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Psych > Neurogcognitive D/O > Flashcards

Neurogcognitive D/O Flashcards

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1
Q

DSM divisions for Neurocognitive disorders

A

delirium
mild NCD
major NCD

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2
Q

What are the six cognitive domains?

A

1) attention
2) executive function
3) learning and memory
4) language
5) motor skills
6) social

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3
Q

How serious is delirium?

A

up to 40% of individuals with delirium die within one year of diagnosis

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4
Q

How common is delirium?

A

up to 50% of medically admitted patients in hospital develop delirium

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5
Q

What is the “ICU triad”?

A
  • pain
  • delirium
  • agitation
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6
Q

Where is delirium most common?

A
  • ICU

- postoperative settings

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7
Q

What sex is most at risk of delirium?

A

males

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8
Q

What can cause delirium?

A

almost any drug/ withdraw or any illness

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9
Q

Key clinical manifestations of delirium

A
  • fluctuating orientation
  • sudden onset
  • poor attention
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10
Q

Some common drugs indicated in delirium? (7)

A
  • TCAS
  • BDZ
  • H2 blockers
  • anticholinergics
  • Z drugs
  • corticosteroids
  • meperidine
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11
Q

EEG findings in delirium

A

slowing on EEG

*except in delirium tremens

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12
Q

Three types of delirium + which is MC?

A

hypoactive
hyperactive
mixed (MC)

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13
Q

Describe hypoactive vs hyperactive delirium

A
  • hypo: stupor, drowsiness (may go unrecognized)

- hyper: agitation, mood lability, etc

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14
Q

What type of delirium is common in drug withdraw?

A

hyperactive

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15
Q

Ultimate outcome of delirium?

A

some deficits may persist for months or even indefinitely

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16
Q

Useful tool for dx of delirium?

A

CAM (confusion assessment method)

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17
Q

Labs needed in delirium workup?

A
  • urine (drug, culture)
  • BMP
  • CBC
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18
Q

When should you get brain imaging in delirium?

A
  • no clear cause or no improvement when clear causes are treated
  • head trauma
  • focal deficits
  • patient unable to cooperative with exam
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19
Q

DOC for delirium agitation

A

Haldol

**Note: BDZ worsen delirium unless alcohol withdraw is the cause

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20
Q

Contrast major and minor NCDs

A
  • minor= patients have deficit but are able to maintain independence
  • major= patient requires assistance with most iADLs and ADLs causing total dependence
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21
Q

Screening test for dementia

A

MMSE

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22
Q

Clues to vascular disease NCD

A

stepwise decline

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23
Q

Clues to Lewy Body disease

A

cogwheel rigidity, tremor

hallucinations

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24
Q

Clues to NPH

A

wet wacky wobbly

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25
Q

Clues to hypothyroid based NCD

A
  • fatigue
  • cold
  • coarse hair
  • constipation
26
Q

Clues to B12 deficiency based NCD

A
  • paresthesias
  • vibration sense
  • megaloblastic anemia
27
Q

Clues to Wilsons disease based NCD

A

tremor
Kayser Fleischer rings
LFTs

28
Q

Neurosyphillis NCD clues

A

-Arhyll Robertson Pupils

Accomodation Response Present… but not response to light

29
Q

What does the mini cog consist of?

A
  • 3 item recall

- clock drawing

30
Q

In addition to Mini cog and MMSE what screenings for NCDs exist?

A
  • MOCA (montreal cognitive assessment)
  • BOMC (blessed orientation memory concentration)
  • FAB (frontal assessment battery)
31
Q

What are the max number of points on MMSE and what score raises concern?

A

30, 25 or less

32
Q

1 cause NCD

A

alzheimers

33
Q

When does death occur in AD?

A

10 years after dx

34
Q

When are senile plaques and NF tangles found?

A
  • AD
  • Downs Syndrome
  • normal aging!! (less burden)
35
Q

Only definitive dx of AD?

A

post mortem exam of brain

36
Q

Genes assc with CAUSING AD

A

-presenilin 1 or 2
-APP
only 1% is genetic and early (before 65)

37
Q

Gene that increases risk of AD

A

apoliporotein E4

38
Q

What sex is most at risk of AD?

A

2/3 are WOMEN!!

39
Q

How effective are AchEi in treating AD?

A

-slows progression by 6-12 months in 50% of people

40
Q

Risk assc with antipsychotics in AD?

A

-increases MORTALITY!

41
Q

All treatment plans for AD must include ____

A

caregiver support

42
Q

How common is vascular NCD?

A

-20%

43
Q

What domains are most common effected in vascular disease?

A
  • complex attention

- executive function

44
Q

What are lewey bodies made of?

A

a-synuclein, primarily in basal ganglia

45
Q

Sleep disorder assc with LBD ?

A

REM sleep behavior disorder

46
Q

Possible vs Probable LBD

A
  • possible 1 core feature

- probable 2 core features

47
Q

What drugs should be used to manage psychotic symptoms of LBD?

A
  • clozapine

- quetiapine

48
Q

What should be used to manage REM sleep disorder in LBD?

A
  • melatonin

- clonazepam

49
Q

How commonly is FTD familial?

A

-40%, 10% AD inheritance

50
Q

What cognitive domains are spared in FTD?

A

-learning/memory and motor function

most common deficits are in language and behavior

51
Q

What makes FTD probable?

A

atrophy on imaging

52
Q

How is disinhibition treated in FTD?

A

-SSRIs, trazadone

53
Q

MC infectious cause of NCD?

A

HIV

54
Q

Primary cognitive domain effected in HD?

A

executive function

55
Q

Treatment for HD

A

tetrabenazine

atypical antipsychotics

56
Q

Treatment for psychotic symptoms in PD?

A
  • quetiapine

- clozapine

57
Q

How are cognitive symptoms treated in PD?

A

AchEi

58
Q

How commonly is CJD familial?

A

15% of cases are AD familial

59
Q

Biggest clue to CJD?

A

rapid deterioration
myoclonus
(+/- nystagmus, ataxia… cerebellar dysfunction)

60
Q

CSF is positive for _____ in CJD?

A

14-3-3 proteins

61
Q

Where are lesions in CJD

A

caudate and putamen (basal ganglia)

Psych (16 decks)

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