Neurocognitive DO - Collins Flashcards
What is Delirium
transient, reversible cognitive impairment
- acute onset; attention, awareness, cognitive and memory impacted
often fluctuating - 24 hour period
who is at higher risk of delirium
anyone adding “insult to injury”
- polypharmacy
-multiple medical co-morbidities
- sensory impairment (vision, hearing)
substance or alcohol use
What are the three likely causes of delirium
Drugs
Dehydration
Infection
what are mental status exam findings in Delirium
Attention impairment
altered LOC
disorientation
delusions/hallucinations/paranoia
confusion
disordered thinking and/or speech
erratic or irregular behaviors
irritability/agitation
lethargy/withdrawn
poor insight and or judgement
irregular sleeping/eating
What are the diagnostic criteria for Delirium
Disrupted attention/awareness
develops over a short period and fluctuates
acute change in cognition - memory, language, perception, thinking
What is CAM
confusion assessment method
sensitivity: 94-100%
Specificity: 90-100%
what is the difference between Delirium and dementia
delirium: acute, fluctuating, impaired awareness, disturbed attention, poor working memory, short lived or changing, fragmented sleep
Dementia: insidious onset, gradual deterioration, often clear awareness, often good attention, poor short-term memory, more fixed delusions, sleep-wake reversal
what is the treatment of Delirium
treat the underling cause - prevention is the best medicine
remove/treat any exacerbating factors
agitation: Haloperidol IM/IV
high mortality rates
higher risk for long-term cognitive and functional decline
What is Wernicke’s encephalopathy (WE)
first step on the continuum of Wernick-Korsakoff syndrome
acute neuropsychiatric disorder
reversible with appropriate treatment
what are the cerebllar tests
1 rapid alternating movement
2 finger to nose
3 gait and balance
4 heel to shin
5 pronator drift
If WE is left untreated what can happen
it can progress to Korsakoff’s syndrome - more often irreversible
what is the pathophysiology of WE
inadequate thaimine (B1)
ETOH use leads to - GI inflammation -reduced absorption
Poor nutritional intake
what is the classic presentation of WE
delirium
AMS
hypotension
+/- peripheral neuropathy
ataxia - broad based gait - inability to ambulate
Ocular: nystagmus, CN plasies, Sluggish pupils, ptosis, anisocoria
what is the classic Triad of Symptoms for WE:
AMS
Gait ataxia
Ophthalmoplegia (weakness/paralysis)
How is WE trated
Cessation of ETOH use
Thiamine replacement
MUST have thaimine prior to any glucose treatment in AUD patients
what is Korsakoff Syndome (KS)
next step in Wernicke- Korsakoff syndrome - from untreated WE
what is KS characterized
antero- and retrograde amnesia (short term)
Confabulation(fabricated memories or jumbled up old memories)
Apathy
preserved cognitive skills (attention/behavior)
what is the treatment of KS
no specific treatment - nutritional support and ETOH cessation to prevent further insult
What is CJD
Crutzfeldt-Jakob Disease
rapidly progressive prion disease
what is CJD closely related to
Mad Cow disease “bovine spongiform encephalopathy
What are the forms of CJD
sporadic - no known transmission
Hereditary
Acquired - exposure to disease tissue (sx equipment)
what is the presentation of CJD
RAPIDLY PROGRESSIVE DEMENTIA
impaired coordination and cognition
personality change
insomnia
depression
sensory changes
myoclonic jerking
impaired vision
speech impairment
psychiatric distrubances
coma
How do you work-up CJD
definitive diagnosis requires histology (biopsy or autopsy)
supportive lab findings (EEG abnormalities, Brain MRI abnormalities, CSF analysis)
what is the likely diagnosis when Sharp wave complexes are seen on EEG
CJD
what are CJD probable diagnosis criteria
neuropsychiatric disorder and positive CSF
rapidly progressive dementia AND 2+ of the following: myoclonus, visual or cerebellar signs, EPS/Pyramidal symptoms, Akinetic mutism
AND 1+ of the following + labs: Typical EEG, Positive CSF assay, MRI consistent with CJD
what is the treatment of CJD
no curative treatments - 100% fatality
Treatment is palliative: sedatives for anxiety, antidepressants, antispasmodics, pain control
