Neruo: neurocognitive Disorders Flashcards
acute, abrupt, transient confused state
- due to an identifiable cause
- explain the AMS
- recovery?
delirium
Causes: meds, infections, electrolyte disturbs, CNS injury, uremia, organ failure, drugs, ETOH intox or withdrawl,
AMS flucctuates
recovery: usually FULL in 1 week
is dementia a disease or rather the result of specific diseaes?
it is result of specific diseases—esp ones involving cerebral cortex, subcortical connections or both
define dementia
used to desc intellectual and cognitive degeneration of sufficient severity that interferes with normal functioning
- can affect multiple aspects of cognitive function:
- memory
- orientation
- perception
- language
- higher exec function
Before you diagnose anyone with dementia, you must rule out four important things:
normal aging
delirium
depression
drug intox
There are three “categories” of cognitive dysfunction:
- normal aging–minor alerations in neuro funct
- MCI–mild cognitive impairment
- Dementia
explain mild cognitive impairment (MCI)
deficits that are more severe than are customarily seen with normal aging—-but insufficiently pronounced to diagnose dementia
Occasionally forgets appoitnsmens/ names Occasional errors w numbers sometimes needs help using new devices temporary confusion about the day of the week vision changes from cataracts sometimes forget the correct word retraces steps to find lost items occasionally makes poor decision sometimes weary of obligations annoyancce at disruption of routine
NORMAL AGING in HEALTHY brain
Noticeably dissruptive memory loss inability to concentrate on instructions diff with familiar daily tasks loses track of time and place diff understanding vision or space cant' follow a conversation misplaces things and blames others decreased or poor judgement withdraws from favoirte social activities personality and mood changes
DEMENTIA WARNING SIGNS
a state in which the level of consciousness is depressed, but to a lesser extent than a coma.
delirium
dementia is umbrella term to describe:
- alzheimers——MC in PTs >65
- Vascular dementia—20-30% of PTs >65
- Frontotemporal dementia
- Lewy Body Disease
- Parkinson
PTs 45 and younger, the MCC of dementia are:
PTs 65 and older, the MCC of dementia are:
45and younger Huntington MS lupus infectious
65+: AZ VASC dementia Frontotemp dementia lewy body PD
is PT aware of cognitive deteroiration with dementia?
no!!!!!
Most imp part of diagnosis for dementia?
clinical hx—-reports given by fam, care givers, etc
+
very detailed Mental status exam
General s/s for dementia:
memory loss abnormalities of speech diff with problem solving and abtract thinking impaired judgment personality changes emotional lability
MC type of dementia
Alzheimer
Epidemiology for Alzhimer
1/9 people over age 65 have it
6 million ppl in US
RF for Alzhiemer
increasing age
genetics
fam hx
severe head trauma
etiology/patho for alzhiemer
3 hypothesis: depositions of diff proteins cause brain issues:
- Amyloid beta protein deposition (senile plaques)
- Tau proteins–neurofibrillary tangles
- ACH deficiency leads to memory language and visuspatical chagnes
neruofibrillary tangles?
tau proteins
senile plaques?
amyloid beta proteins
CM for alzhimer
progression thought to comprise of pre-symptomatic phase of up to about 10 years and then a symptomatic pd of ten yeasr
asympto pd in alzhiemer caused by?
amyloid plauqes
sympto pd in alzhimer is caused by?
tau proteins
Early CM for alzhier
impairment of recent memory—may only be noticed by fam
which memory is lost first with alzhimer? then develops into?
short term !! its usual first s/s
- –>then develops into long term memory loss AND cognitive deficits: disorientation, behav/personality changes, language difficulties, loss of motor skills.
- gradual**
avg lenght of time from onset of s/s and dx for alzhimer?
