Neurocognitive Flashcards
1
Q
Delirium: Assessment tools
A
- Mini-Mental Status Examination (MMSE)
- Confusion Assessment Method (CAM)
- Disorientation
- Disordered attention
- Disorganized thinking
- Altered and fluctuating state of consciousness
2
Q
Delirium: Symptoms
A
- Disorientation
- Disordered attention
- Disorganized thinking
- Altered level of consciousness
- Emotionally distraught
- Agitation
- Short-term memory deficits
- Concreteness
- Perceptual distortions
3
Q
Delirium Screening: IWATCHDEATH
A
- Infections
- Withdrawal
- Acute metabolic
- Trauma
- CNS pathology
- Hypoxia
- Deficiencies
- Endocrine pathologies
- Acute vascular
- Toxins/Drugs
- Heavy metals
4
Q
Neurocognitive Disorders (NCD)
A
- Alzheimers: 50-70% of dementias
- Frontotemporal Lobar Degeneration (Picks Disease)
- Vascular NCD: 20% of all dementias
- Substance/medication induced (Wernicke-Korsakoff)
- Parkinson’s induced
- Huntington’s disease induced
- HIV induced
- Prion disease (Creutzfeldt-Jakob, kuru)
- Diffuse Lewy body disease
- Traumatic brain injury
- Another medical condition
5
Q
Alzheimer’s
A
- 74% heritability: apoE4 protein on chromosome 19; 14 & 21 also implicated
- Brain atrophy; increased neuritic amyloid plaques and neurofibrillary tangles
- Decreased availability of acetylcholine
- Higher incidence in persons with TBI and Down’s Syndrome
- Mini-mental State Examination declines 3 points/year
- Memory loss is the first symptoms
- Inability to problem solve in complex new situations
- Decline is gradual
6
Q
Vascular NCD
A
- Brain has multiple vascular lesions in cortex and subcortical areas
- Caused by TIAs
- Symptom appearance is more abrupt
- Coupled with neurological symptoms
- Usually stair step deterioration
7
Q
Frontotemporal NCD
A
- Linked to genes on chromosomes 3 and 17
- Atrophy of the frontal and anterior lobes on the brain
- Swollen neurons with well-difined “Pick’s bodies”
- Behavioral changes appear first
8
Q
Prion Disease: Creutzfeldt-Jakob, Kuru
A
- infecting agent known as a prion causes spongiform encephalopathy in which cells are stripped on intracellular material
- Transmissible by blood and bodily fluids
- Bovine Spongiform Encephalopathy (BSE), “mad cow disease”
- Genetic component in 15%
- Personality changes, seizures, myoclonic movements
- Rapid course, death within a year
9
Q
Huntington’s disease
A
- autosomal dominant gene on chromosome 4
- risk for children of affected persons is 50%
- Symptom onset age 30-50
- Insidious behavior changes, disruption of attention, personality changes, choreiform movements appear later
10
Q
Vitamin B-12 deficiency
A
- Inadequate B12 causes demyelination and axon brain loss
* Lesion of optic nerve and cerebral white matter
11
Q
Parkinson’s Disease
A
- 50% reduction in neurons in the substantia nigra; remaining cells contain Lewy bodies
- Parkinson’s symptoms generally precede dementia
12
Q
Diffuse Lewy Body Disease
A
- Lewy bodies in frontal and temporal cortex primarily; lesser in the hippocampus and substantia nigra
- Severe visual hallucinations
- Fluctuating alertness
- Fall risk for those with EPS
13
Q
NCD secondary to HIV
A
- Reduction in total brain volume, cortical thinning, reduction in white matter, hyperintensities
- Cognitive impairment, disorganization, worry, paranoia
- Gait abnormalities, motor dyscoordination
14
Q
Wernicke’s (encephalopathy) Korsakoff’s (amnesia)
A
- ETOH
- Thiamine deficiency
- Korsakoff’s develops from encephalopathy
- Ataxia, nystagmus, confabulation
15
Q
Mini-mental status examination (MMSE)
A
- identify an object (agnosia)
- Write a sentence (aphasia & apraxia)
- Draw interlocked pentagrams (apraxia and visual distortions)
16
Q
Dementia Assessment Tools
A
- Mini-mental status exam (MMSE)
- St. Louis University Mental Status (SLUMS)
- Montreal Cognitive Assessment (MoCA)
- Dementia Rating Scale
- Cognitive Abilities Screening Instrument (CASI)
- Short Portable Mental Status Questionnaire
- Brief Cognitive rating Scale (BCRS)
- Alzheimer’s Disease Assessment Scale
17
Q
Functional Assessment Staging (FAST)
A
- Early: FAST stage 1 & 2: unable to recall words after 5 min, unable to retain new information, confabulation, difficulty word finding; labile mood
- Mild: FAST stages 3 & 4: forgetfulness; paranoid delusions; withdrawal
- Moderate: FAST stage 5: confusion and personality change
- Moderate-severe: FAST stage 6: “ambulatory dementia”; need for instruction on simple tasks, “wandering”, incontinence
- Late: FAST stage 7: inability to eat/walk/talk; moan, scream, thrash
18
Q
AIDS Dementia Complex (ADC)
A
- Subcortical dementia with infiltration of infected macrophages or microglial cell into the brain
- Early, aggressive HIV treatment can reduce ADC by 50%
- Memory loss, speech problems, inability to concentrate
- Loss of bladder function, change in handwriting, ataxia, paraparesis, extensor-plantar responses
- Inability to conduct ADLs
- Mood changes
19
Q
ADC Sub-categories
A
- HIV associated minor cognitive/motor disorder: depression & anxiety
- HIV associated dementia complex: Progressive cognitive and motor deficits
20
Q
ADC: Differential Diagnosis
A
- Syphilis, B12, folate, thyroid, electrolytes, BUN/creatinine, drug screen
- MRI
- Lumbar puncture
- HIV Dementia Scale
- Memorial Sloan Kettering Rating Scale
21
Q
NCD Psychopharmacology
A
- SSRIs for depression: caution with long acting fluoxetine and venlaxafine
- Psychotic symptoms: low dose atypical antipsychotics, avoid anticholinergic and liver toxic
- Agitation: mood stabilizers (Valporic Acid, Depakote; Oxcarbazepine, Trileptal)
22
Q
Dementia treatment
A
- Acetylcholinesterase inhibitor (GI side effects)
- Donezpezil (Aricept) 5 -23 mg qd
- Rivastigmine (Exelon) 1.5 mg BID (daily max 12 mg)
- Galantamine (Reminyl) 4 mg BID (Daily max 12 mg)
- N-methyl D aspartate (NMDA) antagonist prevents excessive glutamate
- Namenda: 5-20 mg/day divided
- Ginkgo Biloba: mixed results
- Vitamin E: some efficacy
- Estrogen: no effect
- Omega 3
