Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Board Certification 2 (Purple book) > Neurocognitive disorders > Flashcards

Neurocognitive disorders Flashcards

1
Q

Hallmark of delirium

A

disturbance in consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Subtypes of delirium

A

Hyperactive
Hypoactive
Mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Delirium with mental health disorders

A

Often we don’t recognize that the Delirium is a separate thing and we assume it’s just part of the mental health disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

High incidences of Delirium in

A

hospitalized people, especially with cancer or ICU patients

More common in men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Prognosis for Delirium

A

within 1 year the mortality is 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk factors for Delirium

A

The more physically ill, the higher risk
Substance abuse
V/H impairment
History of Delirium or other brain disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of Delirium

A 
Reversed sleep-wake cycle 
Impaired recent and intermediate memory 
Usually resolves in 3 to 6 months
Illusions are common. 
Might also have visual hallucinations

Tremors, incoordination, urinary retention, myoclonus, nystagmus, asterixis, increased tone and reflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Delirium work up

A

You’re looking for whatever is the underlying cause.

Do all the normal labs, syphilis, HIV, chest radiograph, EEG

The EEG activity can be slow, or it could be fast if related to alcohol withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Medication for Delirium

A

Haldol or 2nd gens for agitation

Benzos for insomnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Non-pharm management for Delirium

A

They shouldn’t be over or under stimulated

Have pictures of family in the room and a clock/calendar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

the high morbidity of Delirium is related to

A

injury, inactivity, pneumonia, nutrition/hydration deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Not so obvious things that could contribute to Delirium

A

Myocardial factors, reduced sensory input

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Children and Delirium

A

they are especially susceptible because their brains are immature

Often mistaken for uncooperative behavior. If they aren’t able to be soothed by the parents, suspect Delirium.

Anticholinergics, other meds that affect cognition, and fever can cause it.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dementia

A

A group of disorders characterized by cognitive deficits

Impaired executive functioning
Impaired global intellect with preservation of level of consciousness
Impaired problem-solving
Organization skills
Altered memory
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Alzheimers

A

Gradual onset and progressive decline

No focal neuro deficits

The hallmark is amyloid deposits and neurofibrillary tangles. There is also diffuse cerebral atrophy and enlarged ventricles

Decreased ACh and NE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Vascular dementia

A

Second most common (which makes sense because a lot of people have HTN, etc)

Step-wise declines

More common in men

Carotid bruits, fundoscopic abnormalities, enlarged heart chambers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

HIV dementia

A

it’s considered a subcortical dementia

Progressive decline and behavioral changes like alzheimers, but it also has motor abnormalities

It co-occurs with many other psych disorders.

It’s a bad sign, in the late stage they get psychotic (can also have mutism, mania, seizures), and they usually die within 6 months

Parenchymal abnormalities visualized on MRI scan

Antiretrovirals can interact with psych meds, so be careful.

(fyi, HIV neurocognitive disorder and HIV encephalopathy are less severe forms of HIV dementia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pick’s disease

A

Also known as frontotemporal dementia

Personality and behavior change in the early stage, later there are cognitive changes (this makes it unique- first behavior changes, then cognition)

HYPERSEXUAL/HYPERORALITY

Neuronal loss, gliosis, and Pick’s bodies are present

More common men

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Creutzfeldt-Jakob disease

A

Fatal and RAPIDLY progresses

Initially: Fatigue, flulike symptoms, cognitive impairment

Later: Aphasia, apraxia, emotional lability, depression, mania, psychosis, marked personality changes, and dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Huntington’s disease

A

Subcortical dementia

Biggest feature is motor abnormalities (choreoathetoid). It’s not until later that there will be memory, language, and insight problems.

High incidence of depression and psychosis

21
Q

Lewy Body disease

A

Caused lewy bodies in the cortex

VISUAL hallucinations and PARKINSONS features

Antipsychotics are not a good choice

22
Q

Genetics with Alzheimers

A

Chromosomes 1, 14, and 21 are implicated

It’s an autosomal dominant trait

Later onset is linked to E4 APOE4 on chromosome 19

23
Q

Dementia incidence

A

1.6% of people 65 and older

It’s often unrecognized

24
Q

Dementia risk factors

A

complex medical illnesses

genetics

substance use

25
Q

Dementia prevention/screening

A

Cognitive evaluation every 3 years for people 65 and up (however, USPSTF says there is not sufficient evidence to support this)

26
Q

Dementia: when taking their history

A

Screen for history of HTN, stroke, head trauma, and psych illness (depression, anxiety, schizophrenia)