2-3 years
typical timefame for alzheimer
*when is nursing home usualy initiated
9-12 years
**24 hour care usually initated within 3-6 years
DX Alzheimer
CLINICAL
no test
MRI can show cortex atrophy
AUTOSPSY: only way to get confirmation dx:
- amyloid plaque deposition in brain
- tau proteins
TX for alzheimer
1st line
2nd line
adjunct
1st line: ACHE inhibitors——Donepezil (Aracept)
- but does not slow down progression*
- only helps with improving memory function and sympto relief
2nd line/adjunct for mod-severe cases: NMDA anatagonist—>Memantine
Alzheimer PT typically spends ___ yrs in nursing homes befre deaht
3 yrs
Vascular dementia caused by?
chronic ischemia and or multiple infarctions
lacunar strokes*
Most imp RF for vascular dementia?
other RFs
HTN **
DM, HX of CVA, AFIB
Binswanger disease
Dementia related to extensive microvascular changes in white matter
most PTs with vascular dementia have HX of…..
DM and Longstanding HTN
CM vascular dementia
ABRUPT onset of s/s: dep on location of brain
- CORTICAL MANIFESTATIONS:
- dxecutive dusfunction, apathy, inability to make decisions (abulia), inability to perform movements (apraxia), inability to understand language, inability to recognize objects, face and places (agnosia), confusion - SUBCORTICAL:
- focal motor deficits, gait abnormalities, ataxia (impaired coordination–as if they are drunk: slurred speech, stumbling) and personality changes
can vascular dementia cause sudden death?
yes
what do we want to r/o before diagnosing with vascular dementia (or any dementia)
B12 deficiency
folatae def
infectious
TX fo vascular dementia?
No “tx” bc the damage done is permanent
but measures taken to control BP and Hyperlipidemia are good to prevent further clotting
prognosis for Vascular dementia?
3-5 years after diagnosis
Pick’s disease
Frontotemporal dementia
which lobes does alzhiemer primarily affect?
temporal and parietal
lobes that frontotemporal dementia affect?
frontal and temporal
MC cause of Dementia in PTs under 60
FTD
most prominent s/s for FTD
behavior changes PRECEED memory loss
langauge/speech abnormalities
**behaviior changes occurs LATER in alzhimer where this is more acute
AVG age of onset for FTD
50-60
three distinct cinical syndromes for FTD
- Behavioral variant
- prominent behavior changes*: apathy (lack of interest), disinhibition, blunted emotions and lack of insight - Semantic variant
- receptive aphasia*… they can produce language… but what they say makes no sense because they use weird made up words or weird noises - Non-fluent variant:
- expressive aphasia**** can only understnad language..diff time talking
DX for FTD
MRI—–asymmetric frontal and temporal lobe atrophy
MRI—–asymmetric frontal and temporal lobe atrophy
FTD
two diseases that emcompass lewy body disease
parkinson and dementia w/ LBs
dementia starts FIRST and within 1yr+ PT develops Parkinson disease motor s/s (tremor, bradykineasia, rigidity, postural instability)—>????
Dementia with Lewy Body Diseases
If parkinson motor s/s devlop FIRST and then 1yr+ dementia develops——???
Parkinson disease with dementia
Robin Williams had what order for his disease?
Dementia first—then Parkinson
aka he had Dementia with Lewy Body disease
round neuronal inclusions that include α-synuclein—-histology
Lewy Body
Histology report wil show lewy bodies scattered in _______ and more focal and grouped in_____
scattered=dementia
Focal/grouped=PD
list the diseaes that are considered Synucleinopathies
Alzhiemer
LB dementia
PD
CM for Lewy Body dementia
Cognitive decline w/o prominent early emory impariment
VISUAL. HALLUCINATIONS*
episodic delirium (cognitive fluctuations)**
Parkinsonism–rigidity-bradykinesia
REM sleep disorder
onset of s/s for Huntington
30-50 YO
chorea
rapid involuntary movements
three Ms for Huntington
Mood—behavioral changes
Movement–chorea
Memory–dementia
which S/S show up first for Huntington
chorea and behavior changes are first… THEN dementia develops 1-2 years later
Mood s/s seen with Huntington
behavior and mood changes:
- perrsonlity
- cognitive
- intellectual
- psychiatric
- *irritability is often seen
Movement s/s seen with HD
Chorea–rapid invol movements of the face, neck, trunk and limbs *worsens with stress and voluntary movement
*disapears with sleep
Memory s/s with HD
dementia
Most develop dementia before 50
autosomal dominant or recessive HD?
DOMINANT !!!
typical onset for the dementia s/s of HD
can develop before 50
timeline for HD prognosis
fatal w/in 15-20 years after presentation
