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Neurology 2 > Dementia > Flashcards

Dementia Flashcards

1
Q

Delirium

- define

A
  • confusional state
  • acute or subacute disorder of attention
  • MC clinical alteration of mentation
  • often d/t treatable dz outside nervous system
  • true medical emergency!
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2
Q

Delirium

  • most often seen what ages
  • often mistaken for what
A
  • young and old

- psychiatric illness

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3
Q

Causes of delirium

A
  • Drug OD, withdrawal
  • poison
  • head trauma
  • infections (not just of the nervous system, UTI in elderly ex.)
  • metabolic
  • seizure
  • tumor
  • high fever
  • intestinal obstruction
  • pancreatitis
  • fractures (meds to tx)
  • fat embolism
  • lupus cerebritis
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4
Q

Where do pts with delirium generally present to healthcare industry?

A

ER (not clinic)

- someone brings them in bc they’re worried the pt is different

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5
Q

How good of a historian is a pt with delirium?

A

bad - rely on family members, friends, nursing home, etc. for history

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6
Q

Sx of delirium

A
  • disordered attention
  • poor memory recent events
  • poor insight into illness
  • hallucinations, delusions, paranoia, apathy
  • tangental communication
  • anomia
  • agraphia
  • R/L disorientation
  • acalcula
  • retropulsive gait disorder
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7
Q

Anomia

A

can’t name three objects

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8
Q

Agraphia

A

can’t write

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9
Q

Delirium dx

A
  • proper hx is important

- standard labs (CB, UA, EKG, CMP, Troponin, tox screen, fsbs)

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10
Q

If first round of testing was inconclusive, waht is second line of w/u for delirium

A
  • CT or MRI
  • LP
  • ammonia level
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11
Q

Is delirium a disease or a symptom

A

a symptom (with a cause)

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12
Q

Tx of delirium

A
  • treat underlying cause

- Thiamine before dextrose (to avoid acidosis)

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13
Q

When should sedation be used in delirium

A

only AFTER dx of cause is made, never before!

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14
Q

Time frame for delirium vs. dementia

A
  • delirium: hours to days

- dementia: months to years

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15
Q

dementia definition

A
  • irreversible progressive decline in intellectual function
  • disconnection from the cognitive world
  • not a clinical diagnosis (have to have an underlying cause)
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16
Q

What does the ddx of dementia rely on?

A

early patterns of intellectual decline to help establish etiology and anatomical focus

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17
Q

Four types of memory list

A
  1. Exteroceptive (declarative) memory
  2. Interoceptive (emotional, affective) memory
  3. Motor (procedural) memory
  4. Executive memory
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18
Q

Declarative memory

  • define
  • what parts of brain
A
  • info gained from external senses (facts, data, events)

- hippocampus and posterior neocortex

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19
Q

Emotional/affective memory

  • define
  • parts of brain
A
  • info gained through experiential phenomena

- amygdala, posterior insula (limbic system), neocortex

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20
Q

Procedural memory

  • define
  • parts of brain
A
  • info gained through movement

- motor cortex, basal ganglia, cerebellum

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21
Q

executive memory

  • define
  • parts of brain
A
  • gained through “metacognition” across time (insight, foresight, morals, etc.)
  • prefrontal neocortex
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22
Q

name of test to check cognitive status

A
  • cognistat (among others)

- is a snapshot in time, have to test repeatedly to get picture of change over time

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23
Q

DSM 5 criteria for dementia

A
  • memory loss
  • 1 or more cognitive impairment
  • functional impairment of IADLs
  • exclusion of delirium
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24
Q

IADLs

A

instrumental activities of daily living

- allow you to live independently such as bathe, grocery shop

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25
Q

How to measure IADLs

A

Lawton’s IADL scale

- no good or bad number, just watch to see how changes over time

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26
Q

List 9 causes of dementia

A
  1. cognitive aging
  2. drugs
  3. demyelinating diseases (MS)
  4. hydrocephalus
  5. masses
  6. infections
  7. metabolic issues
  8. vascular issues
  9. degeneration
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27
Q

Classic aging/oldtimers dementia

A

Cognitive aging effect

  • decline in multitasking, non-verbal IQ, nominal recall
  • mild forgetfulness
  • mild word finding problems
28
Q

drug induced dementia dt what drugs

A
  • anticholinergics (tricyclics, SSRIs, antihistamines)
  • anxiolytics - benzo
  • neuroleptics
  • cardiac meds (bb, alpha agonists, ACEi, statins)
  • pts taking more 5+ meds
29
Q

Types of masses that cause dementia

A
  • meningiomas
  • gliomas
  • subdural hematomas
30
Q

Infections that cause dementia

A
  • tertiary syphilis
  • Creutzfeld-Jakob disease
  • Tubercular or fungal
  • HIV encephalopathy
  • progressive multifocal leukoencaphalopathy (opportunistic infection)
  • toxoplasmosis
31
Q

Metabolic causes of dementia

A
  • Wilson’s disease
  • B12 deficiency
  • ETOH abuse
  • thyroid disease
32
Q

Vascular causes of dementia

A
  • CVA

- lacunar infarcts

33
Q

Degenerative causes of dementia

A
  • Pick disease
  • Spinocerebellar degeneration
  • Alzheimer’s
  • Lewy body disease
34
Q

Type of dementia seen in pick disease

A

frontotemporal dementia

rare

35
Q

What is affected in spinocerebellar degeneration

A

motor tracks

36
Q

Alzheimer’s disease

- describe

A

Insidious onset and gradual decline in activities, behavior, and cognition over time

37
Q

How many stages of disease in Alzheimer’s?

