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Psychiatry pro +1700 > Neurocognitive Disorders > Flashcards

Neurocognitive Disorders Flashcards

1
Q

What are the diagnostic criteria / domains for neurocognitive decline? (6)

A

Decline in:

  • Language
  • Complex attention
  • Perceptual motor
  • Executive function
  • Learning and memory
  • Social cognition

-(LAPELS)

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2
Q

What is the difference between major and minor cognitive decline?

A

Major = significant impairment

Minor = modest decline

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3
Q

Dementia is unusual to see prior to what age?

A

65

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4
Q

True or false: very few cases of dementia are reversible

A

True

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5
Q

What is the most common cause of dementia?

A

Alzheimer’s disease

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6
Q

What areas of the brain (lobes) are affected with AD?

A

Parietal and temporal lobes

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7
Q

True or false: dementia is a normal part of aging

A

False

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8
Q

What are the genes that are associated with AD?

A

Presenilin 1 and 2

amyloid precursor protein

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9
Q

What is the gene that is associated with early onset AD?

A

ApoE4

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10
Q

What is the gene that is protective against AD?

A

Apo E2

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11
Q

True or false: early onset AD has a strong genetic component

A

True

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12
Q

What is the natural h/o AD?

A

Gradual onset and progression

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13
Q

What are the two major questions that are used to screen for AD?

A
  • lost in a well known area

- Cannot pay bills

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14
Q

What is the neurotransmitter that is changed with AD?

A

Decreased ACh

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15
Q

What are the histological findings of AD?

A
  • Neurofibrillary tangles
  • Neuritic plaques
  • Excess amyloid
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16
Q

What is the average survival rate of AD?

A

8-10 years

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17
Q

What is the function of the Tau proteins?

A

Maintaining neuronal function (microtubule associated proteins)

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18
Q

What areas of the brain are particularly affected with AD?

A

Hippocampus

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19
Q

What is Binswanger’s disease? Which part of the brain is usually affected?

A

Multi Infarct dementia that is usually subcortical, but progresses to cortical dementia

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20
Q

What disease usually coexists with AD?

A

Vascular disease

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21
Q

What is the second most common type of dementia?

A

Vascular disease

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22
Q

What are the psychosis s/sx of lewy body dementia?

A

-Visual hallucinations/ delusions

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23
Q

What are the s/sx of PD? (TRAP)

A
  • Tremor (resting)
  • Rigidity
  • Akinesia
  • Postural instability
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24
Q

What is the treatment for lewy body disease? What should never be used?

A

Cholinesterase inhibitors

Never use antipsychotics

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25
Q

What is Pick’s disease?

A

Frontotemporal dementia–selective atrophy that involved the temporal and/or frontal lobes of the brain

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26
Q

When does frontotemporal dementia usually present, relative to AD?

A

50s as opposed to 70s for AD

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27
Q

What are the first s/sx of frontotemporal dementia?

A

Disinhibition and language problems

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28
Q

When do s/sx of CTE usually present?

A

8-10 years following repeated concussions

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29
Q

What are the usual s/sx of CTE?

A
  • Disorientation, HA
  • Memory loss, poor judgement
  • Progressive dementia
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30
Q

What is the major difference between cortical and subcortical dementia?

A

Cortical = global loss

Subcortical is not

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31
Q

What are the four types of subcortical dementia?

A
  • PD
  • MS
  • HD
  • Vascular disease
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32
Q

What is the inheritance pattern of HD?

A

AD

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33
Q

What is the trinucleotide repeat in HD? What chromosome? What gene?

A
  • CAG
  • Chromosome 4
  • BDNF gene
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34
Q

What part of the brain is specifically affected with HD? What happens to neurotransmitters here?

A

Caudate loses ACh and GABA

“Hunt 4 an animal and put it in a CAGe”

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35
Q

What are the usual first s/sx of HD?

A

Depression, flat affect

Rapid speech

36
Q

What is the classic triad of normal pressure hydrocephalus?

A

“Wacky, wobbly, and wet”

  • Confusion/delirium
  • Ataxic gait
  • Urinary incontinence
37
Q

How do you diagnose NPH?

A

Brain scan and/or LP

38
Q

What is the treatment for NPH?

A

VP Shunt (ventriculoperitoneal shunt)

39
Q

What are the causes of static encephalopathy? (4)

A
  • TBI
  • Hypoxic Brain injury
  • Korsakoff syndrome
  • Post infectious
40
Q

What is the classic triad of Wernicke’s encephalopathy?

A
  • Delirium
  • ocular change
  • Gait disturbance
41
Q

What is the key symptom of Wernicke’s encephalopathy?

A

confabulation

42
Q

What is Korsakoff syndrome?

A
  • Memory impairment part of WK syndrome

- Marked short term memory loss, that are filled in with confabulations

43
Q

What is the rash called with lyme disease?

A

Erythema migrans

44
Q

What is the antibiotic of choice for lyme disease?

