Neurocognitive Disorder Flashcards
Mild Cognitive Impairment MCI
Objective evidence of memory impairment (complaint is only restricted to memory) – episodic memory loss
Alzheimer’s Disease
Memory impairment + one of the following… Aphasia, Apraxia, Agnosia, Executive dysfunction, (gradual and insidious)
Definitive diagnosis of Alzheimer’s?
Autopsy
Genetic association with Alzheimer’s?
APOE-E4 – 5-30% of population (15x risk of AD)
pathological findings of Alzheimer’s?
Amyloid β plaques & Neurofibrillary tau tangles
Plaques & tangles primarily located in
hippocampus
Neuro findings in Alzheimer’s?
flat cortical sulci, atrophy, enlarged ventricles, loss of ACh neurons (from basal forebrain)
Physiologic causes of Alzheimers
Stress –> high glucocorticoid levels –> low neurotrophins (nerve growth factors)
Vascular Dementia Dx
Memory + 2 other cognitive domains, onset: <3mo after stroke, abruptly, incremental
Distinguishing features of vascular dementia
HA, nausea, fatigue, sleep disturbance, pseudo bulbar palsy, focal neuro findings, dysarthria, dysphagia
ACA stroke Findings
c/l hemiparesis of LE, personality changes, decline in executive functioning (d/t involvement of frontal cortex)
MCA stroke Findings
limbic system, Broca’s & Wernicke’s aphasia
PCA stroke Findings
hemianopsia, hemineglect syndrome
Lacunar stroke
white-matter hyperintensities, atherosclerosis, parenchymal lesions of glial cells
TIA
no lesions left, no focal deficits, <1h
MMSE Scoring
27-30: normal
24-26: psych consult for depression, geriatric
<24: consult for neuro, psych, geriatric
Reversible causes of dementia
B12 def, folate def, thyroid, syphilis, HIV, depression
Alzheimers Disease Tx
- AChE Inhibitor
2. NMDA Antagonist
AChE Inhibitors for Alzheimers
Rivastigmine, Galantmine, Donepezil
NMDA Antagonist for Alzheimers
Memantine
AChE Inhibitor S/E
GI problems
Which AChE Inhibitor has the least S/E & needs the least monitoring?
Donepezil
Which antidepressant should be avoided in Alzheimers pts?
Fluoxetine
Which antidepressant should be used in Alzheimers pts w/ depression?
Trazadone, Citalopram
Which Benzos should be used in Alzheimers pts w/ anxiety?
Zolpidem
Vascular Dementia Tx
- Antihypertensives (ACE-I, Diuretics)
- Anticoagulants
- Thrombolysis (w/in 3h)
- Antiplatelet prevention
Which Antihypertensive is avoided for pts w/ Vascular Dementia?
b-blockers
Alzheimer’s dementia is due to…
Hypoactive ACh
Occlusion of the ACA produces deficits in what cognitive domain?
Executive
Early sign of dementia?
Short-term memory loss
Male has loss of cognition, requires more help in basic living activites, most appropriate treatment?
Donepezil
