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WI18 Neuro > Neurocognitive > Flashcards

Neurocognitive Flashcards

1
Q

dementia

A

slow onset, progressive, chronic

not better explained by different disease

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2
Q

how is delirium different from dementia

A

acute onset of reversible mental status

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3
Q

dementia is characterized by

A

significant and progressive decline in cognition involving one more more cognitive domains that affect independence in everyday activities

can’t be exclusively during delirium and not better explained by another disorder

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4
Q

symptoms of dementia

difficulty…

A

retaining new information

handling complex tasks

reasoning

spatial ability/orientation

language

behavior

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5
Q

behavioral disturbances

A

common in dementia

associated with adverse outcomes, increased disability, caregiver stress, earlier institutionalization

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6
Q

behavioral assessment should asses which disturbances

A

agitation/aggression

hallucinations

delusions/paranoia

sundowning

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7
Q

mCI

A

presence of memory difficulty and objective memory impairment BUT preserved ability to function in daily life

increased dementia risk

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8
Q

10 warning signs of dementia

A
  1. memory loss
  2. difficulty preforming everyday tasks
  3. problems with language
  4. disorientation to time and place
  5. poor or decreased judgement
  6. problems with abstract thinking
  7. misplacing things in unusual places
  8. changes in mood/behavior
  9. Changes in personality
  10. loss of initiative
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9
Q

dementia detection

A

minimental status exam

orientation, registration, language, recall

max score is 30, less than 24 Is abnormal

best if done serial

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10
Q

subtypes of dementia

A
  1. Alzheimer’s dz
  2. vascular multi infarct dementia
  3. dementia with Lewey bodies
  4. frontotemporal dementia
  5. Parkinson disease w/dementia
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11
Q

MC cause of all dementia

A

alzheimer

rare autosomal dominant but MAJORITY OF CASES are sporadic

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12
Q

histological findings of AD

A

extracellular amyloid plaques (senile plaques)

intraneuronal protein tau in neurofibrally tangles

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13
Q

AD pathophysiology

A

development of progressive atrophy and gloss

first to hippocampus then moves into areas of brain controlling thinking and decision making

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14
Q

AD risk factors

A

increasing age
family history

HTN, depression, insulin resistance, down’s head trauma

MC in women, African Americans

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15
Q

genetic disposition for AD

A

mutation accounts for <5% of AD but all early onset AD

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16
Q

when to consider AD

A

insidious and progressive memory loss

significant impairment in language, visuospatial dysfunction ,executive function and behavior changes

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17
Q

AD work up

A

should rule out other causes

physical exam, MME

Blood work (LFT, B12, TSH, CBC, RPR)

Imaging (non contrast CT)

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18
Q

staging of AD

pre clinical

A

no changes in judgment or impairment of daily activity

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19
Q

staging of AD

mild AD

A

pts get lost in familiar places, lose ability to handle money

increased dependence on the caregiver,

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20
Q

staging of AD

moderate AD

A

pt can’t make sense of world around and relies on caregivers

agitation, wandering, tearfulness (esp. @ night)

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21
Q

staging of AD

severe AD

A

completely unable to communicate

bed bound with loss of bowel/bladder = infection

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22
Q

mc cause of death in AD

A

infection (aspiration, PNA, UTI, skin infection)

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23
Q

general AD tx

A

symptomatic (cholinesterase, NMDA)

psychotropic drugs to change behavior and mood disturbance

24
Q

cholinesterase inhibitors

A

benefit on cognitive fxn and ADLs, help non cognitive symptoms (personality changes)