A

Doxycycline

45
Q

What are the s/sx Creutzfeldt-Jakob disease? Onset?

A
  • Middle or older age
  • Serious psychiatric disturbances
  • Tremors
  • Obvious abnormal EEG
46
Q

What are the three major s/sx of HIV encephalopathy?

A
  • Cognitive impairment
  • Anxiety, depression
  • Mania
47
Q

What is the gene that is defective in Wilson’s disease?

A

ATP7B

48
Q

What are the features of delirium?

A
  • Disturbed attention/awareness

- Fluctuating course

49
Q

True or false: visual or tactile hallucinations are common with delirium

A

True

50
Q

What are the two extremes of delirium?

A

Hyper or hypo arousability

51
Q

What are the four major risk factors for delirium? Which gender?

A
  • Advanced age
  • Nursing home placement
  • Pre-existing brain damage
  • Male
52
Q

What type of infection commonly causes delirium in the elderly?

A

UTIs

53
Q

Is it possible to have dementia and delirium at the same time?

A

Yes–very common

54
Q

How do you differentiate dementia and delirium?

A

Have to know baseline

55
Q

What is the top priority with treating delirium?

A

Identify cause and correct it

56
Q

If there is a risk of sz with delirium, what drug is indicated? What is agitated?

A 
Sz = Benzo
Agitated = Haldol
57
Q

What is the prognosis for delirium?

A

Usually clears within 1-2 weeks, but one year mortality = 50%

58
Q

What is mild cognitive impairment?

A

an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia

59
Q

What is the prognosis for mild cognitive impairment?

A

Many, but not all, will progress to major NC disorder

60
Q

How do you work up dementia?

A
  • h and p with collateral sources
  • CBC
  • B12
  • Thyroid
  • CMP
61
Q

What is the role of ApoE4 in screening for AD?

A

Not sensitive or specific enough

62
Q

When is head imaging indicated for the workup of dementia? (2)

A
  • Focal neurological signs

- Falls (anticoags)

63
Q

Who determines decision making capacity?

A

Physician

64
Q

What are the FDA approved treatment for Behavioral and psychological symptoms of dementia (BPSD)?

A

None– all are off label

65
Q

What should be the first-line treatment for dementia?

A

CBT

66
Q

What are the seven major behavioral clusters of dementia? Which do not usually respond to medication?

A
  • Explosive
  • Really bad Psychotic
  • Manic
  • Depressed
  • Anxious
  • Confused
  • Oppositional

“COMRADE”

67
Q

What is the role of antidepressants in the treatment for dementia?

A
  • Depression/anxiety

- Sexually inappropriate

68
Q

When are benzo indicated for dementia?

A

PRN anxiety or insomnia, but o/w should be avoided

69
Q

There is a higher mortality rate in dementia patients, when they’re taking what drugs?

A

Antipsychotics

70
Q

What are the atypical antipsychotics? Which two are specifically indicated for elderly patients with dementia?

A
  • Risperidone**
  • Olanzapine**
  • Quetiapine
  • Aripiprazole
  • Ziprasidone
71
Q

When are antipsychotics indicated for dementia patients?

A

Psychotic, manic

72
Q

What are the side effects of risperidone?

A

Less anticholinergic

73
Q

What are the side effects of olanzapine?

A

Weight gain

74
Q

What are the side effects of quetiapine?

A

Sedating, but less EPS

75
Q

What are the side effects of ziprasidone?

A

QT prolongation

76
Q

What is the benefit of aripiprazole compared to other antipsychotics?

A

Less metabolic risk

77
Q

What is the anticonvulsant indicated for dementia patients? When is it indicated?

A
  • Carbamazepine

- Manic or explosive episodes

78
Q

What is the classic side effect of trazodone?

A

Trazo-bone

79
Q

Which drugs in particular are scrutinized by state regulators in nursing homes?

A
  • Sedative-hypnotics

- Antipsychotics

80
Q

What are the two major pharmacological treatments for cognitive s/sx of dementia?

A
  • Acetyl-cholinesterase inhibitors

- Memantine

81
Q

What is the MOA and use for memantine?

A
  • AD

- NMDA receptor blocker

82
Q

What are the three major acetylcholinesterase inhibitors used for dementia?

A
  • Donepezil
  • Rivastigmine
  • Galantamine
83
Q

What is the MOA of donepezil?

A

Acetyl-cholinesterase inhibitor

84
Q

What is the MOA of Rivastigmine?

A

Acetyl-cholinesterase inhibitor

85
Q

What is the MOA of Galantamine?

A

Acetyl-cholinesterase inhibitor

86
Q

Is alcohol a risk factor for the development of dementia?

A

Protective if not abused

Destructive if abused or used excessively

87
Q

What is the TCA of choice for MDD with psychotic features? Why?

A
  • Amoxapine

- Metabolite is a dopamine receptor blocker

Psychiatry pro +1700 (28 decks)

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