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57 Cards in this Set
- Front
- Back
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Patient history:
getting lost in familiar places Forgetting names losing things dx? |
dementia
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Patient history:
Not recognizing familiar people Seeing/hearing things dx? |
Delirium
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Time frame of symptoms:
onset in hrs-days fluctuation of symptoms worse at night |
Delirium
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Time frame of symptoms:
months to years |
Dementia
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How are late stage dementia and delirium alike?
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Can hear/see things
Not recognize people Worsening at night |
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ADLs are useful in evaluating what condition?
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Dementia
Delirious patients are too sick to leave the hospital |
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Mental Status exam - dx?
Fluctuating alertness |
Delirium
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Mental Status exam - dx?
Orientation to person/place/time/situation more affected by |
delirium
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Mental Status exam - dx?
Fluctuation in attention |
Delirium
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Mental Status exam - dx?
Impaired concentraion |
Delirium
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Mental Status exam - dx?
Recent memory impaired, more likely to have all types of memory impaired |
Delirium
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Mental Status exam - dx?
Language problems |
Both delirium and dementia
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Mental Status exam - dx?
Visuospatial design copying problems |
Dementias of right hemisphere and most deliria
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Mental Status exam - dx?
Reading impaired |
delirium, late stage dementia
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Mental Status exam - dx?
Writing impaired |
delirium, late stage dementia
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Mental Status exam - dx?
Calculation inabilities |
Delirium
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Mental Status exam - dx?
Abstraction impaired |
delirium
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Mental Status exam - dx?
Cannot draw clock |
prob with executive function in delirium and early dementias affecting the frontal lobe
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On the MMSE, how do you test the reticular activating system?
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Alertness (awake or stuperous)
Attention (immediate recall) Concentration (spell world backwards) |
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On the MMSE, what tests show non-localized brain dysfunction?
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Orientation
Abstraction Remote memory |
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On MMSE, what tests show lesion in medial temporal lobes?
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Recent verbal memory (5 minutes)
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On MMSE, how do you test the activity of the left hemisphere?
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Language - repitition, naming, comprehension (follow a 3 step command)
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On MMSE, how do you test the activity of the Right hemisphere
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Visuospatial - copy a design
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On MMSE, how do you test the activity of the occipital. left temporal, and parietal lobes?
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Reading
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On MMSE, how do you test the activity of the left frontal and parietal lobes?
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writing
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On MMSE, how do you test the activity of the left parietal lobe?
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Calculate change
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On MMSE, how do you test the activity of the frontal lobes
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Executive function - draw clock at 11:10
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MMSE
what is it used for? WHat does it lack? |
Screen test for cognitive impairment, but low sensitivity -- used to track changes over time in delirium and late-stage dementia
Ignores executive function |
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What is MoCA used for?
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Identify cognitive defecits, more popular than the MMSE
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Physical exam-dx:
Vital signs abnormal |
delirium
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Evidence of trauma
Next course of action? |
search for brain bleed, which can cause delirium or subacute dementia
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Physical exam-dx:
Dry mount, red skin, urinary retention, constipation, visual problems + delirium symptoms |
Delirium due to overdose of anticholinergic drugs
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Physical exam-dx:
Pin point pupils + delirium What happened? |
opiod toxicity
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Physical exam-dx:
Sweating+tremulousness+tachycardia + high BP + delirium What happened? |
alcohol or benzodiazapine withdrawl
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Physical exam-dx:
Jaundice (liver failure) or cyanosis (low oxygen) |
delirium
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Physical exam-dx:
Dilated pupils Constricted pupils |
Increased sympathetic tone
Opiod Both are DELIRIUM |
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DSM-IV definition of Delirium
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Fluctuating levels of consciousness and change in cognition developing over hours to days due to medical condition/substance intoxication or withdrawl
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Common causes of delirium - substances
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-alcohol or benzodiazepine withdrawl
-intoxication (amphetamines, cocaine, opiods, PCP, sedatives) |
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Common causes of delirium - infection
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UTI in the elderly
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-Altered level of consciousness
-Diminished attention -Disorientation/confusion, sundowning -Emotional lability/disinhibition -Disorganized thoughts -Disruption of sleep/wake cycle -Hallucinations, delusions, illusions -Autonomic instability -Tremor/nystagmus, ataxia, urinary incontinence |
Symptoms of delirium
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Delirium prognosis
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Poor, 50% mortality
But if underlying cause is not fatal, recovery |
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Pharmacological treatment for delirium
Treat delirium from anticholinergic toxicity |
-Low dose, scheduled antipsychotics (esp. nighttime)
-Delirium from anticholinergic toxicity, physostigmine |
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When were benzodiazepines used to treat delirium
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if delirium is caused by alcohol or benzodiazepine withdrawal
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Dementia + muscular jerking
dx? |
Creutzfeld-Jacob
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Dementia + hallucinations + adverse response to antipsychotics
dx? |
Lewy body dementia
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Dementia that has progressed slowly over 10-15 years, slow cognitive decline
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alzheimer's
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Dementia with 'stair step' pattern of decline
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Vascular dementia
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Physical exam of dementia - dx?
Focal neurological findings - asymmetric reflexes or CNVII palsy |
vascular dementia
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Physical exam of dementia - dx?
Dry skin, thin hair, edema, slow reflexes |
hypothyroidism induced dementia
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Physical exam of dementia - dx?
Ataxia + urinary incontinence |
hydrocephalus
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Physical exam of dementia - dx?
Memory problems + recognition and naming problems |
Alzheimer's
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Pharmacotherapy for AD
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1. Cholinesterase inhibitors
-Donepezil -Rivastigmine -Galantamine 2. NMDA-antagonist: regulate activity of glutamate |
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Patient presents with symptoms of:
-Alzheimer-like (memory) -Parkinson's (motor abnormalities) -Hallucinations |
Lewy Body dementia
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What happens if you give antipsychotics to someone with Lewy Body Dementia
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Develop adverse neurological effects even at tiny doses
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Neuropathology of vascular dementia
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Multiple lacunar thrombotic/embolic infarcts
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Patient presents with:
-memory impairment -aphasia/apraxia/agnosia/executive dysfunction -evidence of cerebrovascular disease (physical or radiological) -Depression -Step-wise pattern of detrioration |
Vascular dementia
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-Asymmetric DTR
-Abnormal gait -unilateral weakness -dysarthria -dysphagia -pathological crying/lauging symptoms of? |
Vascular dementia
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