Flashcards in Neurocognitive Disorders Deck (87):
What are the diagnostic criteria / domains for neurocognitive decline? (6)
-Learning and memory
What is the difference between major and minor cognitive decline?
Major = significant impairment
Minor = modest decline
Dementia is unusual to see prior to what age?
True or false: very few cases of dementia are reversible
What is the most common cause of dementia?
What areas of the brain (lobes) are affected with AD?
Parietal and temporal lobes
True or false: dementia is a normal part of aging
What are the genes that are associated with AD?
Presenilin 1 and 2
amyloid precursor protein
What is the gene that is associated with early onset AD?
What is the gene that is protective against AD?
True or false: early onset AD has a strong genetic component
What is the natural h/o AD?
Gradual onset and progression
What are the two major questions that are used to screen for AD?
-lost in a well known area
-Cannot pay bills
What is the neurotransmitter that is changed with AD?
What are the histological findings of AD?
What is the average survival rate of AD?
What is the function of the Tau proteins?
Maintaining neuronal function (microtubule associated proteins)
What areas of the brain are particularly affected with AD?
What is Binswanger's disease? Which part of the brain is usually affected?
Multi Infarct dementia that is usually subcortical, but progresses to cortical dementia
What disease usually coexists with AD?
What is the second most common type of dementia?
What are the psychosis s/sx of lewy body dementia?
-Visual hallucinations/ delusions
What are the s/sx of PD? (TRAP)
What is the treatment for lewy body disease? What should never be used?
Never use antipsychotics
What is Pick's disease?
Frontotemporal dementia--selective atrophy that involved the temporal and/or frontal lobes of the brain
When does frontotemporal dementia usually present, relative to AD?
50s as opposed to 70s for AD
What are the first s/sx of frontotemporal dementia?
Disinhibition and language problems
When do s/sx of CTE usually present?
8-10 years following repeated concussions
What are the usual s/sx of CTE?
-Memory loss, poor judgement
What is the major difference between cortical and subcortical dementia?
Cortical = global loss
Subcortical is not
What are the four types of subcortical dementia?
What is the inheritance pattern of HD?
What is the trinucleotide repeat in HD? What chromosome? What gene?
What part of the brain is specifically affected with HD? What happens to neurotransmitters here?
Caudate loses ACh and GABA
("Hunt 4 an animal and put it in a CAGe")
What are the usual first s/sx of HD?
Depression, flat affect
What is the classic triad of normal pressure hydrocephalus?
"Wacky, wobbly, and wet"
How do you diagnose NPH?
Brain scan and/or LP
What is the treatment for NPH?
VP Shunt (ventriculoperitoneal shunt)
What are the causes of static encephalopathy? (4)
-Hypoxic Brain injury
What is the classic triad of Wernicke's encephalopathy?
What is the key symptom of Wernicke's encephalopathy?
What is Korsakoff syndrome?
-Memory impairment part of WK syndrome
-Marked short term memory loss, that are filled in with confabulations
What is the rash called with lyme disease?
What is the antibiotic of choice for lyme disease?
What are the s/sx Creutzfeldt-Jakob disease? Onset?
-Middle or older age
-Serious psychiatric disturbances
-Obvious abnormal EEG
What are the three major s/sx of HIV encephalopathy?
What is the gene that is defective in Wilson's disease?
What are the features of delirium?
True or false: visual or tactile hallucinations are common with delirium
What are the two extremes of delirium?
Hyper or hypo arousability
What are the four major risk factors for delirium? Which gender?
-Nursing home placement
-Pre-existing brain damage
What type of infection commonly causes delirium in the elderly?
Is it possible to have dementia and delirium at the same time?
How do you differentiate dementia and delirium?
Have to know baseline
What is the top priority with treating delirium?
Identify cause and correct it
If there is a risk of sz with delirium, what drug is indicated? What is agitated?
Sz = Benzo
Agitated = Haldol
What is the prognosis for delirium?
Usually clears within 1-2 weeks, but one year mortality = 50%
What is mild cognitive impairment?
an intermediate stage between the expected cognitive decline of normal aging and the more serious decline of dementia
What is the prognosis for mild cognitive impairment?
Many, but not all, will progress to major NC disorder
How do you work up dementia?
-h and p with collateral sources
What is the role of ApoE4 in screening for AD?
Not sensitive or specific enough
When is head imaging indicated for the workup of dementia? (2)
-Focal neurological signs
Who determines decision making capacity?
What are the FDA approved treatment for Behavioral and psychological symptoms of dementia (BPSD)?
None-- all are off label
What should be the first-line treatment for dementia?
What are the seven major behavioral clusters of dementia? Which do not usually respond to medication?
-Really bad Psychotic
What is the role of antidepressants in the treatment for dementia?
When are benzo indicated for dementia?
PRN anxiety or insomnia, but o/w should be avoided
There is a higher mortality rate in dementia patients, when they're taking what drugs?
What are the atypical antipsychotics? Which two are specifically indicated for elderly patients with dementia?
When are antipsychotics indicated for dementia patients?
What are the side effects of risperidone?
What are the side effects of olanzapine?
What are the side effects of quetiapine?
Sedating, but less EPS
What are the side effects of ziprasidone?
What is the benefit of aripiprazole compared to other antipsychotics?
Less metabolic risk
What is the anticonvulsant indicated for dementia patients? When is it indicated?
-Manic or explosive episodes
What is the classic side effect of trazodone?
Which drugs in particular are scrutinized by state regulators in nursing homes?
What are the two major pharmacological treatments for cognitive s/sx of dementia?
What is the MOA and use for memantine?
-NMDA receptor blocker
What are the three major acetylcholinesterase inhibitors used for dementia?
What is the MOA of donepezil?
What is the MOA of Rivastigmine?
What is the MOA of Galantamine?
Is alcohol a risk factor for the development of dementia?
Protective if not abused
Destructive if abused or used excessively