Neurocognitive Disorders Flashcards
What is normal pressure hydrocephalus
Reversible cause of dementia which is seen in predominantly elderly patients
What is the cause of normal pressure hydrocephalus
Impaired absorption of CSF at the arachnoid villi. Can be triggered by bleed or head injury
Classic triad of features
Urinary incontinence, dementia, gait abnormality which develops over several months
Investigations into normal pressure hydrocephalus
Neuro imaging can be used but appears similar to Parkinson’s. Being unresponsive to L-DOPA can be used a sign of normal pressure hydrocephalus
Treatment of normal pressure hydrocephalus
Ventriculo-peritoneal shunting in patients fit for surgery.
If not managed with conservative treatment and repeated CSF taps.
What is transient global amnesia
Neurological condition characterised by temporary but total disruption of both short and long term memory.
What is delirium
Distrubance in consciousness / cognitive function / perception.
Acute onset
Fluctuating course
Presentation of delirium
Hallucinations, delusions, paranoia, developing quick and usually temporary
Hyperactive delirium type
Increased confusion
Hallucinating delusions
Sleep disturbance
Being less co-operative
Hypoactive delirium type
Poor concentration
Being less aware
Reduced mobility or movement
Reduced appetite
Predisposing factors
Previous mental health issues. Frail. Over 65. Cognitive impairment. Co-morbidities. Alcohol excess. Iatrogenic events. Sensory impairment. Poor nutrition. Lack of stimulation. Terminal phase illness. Significant injuries such as hip fracture.
Precipitating factors for delium
Infection. Metabolic or electrolyte disturbances. MI or HF. PE or COPD. Stroke, encephalitis, haematoma. Urinary retention. Thyroid dysfunction or Cushings. Severe pain. Hepatic failure or constipation. Alcohol intoxification or withdrawal. Medications such as opiates, steroids, antidepressants. Depression, sleep, sensory impairments
Causes of delirium - I WATCH DEATH
Infections.
Withdrawal.
Acute metabolic.
Toxins or drugs.
CNS pathology.
Hypoxia.
Deficiencies.
Endocrine.
Acute vascular.
Trauma.
Heavy metals.
The 4 A’s delirium assessment
Alertness (0-4)
AMT4 (0-2)
Attention (0-2)
Acute change or fluctuating course (0-4)
Management of delirium
Treat underlying cause.
Address physical needs.
Orientate.
Haloperidol 0.5mg 2-4 hourly
What is dementia
Syndrome of chronic or progressive nature which involves impairment of multiple higher cortical functions, such as memory, thinking, orientation, comprehension and language.
Cause of Alzheimers disease
Build up of amyloid protein deposits around brain cells and tau protein tangles within brain cells.
Cause of lewy body dementia
Lewy body build ups
Cause of vascular dementia
Result of multiple infarcts in the brain, previous CVD or events
Presentation of Lewy body dementia
Cognitive decline associated with parkinsonism - rigidity, tremor, bradykinesia
Presentation of fronto-temporal dementia
Cognitive impairment, personality change and disinhibition, in keeping with the frontal area of the brain which is affected. Atrophy of frontal and temporal lobes
Presentation of vascular dementia
Sudden onset cognitive decline and deterioration in someone with previous CVS or event.
Presentation of Wernicke’s encephalopathy
Ataxia, opthalmoplegia, nystagmus and acute confusional state
The 4 A’s of alzheimers disease
Amnesia, aphasia, agnosia, apraxia
Three core features of Lewy body dementia
Fluctuating cognition, parkinsonism and visual hallucinations
