Psych- NCD / Dementia Flashcards
What are the 6 cognitive domains looked at in NCD?
Complex attention - attention difficulty with mutlple sitmuli
Executive function - unable to perform complex projects
Learning and Memory - repeats self in conversation, can’t keep track of things
Language - “you know what I mean” or can’t process simple directions
Perceptual-motor - hard time with previously familiar activities like driving
Social Cognition - changes in behavior insensitive to social standards
What is AD? what do you need to have AD?
AD is the gradual progression of impairment in 1 or more cognitive domains
Diagnosed with evidence of genetic mutation and family history and/or
all 3 of the following are present:
1) clear evidence of decline in memory and learning and at least one other cognitive domain
2) steadily progression with gradual decline without extended plateaus
3) absence of other neurodegenerative or cerebrovascular disease
What do you need for the assessment with history of NCD?
Collateral information
information about onset, duration, progression, associated non-psychiatric
independence status
family history
history of head trauma or loss of consciousness
Why do you ask about education?
There are Age related and Education related normative values for the MOCA and MMSE
Ask how far did you go in school to understand baselines
What is the standard minimum lab testing that you would get with anyone presenting with NCD?
CBC and Electrolytes with Calcium, Glucose, BUN/Creatinine, and Liver function tests
Thyroid function
B12 - VERY TREATABLE CAUSE OF NCD
Syphilis serology with RPR
Niacin levels for Pellegra
Thiamine Levels
What other additional testing do you run on someone with NCD?
could do CXR and EKG
Urinalysis@!!!! UTI CAN CAUSE DEMENTIA IN OLD PEOPLE!!!!!
Check ESR
Structural Brain imaging with CT or MRI to diagnose CNS tumor, inflammation/infection, subdural hematoma, hydrocephalus or stroke
Functional Brain IMaging - brain SPECT to assess flow and FDG PET to asses brain metabolism to diagnose AD and FTD
Lumbar Puncture - CJD, mets, RPR, Hydrocephalus etc
EEG - look for seizures
What is the most treatable form of dementia?
Vitamine B12 deficiency!!!!!
What are the specific requirements for AD?
insidious onset and progressive worsening of demenita
Prominent dificulty w memory early in the course of illness
Onset AFTER age 60
No focal signs or gait difficultues on exam - especially early in the course
Exclusion of other treatable conditions
What do you see on imaging for AD?
T2 Weighted MRI shows enlarged ventricles and sulcal widening
Global brain atrophy so ventricals get bigger
-Parietal and Temporal Areas are first
See attached image
What is the presentation fo someone with NCD from Vascular-type dementia?
Sudden onset of dysfunction in one or mre cognitive domains
Stepwise deteriorating course (decline after each event)
Focal neurologic signs - weakness of a limb, exagerated DTR, gait abnormalities etc
History of neuroimaging evidence of previous strokes
What are the reversible causes of dementia that we are always looking for to rule out?
Depression
Delirium
VITAMIN DEFICIENCY: B12, Thiamine, Niacin
Medication-induced encephalopathy
CNS infections
Thyroid disease
Structural brain lesions
Tumors, hydrocephalus etc
Compare and contrast mild NCD with Major depression
Depression - mood is fixed, patient complains of cognitive problem, patient agoniizes over cognitive testing and performs slowly, cognitive deficit improves with mood
vs
NCD - mood varies, pt unaware of cognitive problem, pt refuses testing or does uniformly poorly, and pt deficit is fixed or progressive
Compare and contrast Delirium vs mild NCD
Delirium - acute onset, fluctuating level of consciousness, usually curable and brief, and visual hallucinations are common
vs
NCD - insidious onset (*except for hypoxia, trauma, stroke), stable level of consciousness, incurable and lifelong, and rare hallucinations
what do you see on MRI with Tertiary Syphilis?
Periventricular and deep white matter hyperintensities likely due to demyelination
(see attached image)
Difference in imaging in AD vs Normal pressure hydrocephalus?
AD see wide sulci and large ventricles
NPH - see ventricular enlargement WITHOUT sulcal widening
see picture
