’s

A

Insidious behavioral changes
Disruption of attention
Personality
Choreiform movements

31
Q

Order of Sx: Korsakoff’s

A

Wernicke’s (reversible with thiamine)
Ataxia
Nystagmus
Confabulation

32
Q

AIDS/Dementia Complex

A

Subcortical Dementia with infiltration of infected macrophages or microglial cell into the brain

33
Q

AIDS/Dementia Complex: Cognitive Deficits

A

Memory loss, speech problems

34
Q

ADC: Motor Deficits

A 
Loss of bladder tone is early indication
Paraparesis
Lower-extremity spasticity
Ataxia
Extensor-plantar responses in the absence of spinal cord abnormalities
35
Q

ADC: Behavioral Sx

A

Early presentation with inability to conduct ADLs

36
Q

ADC: Mood Sx

A

Severe changes in usual mood, with wide variation from psychosis, or mania, or depression

37
Q

ADC: Differential Dx

A 
Syphilis
B12 and folate
Thyroid
Electrolytes 
BUN/Cr
38
Q

Non-pharm interventions in post-TBI dementia

A

Safety Plan
Follow-up for one year after any suicide attempts
PT for the vestibular dysfunction
OT for traumatic vision syndrome, characterized by scanning and accommodation difficulties

39
Q

Rules for treating depression in persons with dementia (or the elderly in general)

A

Start low and go slow

TCAs work well in the elderly, but a lot of anticholinergic activity

40
Q

Fluoxetine in the elderly

A

Don’t use it

41
Q

SIADH

A

Syndrome of inappropriate antidiuretic hormone:

Possible side effect of SSRIs in the elderly

42
Q

EPS with SSRIs

A

Rare, but can occur

43
Q

First-line drug therapy

A

Donepezil (Aricept) 5mg orally daily (max 10mg/day)

44
Q

Features of Delirium

A 
Rapid onset
Altered state of consciousness
Presence of a general medical condition
Presence or withdrawal of a substance
Generally reversible
Acute medical emergency

Licensure (24 decks)

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