Neurocognitive disorders

Question 1

Delirium vs Dementia

Answer 1

• Delirium:
  Fast onset, can happen to anyone, mostly a complication of something, reversible
• Dementia:
  Slow onset over the years, irreversible

Question 2

Causes of Delirium:

Answer 2

1- Hypoxic: poor cardiac output, severe pneumonia, stroke.
2- Infective: UTI, Syphilis, cerebral infection
3- Toxic: substance intoxication, medications
4- Metabolic: thyrotoxicosis, Low Mg, High Ca, thiamine deficiency

Question 3

Most common cause of delirium in children:

Answer 3

• Febrile illnesses
• Medications

Question 4

Types of delirium:

Answer 4

1- Hypoactive
2- Hyperactive: mc with drug withdrawal and toxicity
3- Mixed: most common type

Question 5

Degrees of delirium:

Answer 5

Mild: inattention, memory gaps, uncertain
Moderate: distractable, sleep/wake cycle disturbance
Severe: mixed periods of coma or increased arousal
Coma: unresponsive to all except noxious stimuli

Question 6

Diagnostic criteria of delirium?

Answer 6

• Disturbance in:
  Attention, Awareness, Cognitive behavior
• Acute onset (hours or days), fluctuation
• Not accounted by other NCD, or due to coma
• Evidence from history, examination or lab that there is a CAUSE.

Question 7

Alzheimer’s disease prevanlence:

Answer 7

• Elderly > 65 ys
• Females more common 68%

Question 8

Pathophysiology of Alzheimer’s?

Answer 8

• Accumulation of extra-neuronal senile plaques & intra-neuronal tau protein tangles.

Question 9

Diagnostic criteria for Alzheimer’s?

Answer 9

• Must: Memory impairment (old information or learn new ones)
  + 2 of any of the following:
• Aphasia (language disturbance)
• Apraxia (inability to draw a watch)
• Agnosia (inability to recognize a watch)
• Dysfunction in executive function
• Social and occupational dysfunction
• Gradual onset, cognitive decline
• Dont occur exclusively during delirium
• not due other medical illnesses

Question 10

Tx of Alzheimer’s?

Answer 10

• Cholinesterase inhibitors (Donepezil)
• NMDA-R Antagonists (memantine)

Question 11

Vascular dementia

Answer 11

• Result of a stroke
• Risk factors: HTN, DM, smoking, obesity, hyperlipidemia, old age
• Tx: manage risk factors and symptomatic Tx

Question 12

Lewy body disease pathophysiology

Answer 12

Accumulation of Alpha-synuclein and lewy neurites in basal ganglia

Question 13

Core features of Lewy Body disease:

Answer 13

• Waxing and waning in cognition (esp attention and alertness)
• Visual hallucinations (animal or people)
• Extrapyramidal sign after 1 year of cognitive decline

Question 14

Tx of Lewy body disease:

Answer 14

Cholinesterase inhibitor for cognition and clozapine for psychotic symptoms

Question 15

Normal pressure hydrocephalus:

Answer 15

• Reversible cause of cognitive dysfunction
• Idiopathic or secondary to meningitis & hemorrhage

Question 16

Clinical features of Normal pressure hydrocephalus 3W’s

Answer 16

Wobbly Gait
Wacky cognition
Wet (urinary incontinence)

Question 17

Tx of Normal pressure hydrocephalus?

Answer 17

Ventriculoperitoneal shunt (gait is responsive and cognition is least likely to improve)