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neurocognitive disorder Flashcards

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1
Q

the six cognitive functions affected in neurocognitive disorders

A
  1. complex attention.
  2. executive function
  3. learning and memory
  4. language
  5. perceptual-motor skills
  6. social cognition–interaction
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2
Q

ICU triad

A

delirium, pain and agitation

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3
Q

delirium is a medical emergency

A

yep, it is associated with high mortality rates

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4
Q

primarily a disorder of attention and awareness, developing acutely over hours and days. Sxs. may fluctuate throughout the course of the day and worsening at night

A

delirium

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5
Q

most common precipitants if delirium in children are (2)

A

febrile illness and medications

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6
Q

delirium generally manifests as ____________________ on electroencephalography (EEG). An exception is delirium tremens, which is associated with ___________. EEG lacks sensitivity and specificity for the diagnosis of delirium but it is useful for ruling out ____________________.

A

delirium generally manifests as diffuse background slowing on electroencephalography (EEG). An exception is delirium tremens, which is associated with fast activity. EEG lacks sensitivity and specificity for the diagnosis of delirium but it is useful for ruling out non-convulsive seizures

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7
Q

A quick, first glance bedside exam for suspected substance/medication intoxication is VALEUMS

A

VALEUMS

  • vital signs
  • alertness level
  • eyes–pupil size and position
  • urine–bladder distension or incontinence
  • mucous membrane– moisture
  • skin– temperature and moisture
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8
Q

these sxs are associated with what?

short attention span, disorientation, fluctuations in level of consciousness, visual hallucinations, and impairment in recent memory

A

Delirium

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9
Q

most likely diagnosis and which diagnostic test to do?

Delirium + hemiparesis or other focal neurological signs and sxs

A

CVA or mass lession

  • do a Head CT/Brain MRI
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10
Q

most likely diagnosis and which diagnostic test to do?

Delirium + elevated blood pressure _ papilledema

A

hypertensive encephalopathy

  • do a Head CT/ Brain MRI
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11
Q

most likely diagnosis and which diagnostic test to do?

Delirium + dilated pupils + tachycardia

A

drug intoxication

  • do a urine tox screen
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12
Q

most likely diagnosis and which diagnostic test to do?

Delirium + fever + nuchal rigidity + photophobia

A

Meningitis

  • do a lumbar puncture
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13
Q

most likely diagnosis and which diagnostic test to do?

Delirium + tachycardia + tremor + thyromegaly

A

thyrotoxicosis

  • do a free T4, T3 and TSH
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14
Q

preferred agent for Delirium

A

Haloperidol

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15
Q

Which medication is indicated for treatment of agitation that places the patient or others at risk?

A

D2 antagonists

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16
Q

which medications often worsen delirium by causing paradoxical disinhibition or oversedation?

A

Benzodiazepine

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17
Q

most likely diagnosis and which diagnostic test to do?

Cognitive impairment with stepwise increase in severity + focal neurological signs

A

vascular disease

  • do a Head CT/Brain MRI
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18
Q

most likely diagnosis and which diagnostic test to do?

Cognitive impairement + cogwheel rigidity + resting tremor

A

Lewy body disease and parkinson’s disease

  • clinical
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19
Q

most likely diagnosis and which diagnostic test to do?

cognitive impairment + gait ataxia + urinary incontinence + dilated cerebral ventricles

A

normal pressure hydrocephalus

  • do a Head CT/ Brain MRI
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20
Q

most likely diagnosis and which diagnostic test to do?

cognitive impairment + fatigue + cold intolerance + coarsse hair + constipation

A

hypothryoidism

  • get a TSH/free T4
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21
Q

most likely diagnosis and which diagnostic test to do?

cognitive impairment + parasthesias + diminished position anad vibration sensation + megaloblasts on CBC

A

Vit. B 12 deficiency

  • get a serum B12
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22
Q

most likely diagnosis and which diagnostic test to do?

cognitive impairment + tremor + Kayser-Fleischer rings + abnormal LFTs

A

Wilson’s disease

  • Ceruloplasmin
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23
Q

most likely diagnosis and which diagnostic test to do?

cognitive impairment + diminished position and vibration sensation + argyll robertson pupils ( accomodation response present to light absent_

A

Neurosyphilis

  • CSF FTA-ABS and VDRL
24
Q

thyroid dysfunction can cause reversible or irreversible cognitive impairment

A

reversible

25
Q

Hyperthyroidsim in the elderly may manifest as an “apathetic thyrotoxicosis” characterized by (2)

A

depression and lethargy

26
Q

assesses orientation, attention/concentration, language, constructional ability and immediate and delayed recall.

