Neurocognitive disorders Flashcards
What is delirium?
Acute and fluctuating
Impaired attention and awareness
+ 1 more cognitive domain
How to assess delirium?
Abbreviated Mental Test Score (AMTS): delirium if <6/10
How to manage delirium?
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
What are the causes of delirium?
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
What are the risk factors of delirium?
Age Male Pre-existing dementia, depression, CNS disorders Alcohol use Comordities Cholinergic deficit Hearing / visual impairment Malnutrition
What are the primary causes of dementia?
Vascular, PD, AD, FTD, LBD, Huntington, prion disease
What are the secondary causes of dementia?
Inf: HIV, syphilis Trauma Metabolic: liver failure, folate/B12 deficiency, uremia, electrolyte Inflammatory: MS, SLE Neoplasm, NPH Endocrine: thyroid, PTH, adrenal gland
What is dementia?
Cognitive decline + functional impairment
How to assess dementia?
Screening: MOCA, MMSE
Functional: clinical dementia rating
How to manage dementia?
Pharm: cholinesterase ihb (donezepil, rivastigmine, galantamine), NMDA antagonist (memantine)
Non-pharm: cognitive stimulating activities, reminiscence therapy, group cognitive therapy
What are the features of Alzheimer’s?
Impaired memory, learning & language
Mood swing, personality change, paranoia
What is the pathology of Alzheimer’s?
Cerebral atrophy
Abnormal protein deposition (amyloid & tau)
What are the RF of Alzheimer’s?
Old age Female Low education Genetic: early (APP, presenilin), late (apolipoprotein E) CV: HT, HL, DM, obesity Lifestyle: sedentary, diet Down
What are the features of vascular dementia?
Stepwise deterioration in cognitive function
Focal neuro sx
How to investigate vascular dementia?
CT/MRI: WM ischemia, infarct, hemorrhage
What is PDD?
Parkinsonian features >1y before dementia
What is LBD?
Parkinsonian features <1y before dementia
What are the features of PDD/LBD?
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
What is the pathology of LBD/PDD?
Alpha synuclein deposition in BG (substantia nigra)
How to manage LBD/PDD?
Cholinesterase inhibitor
Antipsychotic: clozapine, quetiapine
Levodopa-carbidopa (motor)
Melatonin, clonazepam (sleep)
What is the pathology of FTD?
Degeneration of frontal (behavior & personality) & temporal (language) lobes
What are the features of FTD?
Decline in social & personal conduct: disinhibition, tactless
Emotional blunting
Impaired speech & comprehension: echolalia, perseveration, mutism
Early loss of insight
Impaired executive function
Memory intact
How to manage FTD?
Serotoninergic e.g. SSRI, trazodone
How to address carer distress of dementia patients?
Explore relationship with patient Explore mood & social support Psychoeducation Carer support group Liaison with social services
What rehabilitative services are available for dementia patients?
Psychogeriatric day hospital, day care centre, ICCMW, long term care home
What are the risks of dementia patients?
Safety issues
Self harm / suicide
Violence to others
Self neglect
