First Aid CH8 NCDs Flashcards
three main categories of NCDs
delirium, mild NCDs, major NCDs
define delirium
acute brain failure, disorder of orientation (attention, awareness) and language/vision, medical emergency that’s generally reversible but potentially deadly
onset time of delirium
hours to days, sxs worse at night (usually)
risk factors for delirium
polypharm, advanced age, immobility, pre-existing cog impairment, ETOH use, severe/terminal illness, malnutirtion
medications that can cause delirium
TCAs, Benzos
Anti-cholinergics, H2 blockers
Corticosteroids, Meperidine (opioid)
five categories of delirium
substance intoxication/withdrawal
medication-induced
delirium d/t medical condition/multiple etiologies
three types of delirium based on psychomotor activity (one of the five categories then gets sub-classed with one of these)
mixed: most common, normal psychomotor or fluctuating
hypoactive: most likely to go undetected, presents as drowsiness or lethargy
hyperactive: agitation, uncooperative, disruptive, MC in drug withdrawal/toxicity
CAM test
evaluation for suspected delirium
sxs of delirium
short attention span, disorientation, fluctuations in lvl of consciousness, visual hallucinations, poor short-term memory
MC precipitants of delirium in kids
febrile illness, meds
delirium does what on EEG?
background slowing of activity
- exception is delirium tremens (fast activity)
delirium tx
treat underlying cause, keep family member at bedside for redirection and reorientation
- Haloperidol for agitation
when are benzos appropriate in delirium tx?
if the pt is delirious d/t benzo or ETOH withdrawal
can folks with mild NCDs maintain independence? major NCDs?
yes (can perform activities of daily living)
no
what tests are typically included in initial eval of any psych illness?
thyroid function tests
- look for sx pattern (hypo vs hyper)
efficacy of mini mental state exam (MMSE)
sensitive for major NCDs
- dysfunction < 25
unreliable sensitivity for mild NCDs and early major NCDs
define Mini-Cog
3-item recall + drawing clock
define Alzheimer’s Dx
MC underlying etiology of major NCDs, d/t accumulation of beta-amyloid plaques and tau proteins, seen as gradual progressive decline in cog function that affects memory, learning, and language
- personality changes
- mood swings
- paranoia
what other dx state are the beta-amyloid plaques and tau proteins found?
down syndrome (T21), inc risk of early-onset Alzheimer's in these pts - can be seen with NORMAL aging
what’s the definitive diagnostic test for Alzheimer’s?
postmortem path studies of brain
genetics that inc risk for Alzheimer’s
autosomal dominant mutation
- presenilin 1 or 2
- episilon-4 variant of apolipoprotein gene
typical diagnostic age of Alzheimer’s
65 yo
tx for Alzheimer’s dx
no cure
- cholinesterase inh (donepezil/aricept, rivastigmine, galantamine) slows clinical deterioration by 6-12 months in 50% of pts with mild-mod dx
- NMDA R ant (memantine/Namenda)
- low-dose antipsychotics (inc mortality in pts w/ dementia)
- environmental interventions (puzzles, music, etc)
define vascular cognitive impairment (vascular dx)
2nd MC cause of major NCD (20% of cases), cog decline occurs in step-wise fashion d/t cortical strokes and microvascular dx in white matter
risk factor for vascular cog impairment
HTN, diabetes, smoking, obesity, hyperlipidemia, a-fib, old age
what can occur with a vascular lesion to the frontal lobe?
personality changes, disinhibition, inappropriate behavior, aggression, apathy (lack of interest/concern), paranoia
can vascular cognitive impairment be confirmed by testing?
yes, neuroimaging
tx for VCI
no cure
- manage risk factors
- environmental interventions (puzzles, music, etc)
define Lewy body dx
(core fxs) progressive NCD revolving around path features of Lewy bodies (aggregations of alpha-synuclein) in brain (basal ganglia), visual hallucinations and extrapyramidal signs (Parkinsonism) common
suggestive fxs
- pt may have violent movements during sleep
- pt sensitive to antipsychotics
does Lewy body dx have a definitive diagnostic test?
yes.. but during autopsy
Lewy body dx tx
cholinesterase inh (donepezil/Aricept, rivastigmine, galantamine)
- quetiapine or clozapine (mine EPS and NMS)
- levo-carbidopa
define Frontotemporal degeneration (FTD)
diverse clinical and path disorders that present age 45-65, cog deficits in: attention, abstraction, planning, problem solving, speech and comprehension, disinhibited behavior (verbal, physical, sexual), apathy/inertia
pathological presentation of Frontotemporal degen, is this definitive?
atrophy of frontal and temporal lobes
- not definitive unless studied in autopsy
tx for Frontotemporal degen
tx sxs, SSRIs or Trazodone may reduce impulsive behaviors
what’s the most common infectious agent known to cause cognitive impairment?
HIV (causes mild NCD)
tx for HIV-related NCD
HAART antiviral tx for HIV
define Huntington’s Dx
genetic disorder causing motor (chorea = jerky dance-like movements, bradykinesia), cognitive (executive functioning), and psychiatric (depression, apathy, impulsivity, obsessions) sxs
- avg diagnostic age = 40
genetics of Huntington’s Dx
CAG trinucleotide repeat in..
HTT gene that encodes huntingtin protein all on..
Chromosome 4
autosomal dominant inheritance pattern
tx for HD
treat sxs
- Tetrabenazine (movement disorder tx, MOA unknown)
- atypical antipsychotics
define Parkinson’s Dx
idiopathic progressive neurodegenerative dx d/t depletion of dopamine in the basal ganglia, causes cogwheel rigidity, resting pill-rolling tremor, bradykinesia, and postural instability (Joan needed to hold things while walking)
- 75% of PD pts have major NCD
- perceptual disturbances may occur
PD tx
carbidopa-levodopa (or other dopamine agonists)
- quetiapine or clozapine used for psychotic sxs (careful w/ dosing d/e risk of exacerbating PD sxs)
what are the only two antipsychotics recommended in PD?
quetiapine
clozapine
define Prion dx
rapidly progressing form of encephalopathy d/t proteins that act like infectious particles, bind to molecules in the body and change their function
- MC example = Creutzfeldt-Jakob dx
- 90% of pts experience myoclonus (jerky contractions of muscle groups)
- other sxs: ataxia, nystagmus, hypokinesia
diagnosis based on
brain tissue biopsy
supportive diagnostics
periodic sharp-wave complexes on EEG
CSF positive for 14-3-3 proteins
lesions in putamen or caudate nucleus on MRI
Prion dx tx
none, prognosis poor w/ death in 1 year
restlessness and a feeling of wanting to jump out of ones self
akathesia
- caused by antipsychotics
define Normal Pressure Hydrocephalus (NPH)
potentially reversible cause of cog dysfunction, d/t enlarged ventricles with inc CSF pressure BUT normal opening pressures on lumbar puncture, stems from infection or hemorrhage preventing appropriate CSF reabsorption
how does NPH present?
3 W’s:
- wobbly (gait disturbance, feet stuck on floor, postural instability)
- wet (urinary urgency)
- wacky (cog impairment, dec attention, apathy)
tx of NPH
ventriculoperitoneal shunt, CSF removal via lumbar puncture
