Neurocognitive disorders

Question 1

What is delirium?

Answer 1

Acute and fluctuating
Impaired attention and awareness
+ 1 more cognitive domain

Question 2

How to assess delirium?

Answer 2

Abbreviated Mental Test Score (AMTS): delirium if <6/10

Question 3

How to manage delirium?

Answer 3

1) Tx underlying cause
2) Address exacerbating factors
3) Relieve symptoms: quiet isolated room, friends and family, avoid restraints unless high risk, orientation aids, maximise sensory acuity
4) Pharm: haloperidol, avoid BZD

Question 4

What are the causes of delirium?

Answer 4

1) Infection
2) Metabolic: hypogly, hepatic encephalopathy, electrolyte, uremia, porphyria
3) Endocrine: thyroid, PTH, adrenal gland, hypopit
4) Nutritional: thiamine, folate, niacin, B12
5) Intracranial: SOL, trauma, inf, epilepsy, vascular
6) Drugs

Question 5

What are the risk factors of delirium?

Answer 5

Age
Male
Pre-existing dementia, depression, CNS disorders
Alcohol use
Comordities
Cholinergic deficit
Hearing / visual impairment
Malnutrition

Question 6

What are the primary causes of dementia?

Answer 6

Vascular, PD, AD, FTD, LBD, Huntington, prion disease

Question 7

What are the secondary causes of dementia?

Answer 7

Inf: HIV, syphilis
Trauma
Metabolic: liver failure, folate/B12 deficiency, uremia, electrolyte
Inflammatory: MS, SLE
Neoplasm, NPH
Endocrine: thyroid, PTH, adrenal gland

Question 8

What is dementia?

Answer 8

Cognitive decline + functional impairment

Question 9

How to assess dementia?

Answer 9

Screening: MOCA, MMSE
Functional: clinical dementia rating

Question 10

How to manage dementia?

Answer 10

Pharm: cholinesterase ihb (donezepil, rivastigmine, galantamine), NMDA antagonist (memantine)
Non-pharm: cognitive stimulating activities, reminiscence therapy, group cognitive therapy

Question 11

What are the features of Alzheimer’s?

Answer 11

Impaired memory, learning & language

Mood swing, personality change, paranoia

Question 12

What is the pathology of Alzheimer’s?

Answer 12

Cerebral atrophy

Abnormal protein deposition (amyloid & tau)

Question 13

What are the RF of Alzheimer’s?

Answer 13

Old age
Female
Low education
Genetic: early (APP, presenilin), late (apolipoprotein E)
CV: HT, HL, DM, obesity
Lifestyle: sedentary, diet
Down

Question 14

What are the features of vascular dementia?

Answer 14

Stepwise deterioration in cognitive function

Focal neuro sx

Question 15

How to investigate vascular dementia?

Answer 15

CT/MRI: WM ischemia, infarct, hemorrhage

Question 16

What is PDD?

Answer 16

Parkinsonian features >1y before dementia

Question 17

What is LBD?

Answer 17

Parkinsonian features <1y before dementia

Question 18

What are the features of PDD/LBD?

Answer 18

Cognitive impairment: day-to-day fluctuation in alertness & attention
Neuropsychiatric: VH, REM sleep disturbance, ANS symptoms
Motor: resting tremor, rigidity, bradykinesia
Extreme sensitivity to antipsychotics

Question 19

What is the pathology of LBD/PDD?

Answer 19

Alpha synuclein deposition in BG (substantia nigra)

Question 20

How to manage LBD/PDD?

Answer 20

Cholinesterase inhibitor
Antipsychotic: clozapine, quetiapine
Levodopa-carbidopa (motor)
Melatonin, clonazepam (sleep)

Question 21

What is the pathology of FTD?

Answer 21

Degeneration of frontal (behavior & personality) & temporal (language) lobes

Question 22

What are the features of FTD?

Answer 22

Decline in social & personal conduct: disinhibition, tactless
Emotional blunting
Impaired speech & comprehension: echolalia, perseveration, mutism
Early loss of insight
Impaired executive function
Memory intact

Question 23

How to manage FTD?

Answer 23

Serotoninergic e.g. SSRI, trazodone

Question 24

How to address carer distress of dementia patients?

Answer 24

Explore relationship with patient
Explore mood & social support
Psychoeducation
Carer support group
Liaison with social services

Question 25

What rehabilitative services are available for dementia patients?

Answer 25

Psychogeriatric day hospital, day care centre, ICCMW, long term care home

Question 26

What are the risks of dementia patients?

Answer 26

Safety issues
Self harm / suicide
Violence to others
Self neglect