A

7

38
Q

Alzheimer’s Stage 1

A

no impairment

  • not detectable
  • no memory problems or other sx
39
Q

Alzheimer’s stage 2

A

very mild decline

  • minor memory problems
  • lose things around the house
  • hard to distinguish from aging memory loss
40
Q

Alzheimer’s stage 3

A

mild decline

  • friends/fam start to notice cognitive problems
  • performance on memory/cognitive tests impaired
  • lose personal possessions
  • trouble with the following:
  • finding words
  • remembering names of new acquaintances
  • planning and organizing
41
Q

Alzheimer’s stage 4

A

moderate decline

  • clear cut sx of Alzheimer’s
  • difficulty with arithmetic
  • may forget details about own life
  • poor short term memory (what ate for breakfast)
  • inability to manage finances/pay bills
42
Q

Alzheimer’s stage 5

A

moderately severe decline

  • need help with day to day activities
  • significant confusion
  • can’t recall simple details about self like phone number
  • still can bathe and toilet
  • still know family members and own family history, esp childhood and youth
43
Q

Alzheimer’s stage 6

A

severe decline

  • need constant supervision and require personal care
  • unaware/confusion of surroundings
  • major personality changes
  • need assistance with toilet and bathing
  • inability to recognize faces except friends/family
  • inability to remember most details of personal history
  • loss of bowel/bladder function
  • wandering
44
Q

Alzheimer’s stage 7

A

very severe decline

  • nearing death
  • lose ability to respond to environment or communicate
  • no insight into condition
  • require assistance with all activities of daily living
  • may lose ability to swallow
45
Q

Summary of Alzheimer’s

A
  • overt amnestic memory loss
  • anomia
  • posterior cognitive defects
  • loss of social interaction and personal hygiene
  • global aphasia
  • severe cognitive decline
  • retain ability to walk
  • bedridden, eventually in fetal position
46
Q

posterior cognitive deficit seen in Alzheimer’s

A
  • spatial disorientation
  • loss of math abilities
  • trans cortical sensory aphasia
  • paranoia, hallucinations, hoarding, agitation
  • sensory aphasia - repetitive speech
47
Q

Two histological markers seen in Alzheimers’

A
  • Tao protein (tangles)
  • Amyloid plaques
  • in cortical mass
48
Q

Brain changes in Alzheimers on CT

A
  • gray matter degeneration

- ventricles appear enlarged

49
Q

Explain teh cholinergic hypothesis for Alzheimer’s

A
  • cholinergic cells die early
  • nucleus basalts, neocortex, temporal lobes
  • tx by giving ACh
50
Q

Common drug used to treat Alzheimer’s

A

Donepezil (Aricept) 5 mg daily

51
Q

What is the benefit of donepezil?

A

Delays entrance to nursing home by about 18 months

52
Q

Non pharm management of Alzheimer’s

A
  • caregiver to AD support group
  • pt wear medic alert ID bracelet
  • pt assign POA to caregiver
  • Screening labs (B12, TSH, RPR, HbA1c)
  • reduce alcohol
  • discuss driving issue
53
Q

What is the effect of ginkgo biloba on AD?

A

no difference from placebo

54
Q

Lewy Body dementia

  • how common
  • sx overview
A
  • second MC after AD

- fluctuating course with prominent neuropsychiatric and parkinsonism sx

55
Q

Lewy body dementia

- what general effect that AD does not have

A
  • motor problems
56
Q

Lewy body dementia

- histology

A

abnormal collections of protein (plaques) but no tangles

57
Q

Sleep issues in Alzhiemer’s vs. Lew Body

A

AD: insomnia

Lewy Body: disordered sleep

58
Q

Three core features in Lewy Body Dx

A
  • fluctuations in alertness during day
  • parkinsonism (bradykinesia, rigidity>tremor)
  • visual hallucinations
59
Q

What meds does Lewy body Dementia respond to?

A

ACH-esterase inhibitors

*but study didn’t go past 24 weeks or have large sample size…

60
Q

What is effect of NMDA receptor antagonist on Lewy body dementia

A

stabilizes patients for 6-12 months

61
Q

How to manage lewy body dementia

A
  • donepezil (Aricept) 5 mg daily for dementia
  • Sinemet for parkinsons sx
  • clonazepam for sleep issues
  • PT to help with motor issues
62
Q

Vascular dementia

A
  • acute or subacute onset of gait disorder and or memory loss
  • related to atherosclerosis: multiple small infarcts over time
  • bruits in carotids and subclavian
  • end up having massive stroke
63
Q

Binswanger’s Disease is an extension of what

A

vascular dementia

- also multi infarct type of disease

64
Q

How to manage vascular dementia

A
  • donepezil
  • same tx as any vascular disease
  • reduce bp, cholesterol, the rate (heart rate?)
  • daily ASA
65
Q

Chronic traumatic encephalopathy (CTE)

  • related to what histological finding
  • who gets it
A
  • tao proteins

- NFL, NHL, professional boxers, veterans from gulf war

Neurology 2 (21 decks)

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