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neurocognitive disorders Flashcards

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1
Q

AD buzzwords

A

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

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2
Q

vascular dementia buzzwords

A

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)
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3
Q

delirium buzzwords

A
  • 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?”
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4
Q

Lewy body dementia buzzwords

A
  • 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
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5
Q

Frontotemporal dementia (Pick’s)

A
  • 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.
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6
Q

Parkinson’s

A
  • established prior to cognitive decline
  • apathy, depressed/anxious
  • hallucinations/delusions
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7
Q

vascular dementia; look for ?

A

look for focal neurological sign i.e. numbness

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8
Q

ACA occlusion

A

Motor/Sensory cortex (anteromedial MEDIAL) , Frontal lobe
contralat LE weakness/paralysis
executive dysfunction, personality changes

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9
Q

MCA occlusion

A

Motor/Sensory cortex(LATERAL), Temporal Lobe, Parietal Lobe
contralat UE weakness/paralysis
hemineglect, aphasia (Broca’s and Wernicke)

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10
Q

PCA occlusion

A

Occipital Lobe, Posterior Parietal
contralateral hemianopia
prosopagnosia (can see person, can’t perceive who they are)

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11
Q

vascular dementia risk factors

A

“multiple cerebral infarction”

  • atherosclerosis, valvular heart disease, arrhythmias, HTN
  • multiple parenchymal lesions diffusely spread
  • “white matter disease” affects axons
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12
Q

NPH (normal pressure hydrocephalus)

A

urinary incontinence, dementia, ataxia

“wet, wobbly, wacky”

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13
Q

AD tx

A

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

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14
Q

antidepressants for AD tx

A

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

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15
Q

benzos for AD?

A

NO
Nonbenzo Β-antagonist: Trazodone, Nefazodone, Zolpidem, Propranolol
-Increase SE Increase GABA Decrease NE
-for insomnia and anxiety

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16
Q

in AD avoid

A

Avoid benzo b/c cardiovascular & kidney effects, confusion, disinhibition, falls
Avoid antihistamines b/c anticholinergic effects

17
Q

for AD hallucinations

A

Antipsychotic
Risperidone Haloperidol
Decrease DA and 5HT
-treat late-stage psychosis, agitation , aggression Increased risk for cardiac arrhythmia & EPS, OSH

18
Q

AD antiHTN

A

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

19
Q

VaD Anticoagulants

A

Heparin Warfarin
prevent blood clots
Especially for afib & additional risk factor
-increased risk GI bleeds

20
Q

VaD Thrombolysis

A

tPA if have stroke w.in 3 hrs

21
Q

VaD antiplatelet/NSAIDS

A

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

22
Q

question 1

A

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

23
Q

question 2

A

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 ??
24
Q 
question 3: Neurotransmitters involved in pathogenesis of dementia: include ACh and what else?
A. dopamine
B. glycine
C. serotonin
D. glutamate
E. norepinephrine
A

D. glutamate

25
Q

question 4:

A

vascular dementia

26
Q

question 5:

A

D. acetylcholinesterase inhibitor

  • dx is AD: cortical atrophy, low MMSE, difficulty with ADLs, visual/spatial problems
  • probably in intermediate phase
  • memintide, combo with donepizil
  • if psychotic features would give risperidone, halperidol (be cautious of arrhythmias)
  • if had insomnia: would give B-blocker, or trazadone
  • DA agonist only if parkinson’s/lewy body
  • valproic acid for seizures or for bipolar
27
Q

question 6: 72 yr old, sudden onset confusion/clumsiness

  • hx of a fib, HTN
  • cannot draw picture
  • normal strength, intelligence, speaking, repetition
A

has constructional apraxia

  • lesion on the right: NON-dominant
  • would also see: hemineglect, may get lost, confusion
  • if dominant (left) lobe: see math/writing problems
  • if nondom (right) temp lobe: auditory agnosia (hear but can’t make sense)
  • if dominant( left) temp lobe: Wernicke’s
28
Q

question 7: 56 yo man, behavioral changes, irritable moody, wandering around, hyper oral, impaired goals, disinhibition, sparing of parietal

A

C. Pick’s dementia

  • have gradual onset, speech decline
  • not Lewy: no hallucinations, parkinsons
29
Q

question 8: 81 yo with AD

A

A. condition is irreversible; meds slow progression but no cure

30
Q

question 9: 74 yo nursing home pt; combative; suspicious of fellow resident, temp is 104, BP 90/50; family reports fine earlier except for cough

A

delirium

31
Q

question 10: what benzo will be short acting

A

triazolam: intermediate onset, short duration?

UWorld says lorazepam: bc of liver failure

32
Q

question 11: depressed pt hearing voices telling her she doesn’t deserve to live for past month

A

C. MDD w. psychotic features

-not schizoaffective; psychosis would have to happen in absence of depression

33
Q

question 12: singing loudly, playing piano all night for past month, hearing voices, mood is terrific, makes inappropriate advances to nurses
-hx of multiple psych hospitalizations starting age 22 (now 35)

A

D. schizoaffective disorder

  • not BP w. psychotic features bc psychotic features not dependent on BP symptoms
  • not schizophrenia: no delusions/hallucinations continuous for more than 6 mos
34
Q

question 13: pt depressed for month; hypothyroidism, controlled

A

MDD

  • not adjustmant disorder; would not see 5 SIGECAPS criteria, would see tearfulness, hopelessness, etc
  • has medical condition, but under controlled
  • not PMDD; major depressive episode happens 1 week before period, then go away during period, needs to happen for a year
  • not substance abuse: depression is NOT induced by drinking wine, smoking weed in this case
35
Q

question 14: 24 yo w. mood swings, tx and comes in later w. manic episode

A

given SSRI (sertraline) and it induced mania

psych (5 decks)

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