Neurogcognitive D/O Flashcards
DSM divisions for Neurocognitive disorders
delirium
mild NCD
major NCD
What are the six cognitive domains?
1) attention
2) executive function
3) learning and memory
4) language
5) motor skills
6) social
How serious is delirium?
up to 40% of individuals with delirium die within one year of diagnosis
How common is delirium?
up to 50% of medically admitted patients in hospital develop delirium
What is the “ICU triad”?
- pain
- delirium
- agitation
Where is delirium most common?
- ICU
- postoperative settings
What sex is most at risk of delirium?
males
What can cause delirium?
almost any drug/ withdraw or any illness
Key clinical manifestations of delirium
- fluctuating orientation
- sudden onset
- poor attention
Some common drugs indicated in delirium? (7)
- TCAS
- BDZ
- H2 blockers
- anticholinergics
- Z drugs
- corticosteroids
- meperidine
EEG findings in delirium
slowing on EEG
*except in delirium tremens
Three types of delirium + which is MC?
hypoactive
hyperactive
mixed (MC)
Describe hypoactive vs hyperactive delirium
- hypo: stupor, drowsiness (may go unrecognized)
- hyper: agitation, mood lability, etc
What type of delirium is common in drug withdraw?
hyperactive
Ultimate outcome of delirium?
some deficits may persist for months or even indefinitely
Useful tool for dx of delirium?
CAM (confusion assessment method)
Labs needed in delirium workup?
- urine (drug, culture)
- BMP
- CBC
When should you get brain imaging in delirium?
- no clear cause or no improvement when clear causes are treated
- head trauma
- focal deficits
- patient unable to cooperative with exam
DOC for delirium agitation
Haldol
**Note: BDZ worsen delirium unless alcohol withdraw is the cause
Contrast major and minor NCDs
- minor= patients have deficit but are able to maintain independence
- major= patient requires assistance with most iADLs and ADLs causing total dependence
Screening test for dementia
MMSE
Clues to vascular disease NCD
stepwise decline
Clues to Lewy Body disease
cogwheel rigidity, tremor
hallucinations
Clues to NPH
wet wacky wobbly
Clues to hypothyroid based NCD
- fatigue
- cold
- coarse hair
- constipation
Clues to B12 deficiency based NCD
- paresthesias
- vibration sense
- megaloblastic anemia
Clues to Wilsons disease based NCD
tremor
Kayser Fleischer rings
LFTs
Neurosyphillis NCD clues
-Arhyll Robertson Pupils
Accomodation Response Present… but not response to light
What does the mini cog consist of?
- 3 item recall
- clock drawing
In addition to Mini cog and MMSE what screenings for NCDs exist?
- MOCA (montreal cognitive assessment)
- BOMC (blessed orientation memory concentration)
- FAB (frontal assessment battery)
What are the max number of points on MMSE and what score raises concern?
30, 25 or less
1 cause NCD
alzheimers
When does death occur in AD?
10 years after dx
When are senile plaques and NF tangles found?
- AD
- Downs Syndrome
- normal aging!! (less burden)
Only definitive dx of AD?
post mortem exam of brain
Genes assc with CAUSING AD
-presenilin 1 or 2
-APP
only 1% is genetic and early (before 65)
Gene that increases risk of AD
apoliporotein E4
What sex is most at risk of AD?
2/3 are WOMEN!!
How effective are AchEi in treating AD?
-slows progression by 6-12 months in 50% of people
Risk assc with antipsychotics in AD?
-increases MORTALITY!
All treatment plans for AD must include ____
caregiver support
How common is vascular NCD?
-20%
What domains are most common effected in vascular disease?
- complex attention
- executive function
What are lewey bodies made of?
a-synuclein, primarily in basal ganglia
Sleep disorder assc with LBD ?
REM sleep behavior disorder
Possible vs Probable LBD
- possible 1 core feature
- probable 2 core features
What drugs should be used to manage psychotic symptoms of LBD?
- clozapine
- quetiapine
What should be used to manage REM sleep disorder in LBD?
- melatonin
- clonazepam
How commonly is FTD familial?
-40%, 10% AD inheritance
What cognitive domains are spared in FTD?
-learning/memory and motor function
most common deficits are in language and behavior
What makes FTD probable?
atrophy on imaging
How is disinhibition treated in FTD?
-SSRIs, trazadone
MC infectious cause of NCD?
HIV
Primary cognitive domain effected in HD?
executive function
Treatment for HD
tetrabenazine
atypical antipsychotics
Treatment for psychotic symptoms in PD?
- quetiapine
- clozapine
How are cognitive symptoms treated in PD?
AchEi
How commonly is CJD familial?
15% of cases are AD familial
Biggest clue to CJD?
rapid deterioration
myoclonus
(+/- nystagmus, ataxia… cerebellar dysfunction)
CSF is positive for _____ in CJD?
14-3-3 proteins
Where are lesions in CJD
caudate and putamen (basal ganglia)
