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Clin Med > Neruo: neurocognitive Disorders > Flashcards

Neruo: neurocognitive Disorders Flashcards

1
Q

acute, abrupt, transient confused state

  • due to an identifiable cause
  • explain the AMS
  • recovery?
A

delirium
Causes: meds, infections, electrolyte disturbs, CNS injury, uremia, organ failure, drugs, ETOH intox or withdrawl,

AMS flucctuates
recovery: usually FULL in 1 week

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2
Q

is dementia a disease or rather the result of specific diseaes?

A

it is result of specific diseases—esp ones involving cerebral cortex, subcortical connections or both

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3
Q

define dementia

A

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
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4
Q

Before you diagnose anyone with dementia, you must rule out four important things:

A

normal aging
delirium
depression
drug intox

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5
Q

There are three “categories” of cognitive dysfunction:

A
  1. normal aging–minor alerations in neuro funct
  2. MCI–mild cognitive impairment
  3. Dementia
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6
Q

explain mild cognitive impairment (MCI)

A

deficits that are more severe than are customarily seen with normal aging—-but insufficiently pronounced to diagnose dementia

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7
Q 
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
A

NORMAL AGING in HEALTHY brain

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8
Q 
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
A

DEMENTIA WARNING SIGNS

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9
Q

a state in which the level of consciousness is depressed, but to a lesser extent than a coma.

A

delirium

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10
Q

dementia is umbrella term to describe:

A
  1. alzheimers——MC in PTs >65
  2. Vascular dementia—20-30% of PTs >65
  3. Frontotemporal dementia
  4. Lewy Body Disease
  5. Parkinson
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11
Q

PTs 45 and younger, the MCC of dementia are:

PTs 65 and older, the MCC of dementia are:

A 
45and younger
Huntington 
MS 
lupus 
infectious
65+: 
AZ 
VASC dementia 
Frontotemp dementia 
lewy body 
PD
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12
Q

is PT aware of cognitive deteroiration with dementia?

A

no!!!!!

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13
Q

Most imp part of diagnosis for dementia?

A

clinical hx—-reports given by fam, care givers, etc
+
very detailed Mental status exam

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14
Q

General s/s for dementia:

A 
memory loss 
abnormalities of speech 
diff with problem solving and abtract thinking 
impaired judgment 
personality changes 
emotional lability
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15
Q

MC type of dementia

A

Alzheimer

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16
Q

Epidemiology for Alzhimer

A

1/9 people over age 65 have it

6 million ppl in US

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17
Q

RF for Alzhiemer

A

increasing age
genetics
fam hx
severe head trauma

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18
Q

etiology/patho for alzhiemer

A

3 hypothesis: depositions of diff proteins cause brain issues:

  1. Amyloid beta protein deposition (senile plaques)
  2. Tau proteins–neurofibrillary tangles
  3. ACH deficiency leads to memory language and visuspatical chagnes
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19
Q

neruofibrillary tangles?

A

tau proteins

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20
Q

senile plaques?

A

amyloid beta proteins

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21
Q

CM for alzhimer

A

progression thought to comprise of pre-symptomatic phase of up to about 10 years and then a symptomatic pd of ten yeasr

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22
Q

asympto pd in alzhiemer caused by?

A

amyloid plauqes

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23
Q

sympto pd in alzhimer is caused by?

A

tau proteins

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24
Q

Early CM for alzhier

A

impairment of recent memory—may only be noticed by fam

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25
Q

which memory is lost first with alzhimer? then develops into?

A

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**
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26
Q

avg lenght of time from onset of s/s and dx for alzhimer?

A

2-3 years

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27
Q

typical timefame for alzheimer

*when is nursing home usualy initiated

A

9-12 years

**24 hour care usually initated within 3-6 years

28
Q

DX Alzheimer

A

CLINICAL

no test

MRI can show cortex atrophy

AUTOSPSY: only way to get confirmation dx:

  • amyloid plaque deposition in brain
  • tau proteins
29
Q

TX for alzheimer
1st line
2nd line
adjunct

A

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

30
Q

Alzheimer PT typically spends ___ yrs in nursing homes befre deaht

A

3 yrs

31
Q

Vascular dementia caused by?