  • sensitive for major NCD
  • lacks specificity and not sensitive for mild and early NCDs
A

Mini mental state exam

27
Q

3-item recall and clock-drawing tasks to screen for cognitive impairment

A

Mini-Cog

28
Q

where else besides alzheimer you can find senile plaques and neurofibrillary tangles

A

Down syndrome and normal aging

29
Q

only definitive way to diagnose Alzheimer

A

post-mortem exam

30
Q

what does it meand to have the variant 4-apolipoprotein?

A

increased risk of developing alzheimers

31
Q

Donepezil, rivastigmine and galantamine

A

cholinesterase inhibitors used in Alzheimers to slow clinical deterioration

32
Q

memantine

A

NMDA receptor antagonist may provide benfit in patients with moderate to severe alzheimer

33
Q

antipsychotics carry a black box warning regarding increased risk of death in patients with

A

dementia

34
Q

A lesion to the ______ can manifest with a spectrum of sxs inclusing personality changes, disinhibition, inappropriate behavior, aggresssion, apathy, amotivation and paranoia

A

frontal lobe

35
Q

___________ and _____________ are the cognitive domains typically affected in small vessel disease

A

complex attention and executive function

36
Q

classically pt., with vascular NCDs have a spepwise loss of function corresponding with the occurence of

A

micro-infarcts– multi-infarct dementia

37
Q

pathologic aggregation of alpha-synuclein

A

lewy bodies

38
Q

lewy bodies and lewy neurites accumulate in the

A

basal ganglia

39
Q

waxing and waning of cognition, visual hallucinations, development of EPS, Rapid eye movement REM sleep behavior disorder and pronounced antipsychotic sensitivity

A

Lewey body dementia

40
Q

treatment for Lewy body dementia

  1. cognitive and behavioral sxs
  2. psychotic sxs
A
  1. cognitive and behavioral sxs– cholinesterase inhibitors

2. psychotic sxs– quetiapine or clozapine

41
Q

cognitive defects in attention, abstraction, planning and problem solving, disinhibited verbal/physical/sexual behavior, decline in social cognition and/or executive abilities, language varient– speech and comprehension

A

fronto-temporal dementia– Picks

42
Q

treatment for Fronto-temporal dementia

  1. reduce disinhibition, anxiety, impulsivity, repetetice behavirors and eating disorders
A

serotonergic medications such as SSRIs and trazodone

43
Q

most common infectious agent known to cause cognitive impairment

A

HIV

44
Q

genetic disorder resulting from trinucleotide repeats (CAG) repeats on chromosome 4

A

Huntington

45
Q

triad affect in huntington

A

motor, cognitive and psychiatric

46
Q

primary cognitive domain affected

A

executive function

47
Q

idiopathic, progressive neurodegenerative diease characterized by depletion of dopamine in the basal ganglia

A

Parkinson

48
Q

which antipsychotics are preferred in parkinson and why?

A

quetiapine and clozapine are the preferred medications for treatment of psychotic sxs that are not responsive to dose reduction

49
Q

Sxs of parkinson can be exacerbated by ______________ medications

A

antipsychotics

50
Q

form od subacute spongiform encephalopathy caused by proteinaceous infectious particles… most common type?

A

prion diease, most common is Creutzfeldt-Jakob disease

51
Q

what occurs early in prion diease?

A

difficulties w. concentration, memory and judgment

52
Q

rapidly progressive cognitive decline w/ myoclonus is suggestive of

A

Creutzfeldt-Jakob disease

53
Q

The 3Ws of NPH

A

Wobbly– gait disturbance
Wet– urinary incontinence
Wacky– cognitive impairment

54
Q

what do we see on imaging in normal pressure hydrocephalus? what about LP?

A

enlarged ventricles with a localized elevation of CSF pressure but normal opening pressure on lumbar puncture

55
Q

of the triad which is less likely to improve in NPH?

A

cognitive impairment

56
Q

treatment of NPH?

A

placement of a shunt– netriculoperitoneal

psych FA shelf (17 decks)

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