used in all stages

25
cholinesterase inhibitors ADRs
weight loss, n/v/d and dizziness bradycardia, AV block, syncope, falls SJS
26
cholinesterase inhibitors used inAD
Donepezil (Aricept) Rivastigmine (Exelon) Galantmine (Razadyne)
27
Donepezil brand + indications + ADR+ formulation
(Aricept) AD tx tablets or ODT decreased drug interactions but cholinergic side effects common OK in liver/renal
28
Rivastigmine brand + formulations + ADR + indication
(Exelon) mild-mod AD tablet, patch reiterate if d/c > 3 days cholinergic SE, meals with food, no dose adjustment in CKD but in liver DZ
29
galantamine brand + indications + ADR+ formulation
Razadyne suspension (can be mixed in non-EtOH) mild - mod dementia dose adjust in CKD + Liver dz
30
partial NMDA antagonist used in AD
Memantine (Namenda)
31
AD and NMDA receptor
excessive stimulation due excessive glutamate causing increased CA and disruption of information processing
32
memantine MOA
NMDA antagonist improves glutamate transmission and lessening overstimulation = slowed death
33
Namenda indications
memantine/NMDA antagonist mod-severe AD (+/- cholinesterase)
34
what can you do to slow progression or reduce risk of AD
reducing brain inflammation (I.e. NSAIDs) Good diet and exercise (may slow progression, limited alcohol use)
35
vascular dementia
multi-vascular dz that causes dementia Vascular dementia and AD often co exist
36
types of vascular dementia
multiple cortical infarcts single infarct small vessel disease
37
multiple infarct dementia
combined effects of different infarcts produces cognitive decline
38
single infarct dementia
one large infarct causes severe impairment
39
small vessel dementia is divided into two types
no big step off instead over time subcortical leukoencepholopathy (white matter) numerous lacunae (small vessel occlusions)
40
mild vascular cognitive impairment
cognitive decline worse than expected for age and edu. BUT effects don't meet criteria for dementia memory issue but functional skills are within normal limits
41
vascular dementia epidemiology
MC in men , asians more rapidly fatal due to increased likelihood of other CV risks HTN is main risk factor
42
vascular dementia presentation
acute cognitive impairment after a neurologic event (single infarct) may develop subacute impairment of stepwise progression progressive motor and cognitive, mood changes over years depression and intellectual defects occur = disoriented with memory deficits inattention and vague inability to focus
43
how to differentiate vascular dementia and AD
vascular: greater deficits of frontal executive fxn (balancing check book), PATCHY* neuro deficits AD: long term memory defects (what did I eat for breakfast?), global neuro deficits apathy early on = VD
44
tx of vascular dementia
prevention of NEW strokes Antiplatelet drugs, statins, controlling vascular risk factors
45
DLB
dementia that is 2/2 disruption of neuronal flow from frontal lobe to other areas of brain
46
DLB epidemiology
older age, more common in men, all ethnicities | may be with PD and AD
47
presenting clinical features of DLB
PRESENTS with dementia (AD -= memory loss) early impairment in attention, executive and visuospatial fxn severe sensitivity to neuroleptics, hypersomnia, orthostatic HoTN
48
4 core clinical features of DLB
Must have 2 of 4 1. fluctuation in cognition and alertness (good days and bad days) 2. visual hallucinations (v uncommon in AD) 3. Parkinsonism (less severe than PD) 4. REM sleep behavior disorder (dream enactment)
49
DLB testing
MMSE shows impaired figure copying, clock drawing, spelling world backwards (executive functioning) AD pts have trouble with recall and orientation
50
clues to DLB diagnosis
fluctuations in cognitive functions, naps > 2 hrs, unresponsiveness, orthostatic HotN, hallucinations, delusions, parkonsonians etc.
51
diagnostic work up of DLB + tx
neuropsychological testing cholinesterase inhibitors (tx apathy, anxiety, hallucinations, delusions) Parkinsonism meds SSRI atypical neuroleptics
52
what class of drugs is C/I'd in DLB
HALDOL (first gen antipsychotics)
53
dementia characterized by focal degeneration of frontal and temporal lobes
frontotemporal dementia umbrella term for multiple different types
54
FTD epidemiology
patients in late 50s and early 60s men > female
55
s/s FTD (9)
1. personality/social behavior/language changes progressing to dementia affecting cognition 2. extrapyramidal or motor neuron involvement 3. difficulty with speech 4. disinhibition, impulsiveness, giddiness, apathetic 5. neglect of personal hygiene, mental rigidity, stereotyped behavior 6. loss of social awareness, empathy 7. hyperorality, inappropriate sexuality, binging, carb craving, EtOH and tobacco excess 8. compulsions 9. utilization behavior
56
FTD on exam
speech: non-fluent, difficulty finding words behavior changes visual and spatial functions and constructional tasks memory is preserved new artistic or musical talents
57
tx of FTD
symptomatic management SSRI (Zoloft, Paxil) trazodone (sleep and behavior changes) neurotransmitter therapies don't work progresses more rapidly than AD (8-10 yr survival)

WI18 Neuro (16 decks)

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