27
Q

Assessment tools for dementia

A

MMSE
MoCA (montreal cognitive)
Mini-Cog
SLUMS (St Louis university mental status

28
Q

Possible physical findings for dementia

A

Amaurosis fugax: unilateral transient vision loss, described as “curtain over the eye”

Unilateral focal-motor weakness

Asymmetrical reflexes

29
Q

In the late stages of dementia, a speech assessment could show

A

mutism, echolalia

30
Q

Differential dx for dementia

A 
B12 and folate deficiency
Hearing loss
Parkinsons 
Hypothyroid
Infection
Mood disorder
Anxiety
and others
31
Q

Memantine

A

Use it for moderate to severe AD

It may slow the degeneration

May be used in combination with cholinesterase

32
Q

Cholinesterase inhibitors

A

Use for mild to moderate AD (donepezil can also be used for severe)

It can cause a 2 to 3 point increase on the MSE

Slows loss of function, and may improve some behaviors

You might need to stop if they have side effects (nausea)

Donepezil causes nausea, diarrhea, vomiting, appetite/weight loss, abnormal dreams, insomnia, dizziness

Rivastigmine should be titrated slowly to avoid side effects. It can be used for AD and parkinson’s dementia

33
Q

Benzos and dementia

A

May be used for anxiety and INFREQUENTLY for agitation

34
Q

Dementia and treatment of depression

A

Treat for 6 to 12 months, then taper. If it comes back, they may need indefinite treatment

35
Q

Psychotherapy for HIV dementia

A

You’ll be dealing with guilt, self-esteem, and fear of dying

36
Q

Dementia and children

A

You can’t dx it until 4 to 6 years old, when the cognition can fully be examined

In children dementia presents as deteriorating function in school

37
Q

Criteria for neurocognitive disorder due to TBI

A

A head injury with loss of consciousness, posttraumatic amnesia, disorientation/confusion, or neurological signs (seizures, visual field cuts, etc)

The symptoms must start soon after the injury

38
Q

neurocognitive disorder due to TBI

A

veterans,

worsening of problems such as memory, balance, headaches (anything that would suggest a brain injury)

39
Q

neurocognitive disorder due to TBI, troops compared to civilians

A

It’s harder to heal for troops, for obvious reasons

40
Q

Mild TBI symptoms

A 
concentration
Memory 
Intellect
irritability
depression
anxiety
Dizziness
balance
headaches
tinnitus
numbness/tingling
vision changes
sensitivity to light or sound
extreme fatigue 
sleep problems
41
Q

Moderate TBI symptoms

A

Mild symptoms plus:

worsening headaches
repeated nausea
seizures
difficult to arouse from sleep
slurred speech 
unequal pupils 
confusion
restless/agitated 
Extreme weakness/numbness
loss of coordination
42
Q

There’s a big risk for suicide with TBI, especially if they are

A 
male
18 and 19
comorbid psych disorder
Aggressive 
Substance use
43
Q

Imaging for TBI

A

it doesn’t show anything

44
Q

Pharmacologic Treatment of TBI

A

There are no meds specific to TBI, but you can treat symptoms
Be careful using meds that cause sedation, anticholinergics, TCAs/bupropion/amantadine (they can cause seizure), antipsychotics, benzos

If they have a cognitive disorder with the TBI, you can use:
Stimulants for inattention etc
Bromocriptine (off label) for executive functioning
Amantadine (off label) cognitive function, attention

45
Q

Non Pharmacologic Treatment of TBI

A

Follow up for 1 year after anyone attempts suicide
Physical therapy to reduce dizziness
Occupational therapy to help with vision problems and memory
Psychotherapy: supportive therapy, CBT, behavioral, and family therapy are good.

The hardest thing for families to adjust to is personality/behavioral changes.

46
Q

What to teach families of a TBI patient

A

The hardest thing for families to adjust to is personality/behavioral changes.

Use common sense strategies to cope with poor memory and concentration (for example a note pad to write things down)

If they get angry, the family should stay calm, give them space, maybe leave the room until they calm down

47
Q

Tips for the NP giving therapy for a TBI patient

A

adjust session length depending on their attention span

48
Q

Prognosis for Mild TBI

A

usually a full recovery in 3 months

If they have residual symptoms, 80 to 85 % will clear up in 6 months

49
Q

Screening for TBI is important because

A

it is possible for symptoms to occur later, not right after the injury (which is different from a neurocognitive disorder due to a TBI, where the symptoms start immediately.

Board Certification 2 (Purple book) (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions