Neurocognitive Disorders

Question 1

What is normal pressure hydrocephalus

Answer 1

Reversible cause of dementia which is seen in predominantly elderly patients

Question 2

What is the cause of normal pressure hydrocephalus

Answer 2

Impaired absorption of CSF at the arachnoid villi. Can be triggered by bleed or head injury

Question 3

Classic triad of features

Answer 3

Urinary incontinence, dementia, gait abnormality which develops over several months

Question 4

Investigations into normal pressure hydrocephalus

Answer 4

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

Question 5

Treatment of normal pressure hydrocephalus

Answer 5

Ventriculo-peritoneal shunting in patients fit for surgery.
If not managed with conservative treatment and repeated CSF taps.

Question 6

What is transient global amnesia

Answer 6

Neurological condition characterised by temporary but total disruption of both short and long term memory.

Question 7

What is delirium

Answer 7

Distrubance in consciousness / cognitive function / perception.
Acute onset
Fluctuating course

Question 8

Presentation of delirium

Answer 8

Hallucinations, delusions, paranoia, developing quick and usually temporary

Question 9

Hyperactive delirium type

Answer 9

Increased confusion
Hallucinating delusions
Sleep disturbance
Being less co-operative

Question 10

Hypoactive delirium type

Answer 10

Poor concentration
Being less aware
Reduced mobility or movement
Reduced appetite

Question 11

Predisposing factors

Answer 11

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.

Question 12

Precipitating factors for delium

Answer 12

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

Question 13

Causes of delirium - I WATCH DEATH

Answer 13

Infections.
Withdrawal.
Acute metabolic.
Toxins or drugs.
CNS pathology.
Hypoxia.
Deficiencies.
Endocrine.
Acute vascular.
Trauma.
Heavy metals.

Question 14

The 4 A’s delirium assessment

Answer 14

Alertness (0-4)
AMT4 (0-2)
Attention (0-2)
Acute change or fluctuating course (0-4)

Question 15

Management of delirium

Answer 15

Treat underlying cause.
Address physical needs.
Orientate.
Haloperidol 0.5mg 2-4 hourly

Question 16

What is dementia

Answer 16

Syndrome of chronic or progressive nature which involves impairment of multiple higher cortical functions, such as memory, thinking, orientation, comprehension and language.

Question 17

Cause of Alzheimers disease

Answer 17

Build up of amyloid protein deposits around brain cells and tau protein tangles within brain cells.

Question 18

Cause of lewy body dementia

Answer 18

Lewy body build ups

Question 19

Cause of vascular dementia

Answer 19

Result of multiple infarcts in the brain, previous CVD or events

Question 20

Presentation of Lewy body dementia

Answer 20

Cognitive decline associated with parkinsonism - rigidity, tremor, bradykinesia

Question 21

Presentation of fronto-temporal dementia

Answer 21

Cognitive impairment, personality change and disinhibition, in keeping with the frontal area of the brain which is affected. Atrophy of frontal and temporal lobes

Question 22

Presentation of vascular dementia

Answer 22

Sudden onset cognitive decline and deterioration in someone with previous CVS or event.

Question 23

Presentation of Wernicke’s encephalopathy

Answer 23

Ataxia, opthalmoplegia, nystagmus and acute confusional state

Question 24

The 4 A’s of alzheimers disease

Answer 24

Amnesia, aphasia, agnosia, apraxia

Question 25

Three core features of Lewy body dementia

Answer 25

Fluctuating cognition, parkinsonism and visual hallucinations