neurocognitive disorders Flashcards
(35 cards)
AD buzzwords
memory impairment, cognitive decline, insidious gradual/progressive
memory–>language
diffuse atrophy (cortex), enlarged ventricles
-plaques and tangles in temporal/parietal lobe
NT: decreased ACh (progressive loss of cholinergic neurons)
excessive glutamate: memantine blocks NMDA receptors
vascular dementia buzzwords
stepwise; temporal relationship btw stroke and onset of dementia symptoms; onset may be sudden
- decline in attention (processing speed) and frontal-executive function (MOST affected by vascular system)
- impaired social/occupational functioning
- risk factors: HTN, DM
- MRI or CT shows multiple cortical and/or subcortical infarcts.(FA)
delirium buzzwords
- disturbance in attention, awareness, level of consciousness, disoriented (like “half-way sleeping”)
- acute, fluctuating
- look for systemic medical condition (fever, substance)
- additional cognitive disturbance (memory, disorientation, language, hallucinations)
- “hospitalized, in nursing home, surgical unit, wandering streets?”
Lewy body dementia buzzwords
- impaired cognition (looks like AD) and parkinsonism (looks like PD: bradykinesia, gait impairment)
- sudden and fluctuating attention/alertness (like delirium)
- REM sleep disturbance, very sensitive to EPS and NMS in neuroleptics
- visual hallucinations (early, vs late stages in AD, PD)
- a-synuclein aggregates
Frontotemporal dementia (Pick’s)
- insidious, gradual
- *personality and social conduct and executive dysfunction more than visual/spatial, learning memory spared til later
- language impairment; speech abnormalities
- apapthy, irritable,
- young onset
- Pathology: Pick bodies: silver-staining cytoplasmic inclusions. No plaques and tangles.
Parkinson’s
- established prior to cognitive decline
- apathy, depressed/anxious
- hallucinations/delusions
vascular dementia; look for ?
look for focal neurological sign i.e. numbness
ACA occlusion
Motor/Sensory cortex (anteromedial MEDIAL) , Frontal lobe
contralat LE weakness/paralysis
executive dysfunction, personality changes
MCA occlusion
Motor/Sensory cortex(LATERAL), Temporal Lobe, Parietal Lobe
contralat UE weakness/paralysis
hemineglect, aphasia (Broca’s and Wernicke)
PCA occlusion
Occipital Lobe, Posterior Parietal
contralateral hemianopia
prosopagnosia (can see person, can’t perceive who they are)
vascular dementia risk factors
“multiple cerebral infarction”
- atherosclerosis, valvular heart disease, arrhythmias, HTN
- multiple parenchymal lesions diffusely spread
- “white matter disease” affects axons
NPH (normal pressure hydrocephalus)
urinary incontinence, dementia, ataxia
“wet, wobbly, wacky”
AD tx
1st line: Donepezil: useful for mild-moderate disease; still have enough “forebrain” so can benefit from ACh (nucleus basalis of Meynart)
later stages: block glutamate: Memantine (NMDA antagonist)
can combine these 2
antidepressants for AD tx
Sertraline, Citalopram. Bupropion, Mirtzipine
-increase catecholamines
Avoid paroxetine & TCAs: anticholinergic effects will exacerbate cognitive decline Avoid fluoxetine: activation may cause agitation and insomnia, also avoid paroxetine
benzos for AD?
NO
Nonbenzo Β-antagonist: Trazodone, Nefazodone, Zolpidem, Propranolol
-Increase SE Increase GABA Decrease NE
-for insomnia and anxiety
in AD avoid
Avoid benzo b/c cardiovascular & kidney effects, confusion, disinhibition, falls
Avoid antihistamines b/c anticholinergic effects
for AD hallucinations
Antipsychotic
Risperidone Haloperidol
Decrease DA and 5HT
-treat late-stage psychosis, agitation , aggression Increased risk for cardiac arrhythmia & EPS, OSH
AD antiHTN
ACE inhibitors Diuretics
Control BP; Preferred agents to β- blockers (affect cognition more than others)
-don’t put in lower end of normal, may exacerbate cognitive decline, fine high-normal
VaD Anticoagulants
Heparin Warfarin
prevent blood clots
Especially for afib & additional risk factor
-increased risk GI bleeds
VaD Thrombolysis
tPA if have stroke w.in 3 hrs
VaD antiplatelet/NSAIDS
Aspirin, Clopidogrel (don’t combine!)
-Inhibit thrombus Arterial circulation
Preferred over anticoagulants for 2o stroke prevention.
If patient had a CVA while on aspirin, can combine dipyridamole
question 1
D. Lewy body dementia
neuroleptic response, early onset
-look for good/bad days, Parkinsonism, vivid dreaming
-socially inappropriate suggests frontal-temporal; would look for other personality changes, extreme agitation, urinary incontinence; parkinsonism NOT associated with frontal-temporal dementia
question 2
B. cholinesterase inhibitor
- dx is AD: MMSE low, labs fine, would give donepezil
- the other AChE inhibitors (i.e. rivastigmine) decreases appetite; would not give
- would give NMDA antagonist later on
- would give DA agonist for parkinson’s and Lewy body
- would give B-blocker for insomnia, agitation; but would go to trazadone first
- would give SSRI for ??
question 3: Neurotransmitters involved in pathogenesis of dementia: include ACh and what else? A. dopamine B. glycine C. serotonin D. glutamate E. norepinephrine
D. glutamate
