Neurocognitive disorders Flashcards
How are AMS classified
change in consciousness and cognition
*important to make sure to know what their baseline is
What are the two major pathways of AMS
diffuse dysfunction compromise and focal lesions
What are red flags for AMS
sudden onset
elderly
headache
drug use
trauma
fever
AMS - symptom not diagnosis
What needs to be assessed for a patient presenting with AMS
great history
great physical exam - naked, accurate temp, GLUCOSE
what is AVPU
Assessment of mental status
Alter, or responsive to Verbal stimuli
Unresponsive, or responsive only to Painful stimuli
what are the baseline labs used for AMS
IMMEDIATE BGL
CBC
CMP - sodium/uremia(kidney), Liver
Lactate
UA
Urine drug screen
Urine pregnancy
ABG or VBG
TSH
LP
PT/PTT
What is delirum
acute change in attention/awareness and cognitive status with disturbance of sleep-wake cycle
Dementia
chonic state of AMS with slow, progressive onset
psychosis
patient will have delusions, hallucinations, disorganized thinking, abnormal behavior or negative symptoms
What are the common causes of delirium
Drugs
ETOH/Drug withdrawal
metabolic disorder
TBI
encephalitis
What is the reticular activating system
source of consciousness (wakefulness, sleep/wake and attention)
consists of the nuclei within the brain as well as fibers that send the sensory input to the cerebral cortex
What is the pathophysiology of hyperactive delirium
hyperactive autonomic system
decreased ach and melatonin
excess dopamine, norepi, glutamate
will affect specific areas of the brain leading to the expressed symptoms
what happens when there is increased excitability with change in neurotransmitters?
inflammation. decreased BBB function, change in CBF and CNS metabolic derangements
what is hyperactive delirium with
associated with withdrawal, infection, sepsis, electrolyte, abnormalities, metabolic abnormalities
what is hyperactive delirium presentation
tremor
hallucinations
difficulty concentrating
insomnia
irritability
restlessness
dilated pupils
tachycardia
fever
sweating
what is Agitated Delirium
aka excited delirium syndrome
increased dopamine activity - cocaine, thyroid storm, methamphetamines
AMS, combative, aggressive, high temp, poor awareness, superhuman strength, indefatigable
Can lead to death
what is hypoactive delirium
often associated with right-sided frontal-basal ganglion disruption
associated with CNS depressants, metabolic disorders
will have decreased levels of alterness, decreased attention span, forgetful and apathy
intact perception and interpretation of surroundings
What is the active form of Thyamine
TTP
what is Wernicke-korsakoff syndrome
lack of sufficient thiamine - complication of long term ETOH abuse
hallmarked by paralysis of eye movement, ataxic gait, changes in consciousness
acute syndrome
What is Korsakoff’s syndrome:
hallmarked by memory loss, confusion, confabulation - lesions in mammillary body
Chronic result
what is the pathophysiology of Wernicke encephalopathy
decreased thiamine
increased vascular congestion
increased macrophage activation
petechial hemorrhages
demyelination
neuronal damage is most common in the thalamus
atrophy of mamillary bodies
What is Wernickes encephalopathy triad
encephalopathy
oculomotor dysfunction
gait ataxia (often first symptom)
what is dementia
acquired decline in cognition. may affect many facets including memory, learning, executive functioning, social cognition, motor skills
What is the pathophysiology of dementia
genetic predisposition with environmental triggers
what does dementia lead to
neuron degeneration
compression/deformation of brain parenchyma
head trauma
vascular abnormalities
infectious etiologies
inflammatory issues
will ultimately lead to nerve degeneration and brain atrophy
What is broca’s aphasia
expressive - cannot find words.
comprehension is intact - unable to repeat or write
supplied by MCA
What is wernickes aphasia
receptive aphasia. will have meaningless, inappropriate expression. cannot recognize errors. comprehension impaired, cannot repeat, cannot read or write
affects left posteriosuperior temporal lobe
fed by inferior division of MCA
What is alzheimers disease
most common cause of severe dementia
affects elderly
plaques and tangles are most common in cerebral cortex and hippocampus - frontal and temporal lobe atrophy
what are risk factors for alzheimers
family history
DM
female
HTN
TBI
sedentary lifestyle
What is vascular dementia
associated with decreased vascular flow in the brain
may be associated with ischemia or hemorrhagic infarcts
similar in presentation to Alzheimers
what is the presentation of vascular dementia
memory more intact (initially)
associated with other CVA symptoms (focal weakness, ambulatory disfunction)
anxiety and apathy
presents with cognitive slowing
What is frontotemporal dementia
aka picks disease
onset <60 yo
3 varients: behavioral, progressive nonfluent aphasia (bracas aphasia), semantic dementia
associated with degenerative changes in the frontal lobe
mutation in the tau protein
what is the presentation of frontotemporal dementia
loss of language
difficulty with understanding speech prior to memory deficitis
emotional disturbances with apathy, emotional blunting, inappropriate conduct and loss of judgement and depression
What is Lewy Body dementia
similar presentation to vascular dementia or alzheimers
brain atrophy - frontal, temporal and parietal lobes
how do you diagnose lewy body dementia
histology post mortum
what is the presentation of Lewy Body depenta
initial loss of concerntation/attention
memory and cognition will follow
increased risk of delirium
may have visual hallucinations, sleep disorder
may have motor deficits similar to Parkinsons
What is Creutzfeldt-Jakob disease
“mad cow disease”
considered a rapidly progressive degenerative dementia
prion related disease
pts typically die wtihin a year
what are priors
infectious misfolded protein particles - they replace normal prion proteins thought to typically play a role in memory and sleep
what are the types of Creutzfeldt-jakob disease
Sporadic CJD
variant CJD
genetic CJD
latrogenic CJD
what is the presentation of CJD
mental status change is variable may have frontal/executive dysfunction memory impairment
depression, anxiety and decreased cognitive function
