Cognition + Dementias Flashcards Preview

Psychiatry > Cognition + Dementias > Flashcards

Flashcards in Cognition + Dementias Deck (25)
Loading flashcards...
1
Q

4 areas of cognition to assess

A

Recent memory Language Visuospatial ability Executive function

2
Q

Tests for cognition

A

ACE-III = complex but best AMTS = shorter

3
Q

Physical tests to order when there is cognitive decline

A

Bloods: U+E, LFTs, B12 + folate, TFTs, calcium CT head

4
Q

Frontal lobe deficit symptoms

A

Behaviour + personality changes

5
Q

Temporal lobe deficit symptoms

A

Agnosia, aphasia, hallucinations, visuospatial difficulties, inability to recognise faces (prosopagnosia)

6
Q

Parietal lobe deficit symptoms

A

Aphasia, agnosia, visuospatial difficulties, finger agnosia, dyscalculia, apraxia

7
Q

Occipital lobe deficit symptoms

A

Visual perception defects: visual agnosia, alexia, prosopagnosia, illusions, hallucinations

8
Q

Primary dementias

A

Alzheimers, DLB, frontotemporal (Picks), Huntingtons

9
Q

Secondary dementias

A

Vascular, infective, inflammatory, metabolic, endocrine, trauma

10
Q

Cholinesterase inhibitors: names, action, SE, formulation

A

Donepezil, galantamine, rivastigmine Increase cholinergic transmission Work for Alzheimers + DLB Side effects: GI, hypersalivation, vivid dreams, HTN, syncope Rivastigmine can come in patches

11
Q

Alzheimers pathology, risk factors, S+S

A

Pathology: decreased ACh, extracellular senile plaques made of beta-amyloid, intracellular neurofibrillary tangles, symmetrical atrophy (more pronounced in medial temporal + parietal lobes). Glial proliferation, granulovascular degeneration, Hirano inclusion bodies Risk factors: females, Downs, fam hx, dialysis S+S: insidious onset memory loss + personality changes 5 As: amnesia, apraxia, agnosia, aphasia, associated symptoms (behaviour + personality)

12
Q

DLB pathology, diagnosis, S+S

A

Pathology: Lewy bodies = intracellular eosinophilic inclusions, decreased ACh, senile plaques Lewy bodies more present in cortical areas (temporal lobe, cingulate gyrus, insular cortex) vs Parkinsons - more present in basal ganglia S+S: fluctuating cognition, visual hallucinations, Parkinson like symptoms, frequent faints + falls Formally diagnosed with a DaT scan

13
Q

Vascular dementia pathology, risk factors, S+S

A

Pathology: multiple infarcts Risk factors: male, CV disease, HTN, high cholesterol, DM, smoking, alcohol S+S: sudden onset, stepwise progression. Commonly mood and behavioural changes Don’t use AChEis

14
Q

Frontotemporal dementia pathology, S+S, management

A

Picks disease Pathology: asymmetrical knife blade atrophy, neuronal loss + gliosis Ballooned neurons (Pick cells) + tau-positive neuronal inclusions (Pick bodies) No senile plaques or neurofibrillary tangles S+S: early personality + behavioural changes, pacing + disinhibition, executive impairment Stop anticholinergic drugs

15
Q

Huntington’s pathology, inheritance, S+S

A

Onset in 4th/ 5th decade Pathology: abnormal huntington protein leads to neuronal loss in caudate nucleus and putamen (movement) + cerebral cortex (dementia) Autosomal dominant S+S: choreiform movements, progressive dementia, depression

16
Q

Normal pressure hydrocephalus pathology, S+S, treatment

A

Pathology: impaired CSF reabsorption, reducing CSF production so ICP isn’t raised. S+S: gait disturbance, ataxia, dementia + urinary incontinence Treat with a shunt

17
Q

Cruetzfeld Jakob disease

A

Prion disease causing rapidly progressive dementia and myoclonic jerks

EEG changes

Hummingbird sign

18
Q

Organic syndromes causing psych symptoms

A

Cushings - depression (+ weight gain, thin skin, kidney stones, HTN, loss of periods) Hypothyroidism - depression (+weight gain, lethargy, constipation) Hyperparathyroidism - depression (+N+V, polydipsia/uria, fatigue, bone pain) Acute porphyria - anxiety, confusion, hallucinations (+red urine, abdo pain, vomiting)

19
Q

Treatment of dementias (memory loss, depression, psychosis)

A

1st line = Cholinesterase inhibitors for Alzheimers + DLB Memantine - NMDA receptor antagonist = 2nd line for Alzheimers + DLB SSRI (citalopram) for depressive symptoms Minimise use of APs Quetiapine for psychosis - don’t use typical APs due to risk of EPSEs

20
Q

Delirium S+S, treatment

A

Rapid onset, fluctuating, altered consciousness, distubed sleep-wake cycle Hyper or hypoactive Disorientation to time and place, immediate recall impaired Treatment: supportive, use haloperidol to sedate if needed

21
Q

Psychological treatment of dementias

A

Comfortable environment Visual/ hearing aids Support groups/ respite care Counselling

22
Q

Social treatment of dementias

A

Patient safety at home Mobility help Restrict driving Legal counsel - power of attorney Monitor meds compliance

23
Q

What to give to someone with dementia + gastric ulcers?

A

NMDA receptor antagonist eg memantine

24
Q

What scores on MMSE + ACE III indicate dementia?

A

MMSE: 20-26 = mild cognitive impairment;

10-20 = moderate impairment;

<10 = dementia

ACE III <82 indicates likely dementia

25
Q

What is pseudodementia?

A

Temporary dementia caused by depression, other mental disorders, psychoactive drugs

Can be reversed with correct management of underlying cause