Neurology 2 > Dementia > Flashcards

Dementia Flashcards

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1
Q

Delirium

- define

A
  • confusional state
  • acute or subacute disorder of attention
  • MC clinical alteration of mentation
  • often d/t treatable dz outside nervous system
  • true medical emergency!
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2
Q

Delirium

  • most often seen what ages
  • often mistaken for what
A
  • young and old

- psychiatric illness

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3
Q

Causes of delirium

A
  • Drug OD, withdrawal
  • poison
  • head trauma
  • infections (not just of the nervous system, UTI in elderly ex.)
  • metabolic
  • seizure
  • tumor
  • high fever
  • intestinal obstruction
  • pancreatitis
  • fractures (meds to tx)
  • fat embolism
  • lupus cerebritis
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4
Q

Where do pts with delirium generally present to healthcare industry?

A

ER (not clinic)

- someone brings them in bc they’re worried the pt is different

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5
Q

How good of a historian is a pt with delirium?

A

bad - rely on family members, friends, nursing home, etc. for history

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6
Q

Sx of delirium

A
  • disordered attention
  • poor memory recent events
  • poor insight into illness
  • hallucinations, delusions, paranoia, apathy
  • tangental communication
  • anomia
  • agraphia
  • R/L disorientation
  • acalcula
  • retropulsive gait disorder
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7
Q

Anomia

A

can’t name three objects

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8
Q

Agraphia

A

can’t write

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9
Q

Delirium dx

A
  • proper hx is important

- standard labs (CB, UA, EKG, CMP, Troponin, tox screen, fsbs)

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10
Q

If first round of testing was inconclusive, waht is second line of w/u for delirium

A
  • CT or MRI
  • LP
  • ammonia level
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11
Q

Is delirium a disease or a symptom

A

a symptom (with a cause)

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12
Q

Tx of delirium

A
  • treat underlying cause

- Thiamine before dextrose (to avoid acidosis)

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13
Q

When should sedation be used in delirium

A

only AFTER dx of cause is made, never before!

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14
Q

Time frame for delirium vs. dementia

A
  • delirium: hours to days

- dementia: months to years

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15
Q

dementia definition

A
  • irreversible progressive decline in intellectual function
  • disconnection from the cognitive world
  • not a clinical diagnosis (have to have an underlying cause)
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16
Q

What does the ddx of dementia rely on?

A

early patterns of intellectual decline to help establish etiology and anatomical focus

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17
Q

Four types of memory list

A
  1. Exteroceptive (declarative) memory
  2. Interoceptive (emotional, affective) memory
  3. Motor (procedural) memory
  4. Executive memory
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18
Q

Declarative memory

  • define
  • what parts of brain
A
  • info gained from external senses (facts, data, events)

- hippocampus and posterior neocortex

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19
Q

Emotional/affective memory

  • define
  • parts of brain
A
  • info gained through experiential phenomena

- amygdala, posterior insula (limbic system), neocortex

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20
Q

Procedural memory

  • define
  • parts of brain
A
  • info gained through movement

- motor cortex, basal ganglia, cerebellum

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21
Q

executive memory

  • define
  • parts of brain
A
  • gained through “metacognition” across time (insight, foresight, morals, etc.)
  • prefrontal neocortex
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22
Q

name of test to check cognitive status

A
  • cognistat (among others)

- is a snapshot in time, have to test repeatedly to get picture of change over time

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23
Q

DSM 5 criteria for dementia

A
  • memory loss
  • 1 or more cognitive impairment
  • functional impairment of IADLs
  • exclusion of delirium
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24
Q

