Lecture 23 - Neurocognitive Disease (Dementia)

Question 1

Criteria for major NCD

Answer 1

Substantial impairment in Cognition

Independence Loss

Question 2

what are some IADLs

Answer 2

(shopping, finances, cooking, transportation, telephone use, housekeeping

Question 3

what are some cognitive domains -

Answer 3

Learning and memory, language, attention, executiive function, social cognition,

Question 4

Criteria for Minor NCD

Answer 4

1) Modest Cognitive Decline

2) Intact IADLs but there is increased difficulty

Question 5

most Common cause of NCD
how does it present
Criteria for this dx

Answer 5

Alz – 2/3s
Insidious and gradual
Memory decline

• • known AD FMHx
• -OR Memory decline + Progressive + no other attributable cauase

Question 6

Imaging for Alz

How does it compare to imaging for Normal pressure hydrocephalus

Answer 6

Ventricular enlargement with sulcal widening
Global brain atrophy

NPH – Ventricular enlargemnut but no sulcal widening

Question 7

Common Presenstaion for NCD

what other symptoms are usually present?

Answer 7

CC – forgetfulness, losing things, repeating in converstiaon, getting lost, loss of interest in usual activityies, decline in hygiene, paranoia, depression

• 88% of AD patients have measurable emotional and behavioral changes (non-cognitive)

Question 8

Assessment for suspected NCD

which of the questionaires is more sensitive

Answer 8

History ; need a Collateral Informant
Questionnaires – MMSE, MoCA (more sensitive)

labs – Standard (minimum) – CBC, Serum Electrolytes, Calcium, Glucose, Bun/CR, LFTs
B12 – treatable cause of dementia
Thyroid
Syphilis – impt for baltimore (RPR)

Question 9

Differences in presentation and imaging of NCD due to vascular disease

Answer 9

5-10% of all demented patients
Sudden onset –
Stepwise deteriorate with subsequent vascular events
Accompanied by focal neurological signs – DTRs, babinski, gait abnormalities
Imaging with evidence of previous strokes
Evidence of stroke risk factors and systemic vascular disease

Question 10

Advanced Neurosyphilis — what is the positive lab? what is the imaging look like?

Answer 10

white matter hyper intensities on MRI

Positive RPR

Question 11

Normal Pressure hydrocephalus

• classic triad of symptoms
  Imaging
  Treatment

Answer 11

Triad of Shuffling Gait, Urinary Incontinence and Cognitive Impairment

CT – Ventricular Enlargement without Sulcal Widening

Tx- Shunt

Question 12

B12 Deficiency –
- imaging?
- labs?
treatment?

Answer 12

Demyelination of the CNS and the PNS
MRI – severe diffuse periventricular white matter demyelination
Starts in the brain stem

Don’t have to have macrocytic anemia to have NCD

	Treatable -- can give PO, IM B12

Question 13

what are some contraindicated medications for NCD patients?

Answer 13

anti-cholinergics

			Oxybutin (ditropan) -- used for urinary incontinence
			Benzotropine
			Benadryl
			Paxil -- 
			Amitripyline (