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D&T2 Exam 2 > Dementia and Delirium - Goebel > Flashcards

Dementia and Delirium - Goebel Flashcards

1
Q

what is the most common type of dementia

A

Alzheimer’s disease

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2
Q

what is the life expectancy of Alzheimer’s disease?

A

variable
older diagnosis = faster progression
10 years from diagnosis until death

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3
Q

what is the average life expectancy once end-stage disease is reached

A

average 1 year or less

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4
Q

what is the most likely diagnosis if a patient cannot cary our activities of daily living? and if they can?

A

Alzheimer’s disease

Mild cognitive impairment

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5
Q

what type of memory gets impacted the most in Alzheimer’s

A

short term more than long term

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6
Q

what protein is found in plaques

A

beta amyloid

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7
Q

what protein is found in neurofibrillary tangles

A

tau hyperphosphorlyation

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8
Q

when do plaques develop during the Alzheimers

A

long pre-clinical phase

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9
Q

tangles, and synaptic loss, accelerate during what phase of Alzheimer’s

A

before symptomatic phase appears

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10
Q

what is the progression for vascular type of neurocognitive disorder

A

step-wise

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11
Q

Lewy body has symptoms of what? how is this different form Parkinson’s

A

both dementia and Parkinson’s disease

- symptoms present at the same time unlike Parkinson’s

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12
Q

what is the hallmark clinical presentation of Lewy Body

A

Visual Hallucinations and falls

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13
Q

what is the pathophysiology of Picks disease

A

too much or abnormal tau protein

tau bodies

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14
Q

who usually gets Picks disease

A

younger onset

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15
Q

what does Picks present clinically

A

behavior, emotional and language changes

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16
Q

normal pressure hydrocephalus, what is the clinical feature

A

Wacky, wet, wobbly

memory loss, incontinence, unsteady gait

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17
Q

what infections cause neurocognitive disorder

A

HIV
Syphilis
Creutzfel-Jakob-prion

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18
Q

what deficiencies cause neurocognitive diorder

A

B12

hypothyroidism

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19
Q

what substance abuse is found to lead to neurocognitive disorder

A

chronic alcohol use

Korsakoff’s syndrome-thiamine

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20
Q

name 3 clinical memory tests

A

mini-cog
mini-mental status exam
montreal cognitive assessment (MOCA)

21
Q

what are the minimum lab studies that one needs to do for neurocognitive disorder

A

CBC
CCP
B12
TSH

22
Q

what imaging is done for neurocognitive disorders

A

CT without contrast

23
Q

what early onset genes can get mutated for Alzheimer’s ? what chromosomes are they located on

A 
amyloid percursor protein (Chr21)
presenilin 1 (Chr14)
Presenilin 2 (Chr1)
24
Q

what is the late onset gene gets mutated for Alzheimers

A

APOE gene e4

25
Q

what is the biggest risk factor for Alzheimers

A

age

26
Q

what are 4 risk factors for Alzheimer’s

A

hypertension
Diabetes
hypercholesterolemia
smoking

27
Q

when do yo not give medications to an Alzheimer’s patient

A

when they are bed bound

28
Q

what type of drug is Memantine

A

N methyl D aspartate receptor inhibitor

glutamate pathway

29
Q

what are 2 things that one can do to prevent Alzheimer’s

A

no smoking

control blood pressure

30
Q

what neurocognitive disorder am I?

short term memory loss, gradual decline

A

Alzheimer’s disease

31
Q

what neurocognitive disorder am I?

hallucinations/falls

A

lewy body

32
Q

what neurocognitive disorder am I?

stepwise decline

A

vascular

33
Q

what neurocognitive disorder am I?

behavior, speech, younger

A

picks

34
Q

what neurocognitive disorder am I?

wacky, wet, wobbly

A

normal pressure hydrocephalus

35
Q

What is the DSM-5 definition for Delirium

A

inattention

acute onset or fluctuating

36
Q

what is used to diagnose Delirium

A

CAM

confusion assessment method

37
Q

Diagnosis criteria using CAM ?

A

Both acute onset and fluctuating course and inattention needs to be present
OR
Both disorganized thinking or altered level of consciousness

38
Q

what is the mortality of Delirium

A

overall one year mortality - 35-40%

39
Q

What are patient risk factors for Delirium

A

male; functional impairment
over 65; lack of physical activity
dementia; alcohol abuse
depression; vision problems
terminal illness ; hearing loss
polypharmacy; can’t do ADLs

40
Q

what are etiologies of Delirium

A 
Drugs, drugs, drugs!
Electrolyte/endocrine  disturbances 
lack of drugs ( ETOH withdrawal) 
infection 
reduced sensory input
intracranial 
urinary, fecal 
major organ system issues
41
Q

what are surgeries can precipitate Delirium? When is it seen? what is the cause?

A 
orthopedic surgery
AAA repair
thoracic surgery 
post op day 1 or 2 
blood loss
42
Q

what are the basic evaluations that are done for Delirium

A

history: medication history, alcohol, illicit drug use
physical exam: vital signs
targeted labs: cbc, chem

43
Q

when do you give medication treatment for Delirium

A

severe agitation only

44
Q

what is the first line drug treatment for Delirium

A

haloperidol

45
Q

what is the alternate 1st line drug used to treat Delirium

A

atypical antipsychoitcs - Risperidone, olanzapine, quetiapine

46
Q

what is the second line treatment for Delirium? what type of patients take this drug and side effects?

A

Benzadiazepine- Iorazepam
for ETOH and sedative withdrawal patients
worsen other delirium syndromes

47
Q

what are 3 key features of delirium that differentiates it from dementia

A

acute onset
impaired attention
altered level of consciousness

48
Q

what protein is found in Lewy Body

A

Alpha Synuclein

D&T2 Exam 2 (14 decks)

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