IADLs

A

instrumental activities of daily living

- allow you to live independently such as bathe, grocery shop

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25
How to measure IADLs
Lawton's IADL scale | - no good or bad number, just watch to see how changes over time
26
List 9 causes of dementia
1. cognitive aging 2. drugs 3. demyelinating diseases (MS) 4. hydrocephalus 5. masses 6. infections 7. metabolic issues 8. vascular issues 9. degeneration
27
Classic aging/oldtimers dementia
Cognitive aging effect - decline in multitasking, non-verbal IQ, nominal recall - mild forgetfulness - mild word finding problems
28
drug induced dementia dt what drugs
- anticholinergics (tricyclics, SSRIs, antihistamines) - anxiolytics - benzo - neuroleptics - cardiac meds (bb, alpha agonists, ACEi, statins) - pts taking more 5+ meds
29
Types of masses that cause dementia
- meningiomas - gliomas - subdural hematomas
30
Infections that cause dementia
- tertiary syphilis - Creutzfeld-Jakob disease - Tubercular or fungal - HIV encephalopathy - progressive multifocal leukoencaphalopathy (opportunistic infection) - toxoplasmosis
31
Metabolic causes of dementia
- Wilson's disease - B12 deficiency - ETOH abuse - thyroid disease
32
Vascular causes of dementia
- CVA | - lacunar infarcts
33
Degenerative causes of dementia
- Pick disease - Spinocerebellar degeneration - Alzheimer's - Lewy body disease
34
Type of dementia seen in pick disease
frontotemporal dementia | rare
35
What is affected in spinocerebellar degeneration
motor tracks
36
Alzheimer's disease | - describe
Insidious onset and gradual decline in activities, behavior, and cognition over time
37
How many stages of disease in Alzheimer's?
7
38
Alzheimer's Stage 1
no impairment - not detectable - no memory problems or other sx
39
Alzheimer's stage 2
very mild decline - minor memory problems - lose things around the house - hard to distinguish from aging memory loss
40
Alzheimer's stage 3
mild decline - friends/fam start to notice cognitive problems - performance on memory/cognitive tests impaired - lose personal possessions - trouble with the following: * finding words * remembering names of new acquaintances * planning and organizing
41
Alzheimer's stage 4
moderate decline - clear cut sx of Alzheimer's - difficulty with arithmetic - may forget details about own life - poor short term memory (what ate for breakfast) - inability to manage finances/pay bills
42
Alzheimer's stage 5
moderately severe decline - need help with day to day activities - significant confusion - can't recall simple details about self like phone number - still can bathe and toilet - still know family members and own family history, esp childhood and youth
43
Alzheimer's stage 6
severe decline - need constant supervision and require personal care - unaware/confusion of surroundings - major personality changes - need assistance with toilet and bathing - inability to recognize faces except friends/family - inability to remember most details of personal history - loss of bowel/bladder function - wandering
44
Alzheimer's stage 7
very severe decline - nearing death - lose ability to respond to environment or communicate - no insight into condition - require assistance with all activities of daily living - may lose ability to swallow
45
Summary of Alzheimer's
- overt amnestic memory loss - anomia - posterior cognitive defects - loss of social interaction and personal hygiene - global aphasia - severe cognitive decline - retain ability to walk - bedridden, eventually in fetal position
46
posterior cognitive deficit seen in Alzheimer's
- spatial disorientation - loss of math abilities - trans cortical sensory aphasia - paranoia, hallucinations, hoarding, agitation - sensory aphasia - repetitive speech
47
Two histological markers seen in Alzheimers'
- Tao protein (tangles) - Amyloid plaques * in cortical mass
48
Brain changes in Alzheimers on CT
- gray matter degeneration | - ventricles appear enlarged
49
Explain teh cholinergic hypothesis for Alzheimer's
- cholinergic cells die early - nucleus basalts, neocortex, temporal lobes - tx by giving ACh
50
Common drug used to treat Alzheimer's
Donepezil (Aricept) 5 mg daily
51
What is the benefit of donepezil?
Delays entrance to nursing home by about 18 months
52
Non pharm management of Alzheimer's
- caregiver to AD support group - pt wear medic alert ID bracelet - pt assign POA to caregiver - Screening labs (B12, TSH, RPR, HbA1c) - reduce alcohol - discuss driving issue
53
What is the effect of ginkgo biloba on AD?
no difference from placebo
54
Lewy Body dementia - how common - sx overview
- second MC after AD | - fluctuating course with prominent neuropsychiatric and parkinsonism sx
55
Lewy body dementia | - what general effect that AD does not have
- motor problems
56
Lewy body dementia | - histology
abnormal collections of protein (plaques) but no tangles
57
Sleep issues in Alzhiemer's vs. Lew Body
AD: insomnia | Lewy Body: disordered sleep
58
Three core features in Lewy Body Dx
- fluctuations in alertness during day - parkinsonism (bradykinesia, rigidity>tremor) - visual hallucinations
59
What meds does Lewy body Dementia respond to?
ACH-esterase inhibitors | *but study didn't go past 24 weeks or have large sample size...
60
What is effect of NMDA receptor antagonist on Lewy body dementia
stabilizes patients for 6-12 months
61
How to manage lewy body dementia
- donepezil (Aricept) 5 mg daily for dementia - Sinemet for parkinsons sx - clonazepam for sleep issues - PT to help with motor issues
62
Vascular dementia
- acute or subacute onset of gait disorder and or memory loss - related to atherosclerosis: multiple small infarcts over time - bruits in carotids and subclavian - end up having massive stroke
63
Binswanger's Disease is an extension of what
vascular dementia | - also multi infarct type of disease
64
How to manage vascular dementia
- donepezil - same tx as any vascular disease - reduce bp, cholesterol, the rate (heart rate?) - daily ASA
65
Chronic traumatic encephalopathy (CTE) - related to what histological finding - who gets it
- tao proteins | - NFL, NHL, professional boxers, veterans from gulf war
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