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Estelle Royal College > Geri_EO > Flashcards

Geri_EO Flashcards

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1
Q

What’s the proportion of NCD-mild that progresses to Alzheimer?

A

5-10% per year

75-80% at 10 years

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2
Q

What is the only recommendation with evidence to prevent NCD?

A

Treat HTA (if >160, aim for <140mmHg)

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3
Q

What are the stages and thresholds of the Global deterioration scale?

A

Stage 1 normal
Stage 3 NCD-mild
Stage 4 NCD-major
Stage 7 incontinent, needs assistance for all ADLs

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4
Q

what is the Ddx of NCD?

A 
AD
Vascular
Lewy body
FTD
HIV
TBI
PD
Huntington
Prion disease (creutzfeld-Jakob)
Etoh
NPH
MS
Other
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5
Q

Triad of NPH

A

Ataxia
Cognitive decline
Incontinence

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6
Q

What can mimic NCD?

A

NOT immobilisation

Hospitalisation, fecaloma, visual-auditive deficit

Pseudodementia: MDD - abrupt onset, rapid progression, Past psych Hx, Loi de ribot non applicable (ie baisse de mémoire récente avec préservation des souvenirs anciens)

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7
Q

Give etiopatho of each type of NCD

A

1) proteinoathies (neurodegenerative)
- AD: TAU, amyloid plaques, neurofibrillary tangles)
- FTD: TAU, TDP-34, ubiquitine
- BLD: alpha-synucleine
- Dementia pugilistica: TAU, amyloid plaques, neurofibrillary tangles)
- Huntington: huntingtine

2) repeated insults
- vascular:
- Etoh or other substance
- HIV
- Infections

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8
Q

Under which condition should you order brain imaging ?

A 
<60yo
Rapide decline (1-2 mo)
Recent TBI
Non-explained neurological sx 
ATCD neoplasia
Dementia for less than 2 yrs
AC or trouble de la coagulation
Suden onset of incontience or diff walking
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9
Q

In which case you can do genetic investigation?

A

<65 yo & fam Hx

Cmz 1 = preseniline 2
Cmz 14 = preseniline 1
Cmz 21 = APP

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10
Q

What are the thresholds of MMSE?

A

> 18-26 light
10-18 moderate
<10 severe

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11
Q

What’s the gold standart for NCD-mild?

A

MOCA. - more sensitive than MMSE (100% for AD); more. Specific than MMSE (87% vs 82%)

In MOCA, add a point if <13 years of schooling

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12
Q

Which region we test with Luria serie?

A

Frontal

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13
Q

What is the relationship with caudate and movement?

A

If hyperactivity of caudate = bradykinesia

If reduced activity: OCD, Tics

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14
Q

What does the right equivalent of wernicke area ?

A

Understand emotions in others’ discourse

Right temporal lobe, superio-posterior

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15
Q

Where is the lesion in anosognosie?

A

Non-dominant parietal (right for 99% of righty and 2/3 of lefty

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16
Q

In which type of aphasia the patient does not know he has a problem?

A

Wernicke

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17
Q

What is the D-KEFS verbal fluency test?

A

Name as many words that start with a letter, name as many words in a catégory
For task initiation

18
Q

What is the wisconsin card sorting test and trail making test part b for?

A

Cognitive flexibility - trail making test is the best for driving capacity

19
Q

What is the rey-osterrieth complex figure test

A

Copy complex figure, than draw it by recall

For planification

20
Q

what is the tower of london test

A

For planification

14 cards that tell you how the colored donuts should be on 3 sticks of different lenghts

21
Q

What is the WAIS-III similarities

A

For the reasoning - IQ test

22
Q

What is the stroop color and word test

A

Behavioral inhibition

Written color name differs from color ink it is printed in and tge patient must say the written word

23
Q

What is the main risk factor of AD?

A

1-Advanced age

Other risk factors are:
Female, fam hx, low schooling, HTA, Db, past MDE, past TBI, down syndrome, high level of homocysteine,

24
Q

What are the genes associated with late onset of AD? And early onset AD?

A

Late onset
E4/Ex allele : RR 3
E4/E4 allele: RR 8

early onset, onlu 6-7% of cases (13% of those have a familiale pattern)
Presinilin 1 on cmz 14 (30-70%) et 2 (5%) on cmz 1)
APP (amyoid protein precursor) (10-15%) on cmz 21

25
Q

Most common type of hallucinations in AD?

A

Visual

26
Q

What do you need to know about Binswanger disease?

A 
Type of vascular dementia
Subcortical
Slow progressive
Pseudobulbar and parkinsonism elements
Typically in patients chronically HTA
Incontinence and fluctuation of cognition can happen
27
Q

What are the main caracteristics of BLD?

A

1- fluctuating presentation of sensorium and cognition
2- well formed visual hall
3- cognitive decline prior or at same time of parkinsonism

28
Q

What is the most common type of hallucination in Parkison?

A

Visual

29
Q

Name 4 types of Parkinson plus syndrom?

A

1-PSP (progressive supranuclear palsy) - rigidité axiale
2-Corticobasal degenerescence - frontal, syndrome du memebre étranger
3-multisystemic atrophy: syndrome cerebelleux
4- LBD

Alpha-synucliopathies in cortical and subcortical regions

30
Q

Name the 3 variant of frontotemporal dementia?

A

1-behavioral (50%) more frequent in male
Deshinibition, lack of empathy, apathie, stereotyped behavior/ritualistic/compulsive, hyperorality

2-language variant (primary progressive aphasia) (50%)
subtypes:
-semantic: word comprehension, more male
-non-fluent: speech production, more female
-logopenic

31
Q

pour quel type de démence les AchE Inhibitors ne sont pas indiqués?

A

mild NCD and FTD

ils sont indiqués pour AD, BLD (first choice is rivastigmine) et PD

32
Q

side effects de AchE inhibitors?

A

bradycardie, incontinence, Do,Vo,No, anorexie, crampes, insomne

33
Q

contre-indications des AchE inhibitors?

A

BBG, bloc AV,

relatives: bradycardie, saignement actif GI, MPOC, insuff hepatique sévère, insuffisance rénale pour mémantine,

34
Q

give dosing of donepezil (aricept), rivastigmine (excelon), galantamine (Reminyl) and memantine (ebixa)

A

donepezil: 5mg DIE puis 10mg after 4-6 sem
rivastigmine: 1.5mg BID puis augmenter q2weeks to reach 3-6mg BID OR 5mg patch for 1 month and then 10mg patch
galantamine: 4m BID then 8mg BID after one month. if well tolerated can be increased to 12mg BID
Memantine: 5mg DIE x 7 days, then 5mg BID x 7days, then 10mg am +5mg Qpm x 7 days, then 10mg BID

35
Q

what are the indications and side effects for memantine?

A

monotherapie or adjuvant aux AchE inhibitors in moderate to severe AD.
diziness, headaches, Co
contre-indication is ClCr<30cc/min
reduce dose by 50% if ClCr 30-50cc/min

36
Q

What to use in BPSD of BLD?

A

rivastigmine, no antipsychotics!

37
Q

What to use in FTD?

A

trazodone for irritability, or paxil

38
Q

What to use in PDD?

A

AchE inhibitor, or quetiapine and if does not help, gold standard is clozapine

39
Q

what are the antipsychotics approved for BPSD?

A

risperidone, abilify and ziprexa

40
Q

when is it acceptable to use benzo in BPSD?

A

favoriser courte action, utile pour faire les soins

41
Q

what to use for sleep in BPSD?

A

trazodone

Estelle Royal College (23 decks)

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