A

chronic ischemia and or multiple infarctions

lacunar strokes*

32
Q

Most imp RF for vascular dementia?

other RFs

A

HTN **

DM, HX of CVA, AFIB

33
Q

Binswanger disease

A

Dementia related to extensive microvascular changes in white matter

34
Q

most PTs with vascular dementia have HX of…..

A

DM and Longstanding HTN

35
Q

CM vascular dementia

A

ABRUPT onset of s/s: dep on location of brain

  1. 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
  2. SUBCORTICAL:
    - focal motor deficits, gait abnormalities, ataxia (impaired coordination–as if they are drunk: slurred speech, stumbling) and personality changes
36
Q

can vascular dementia cause sudden death?

A

yes

37
Q

what do we want to r/o before diagnosing with vascular dementia (or any dementia)

A

B12 deficiency
folatae def
infectious

38
Q

TX fo vascular dementia?

A

No “tx” bc the damage done is permanent

but measures taken to control BP and Hyperlipidemia are good to prevent further clotting

39
Q

prognosis for Vascular dementia?

A

3-5 years after diagnosis

40
Q

Pick’s disease

A

Frontotemporal dementia

41
Q

which lobes does alzhiemer primarily affect?

A

temporal and parietal

42
Q

lobes that frontotemporal dementia affect?

A

frontal and temporal

43
Q

MC cause of Dementia in PTs under 60

A

FTD

44
Q

most prominent s/s for FTD

A

behavior changes PRECEED memory loss
langauge/speech abnormalities

**behaviior changes occurs LATER in alzhimer where this is more acute

45
Q

AVG age of onset for FTD

A

50-60

46
Q

three distinct cinical syndromes for FTD

A
  1. Behavioral variant
    - prominent behavior changes*: apathy (lack of interest), disinhibition, blunted emotions and lack of insight
  2. 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
  3. Non-fluent variant:
    - expressive aphasia**** can only understnad language..diff time talking
47
Q

DX for FTD

A

MRI—–asymmetric frontal and temporal lobe atrophy

48
Q

MRI—–asymmetric frontal and temporal lobe atrophy

A

FTD

49
Q

two diseases that emcompass lewy body disease

A

parkinson and dementia w/ LBs

50
Q

dementia starts FIRST and within 1yr+ PT develops Parkinson disease motor s/s (tremor, bradykineasia, rigidity, postural instability)—>????

A

Dementia with Lewy Body Diseases

51
Q

If parkinson motor s/s devlop FIRST and then 1yr+ dementia develops——???

A

Parkinson disease with dementia

52
Q

Robin Williams had what order for his disease?

A

Dementia first—then Parkinson

aka he had Dementia with Lewy Body disease

53
Q

round neuronal inclusions that include α-synuclein—-histology

A

Lewy Body

54
Q

Histology report wil show lewy bodies scattered in _______ and more focal and grouped in_____

A

scattered=dementia

Focal/grouped=PD

55
Q

list the diseaes that are considered Synucleinopathies

A

Alzhiemer
LB dementia
PD

56
Q

CM for Lewy Body dementia

A

Cognitive decline w/o prominent early emory impariment
VISUAL. HALLUCINATIONS*
episodic delirium (cognitive fluctuations)**
Parkinsonism–rigidity-bradykinesia
REM sleep disorder

57
Q

onset of s/s for Huntington

A

30-50 YO

58
Q

chorea

A

rapid involuntary movements

59
Q

three Ms for Huntington

A

Mood—behavioral changes
Movement–chorea
Memory–dementia

60
Q

which S/S show up first for Huntington

A

chorea and behavior changes are first… THEN dementia develops 1-2 years later

61
Q

Mood s/s seen with Huntington

A

behavior and mood changes:

  • perrsonlity
  • cognitive
  • intellectual
  • psychiatric
  • *irritability is often seen
62
Q

Movement s/s seen with HD

A

Chorea–rapid invol movements of the face, neck, trunk and limbs *worsens with stress and voluntary movement
*disapears with sleep

63
Q

Memory s/s with HD

A

dementia

Most develop dementia before 50

64
Q

autosomal dominant or recessive HD?

A

DOMINANT !!!

65
Q

typical onset for the dementia s/s of HD

A

can develop before 50

66
Q

timeline for HD prognosis

A

fatal w/in 15-20 years after presentation

Clin Med (52 decks)

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